Journal of Mental Health (December 2003) 12, 6, 551 563

Etiological paradigms of depression: The relationship

between perceived causes, empowerment, treatment
preferences, and stigma

BENJAMIN GOLDSTEIN & FRANCINE ROSSELLI

Wesleyan University, Connecticut, USA

Abstract
Background: There is a growing trend to view depression as a biological illness rather than a
psychosocial condition, even though there is no consensus as to what causes depression.
Furthermore, there are mixed data on the impact of advocating the biological model.
Aims: This study examined public perceptions concerning the etiology of depression as well as
the relationship between such perceptions and treatment preferences, empowerment, and
stigma.
Method: Survey techniques were used to assess how 66 college students view the etiology of
depression. Etiology beliefs, as well as demographic data, were regressed upon measures of
treatment preference, empowerment, and stigma.
Results: Factor analysis produced three distinct models of etiology: biological, psychological,
and environmental. Regression analyses showed that endorsement of the biological model
was associated with increased empowerment, preference for psychotherapy, and decreased
stigma. Endorsing the psychological model was associated with an increased belief that people
can help themselves and increased stigma. Endorsing the environmental model was associated
with a mixture of positive and negative beliefs concerning depression.
Conclusions: Endorsement of each etiological model is associated with both positive and
negative consequences. The current public emphasis on viewing depression as biologically
based should thus be viewed with some caution.
Declaration of interest: None.
Keywords: mental illness (attitudes towards), major depression, etiology, help-seeking
behavior, stigma.

Our world is entering a biological age.
Through the mapping of the human
genome, genetic engineering, and greater
understanding of the functions of the
brain, biology is playing a greater role in
how we understand the world and
ourselves. Unsurprisingly, then, there is
a concerted eort to view mental illness,
and in particular depression, as a biolo-
gically based disorder. This eort is

Address for Correspondence: Francine Rosselli, Wesleyan University, Department of Psychology, 207 High
Street, Middletown, CT, 06459, USA

ISSN 0963-8237print/ISSN 1360-0567online/2003/060551-13 # Shadowfax Publishing and Taylor & Francis Ltd
DOI: 10.1080/09638230310001627919
552 Benjamin Goldstein & Francine Rosselli
coming from all areas of society and to a
certain degree has been successful in
persuading people to accept a biological
paradigm of depression.
Anti-stigma organizations, like the
National Alliance for the Mentally Ill
(NAMI), suggest that acceptance of a
biological model of mental illness will
help reduce the stigma that those who are
mentally ill encounter. To this end,
NAMI uses strictly medical and biologi-
cal terminology in their informational
brochure about depression (NAMI,
2002). Pharmaceutical companies are
also pedaling the view of depression as
a biological disease. For example, the
website for Zoloft explains the biological
mechanism by which the antidepressant
works (Zoloft, 2002). The hope is that by
understanding the biology behind depres-
sion, one would seek a biological solution
(a pill) to treat depression. A nal
pressure is coming from insurance com-
panies. In an eort to cut down on costs,
insurance companies prefer that patients
rst consult general practitioners, who
are primarily prescribing antidepressants
(Hirschfeld, 1998).
While there are numerous biological,
psychological, and environmental the-
ories of the causes of depression, lay
people have traditionally viewed depres-
sion through a psychosocial framework,
virtually ignoring the biological perspec-
tive (Angermeryer & Matschinger, 1999).
However, the societal forces advocating
the biological model are having an impact.
Paykel et al. (1998) compared attitudes
towards depression in the UK before and
after the Defeat Depression Campaign,
and found a growing acceptance for
biological causal explanations and treat-
ments for depression. In a comparison of
past attitudes towards depression in the
US, Link et al. (1999) found that while the
public still prefers social explanations to
the causes of depression, there is greater
acceptance today of medical explanations.
Unsurprisingly then, between 1990 and
1998 there was a 147.5% increase in the
prescription of antidepressants in the
USA (Skaer et al., 2000). Olfson et al.
(2002) found that patients were 4.8
times more likely to be prescribed an
antidepressant in 1997 than in 1987.
Furthermore, during the same time period
there was 10.9% decrease in the percen-
tage of people who received psychother-
apy to treat depression. Wyatt & Livson
(1994) found that both newer psychiatrists
and psychologists viewed depression
more medically than older psychiatrists
and psychologists (over 31 years of
experience).
However, there has been little public
discussion of the potential impact of how
one views depression. How does a given
model, biological, psychological, or en-
vironmental, aect the depressed indivi-
dual? Does accepting a biological model
induce people to desire pharmaceutical
treatments? Does a psychological model,
as NAMI argues, lead to greater stigma?
The present study examined the way
people view depression and the potential
impact of that perspective on empower-
ment, treatment preferences, and stigma
associated with depression.
Szasz (1961) was among the rst to
argue against the medicalization of men-
tal illnesses. More recently, both Keen
(2000) and Sayce (2000) have also con-
tributed to this argument. The two main
issues in regards to medicalization con-
cern how medicalization aects empow-
erment, specically the belief that people
can help themselves and help-seeking
behavior.
People with depression, compared to
people without depression, prefer to view

depression as biologically based (Kuyken
et al., 1992). Women interviewed by
Gammel & Stoppard (1999) preferred
biologically based causal explanations
for their depression because they felt it
legitimized their condition. However, as
Gammel & Stoppard also found, there is
a trade o. When depression is attributed
to biological factors, the belief that
people can help themselves is reduced.
The researchers concluded that medicali-
zation does not allow individuals (parti-
cularly women) to take control of their
life situations, and therefore can nega-
tively impact help-seeking behavior. The
women in the study viewed their depres-
sion as something that could only be
controlled by taking a pill, not something
over which they had any power. Simi-
larly, Farina et al. (1978) found that
those receiving a biological explanation
to mental illness believed that they could
do less to help themselves. Furthermore,
Fisher & Farina (1979) found that a
psychosocial model makes people more
proactive in seeking treatment. This
research thus suggests both positive and
negative consequences of accepting bio-
logically-based explanations of depres-
sion. Such explanations appear to
legitimize depressive symptoms and re-
move individual blame while at the same
time reducing feelings of self-ecacy and
potentially preventing those with depres-
sion from seeking to improve their
condition.
Once one is able to get beyond the rst
barrier of seeking help, there is still
plenty of debate in the realm of what
type of therapy one should seek. Studies
of general populations show a tendency
against the use of pharmaceuticals and a
preference for psychosocial interventions
(Angermeyer & Matschinger, 1996, 1999;
Angermeyer et al., 1999; Jorm et al.,
Etiological paradigms of depression 553
1997). Examining why people do not
want to take antidepressants, Anger-
meyer & Matschinger (1996) found that
the most common reason was the belief
that pharmaceuticals do not address the
root of depression. This seems to indicate
that there is, in fact, a relationship
between how one views the etiology of
depression and the preferred treatment.
Numerous studies provide support for
this claim, showing a correlation between
beliefs concerning the etiology of depres-
sion and desired treatment. For example,
Furnham & Malik (1994) and Kurihara
et al. (2000) found that culture aects the
way one sees depression, and this in turn
inuences the desired treatment. In addi-
tion, Mulatu (1999) found that the
various causal explanations one gives
for physical and mental illnesses, includ-
ing depression, correlate with a specic
type of treatment. Therefore, one poten-
tial consequence of the current move-
ment to advance biological explanations
of depression might be a corresponding
belief in the ecacy of pharmaceutical
treatments. Pharmaceutical companies
might thus be correct in their assumption
that acceptance of the biological para-
digm will increase sales.
The nal issue that needs to be
addressed is the potential relationship
between etiological perspective and the
stigma one attaches to individuals who
are depressed. Stigma comes in many
forms, including increased desired social
distance (Arkar & Eker, 1994), negative
beliefs about relationships with depressed
people (Coyne, 1987), and negative
stereotypes about depressed people
(Esses & Beaufoy, 1994; Jorm et al.,
1999). In any form, stigma can be
devastating to those who are depressed
or otherwise mentally ill. For example,
stigma can negatively impact the self-
554 Benjamin Goldstein & Francine Rosselli
concept (Coyne et al., 1998) and lead to
treatment discontinuation (Sirey et al.,
2001).
One of the key strategies examined for
reducing stigma has been education
(Mayville & Penn, 1998). However, there
is no consensus as to exactly what
information about depression should be
emphasized. There are those, such as
NAMI, who argue that education and
stigma reduction is best achieved by
advocating a biological model. The logic
is that if depression is seen as a psycho-
logical problem, then it is something that
can be controlled by the individual. This
leads to blaming the individual for his or
her condition or blaming those around
the individual (typically the mother). If
one is not able to overcome his or her
condition, then this indicates a weakness
of character. A biological conception of
depression, then, would hopefully re-
move blame from the individual and
place it on uncontrollable factors, such
as ones biochemistry.
There is some evidence to back up this
claim, however none of it is direct.
Firstly, it has been shown that more
stigma is attached to people with dis-
abilities when those disabilities are seen
as controllable (Jones et al., 1984).
Furthermore, depression is seen as more
controllable and stable than other physi-
cal illnesses (Corrigan et al., 2000), and
not surprisingly depression generates
more negative emotions and stereotypes
than physical illnesses (Esses & Beaufoy,
1994). Finally, those who view depres-
sion as biologically based are less likely
to blame depressed individuals for task
failures (Mehta & Farina, 1997). Taken
as a whole, research has shown that
controllable illnesses provoke greater
stigmatization and that depression is seen
as a controllable illness. There is thus
some circumstantial evidence that a
biological model of depression might
serve to reduce stigma by eliminating
the belief that depression is controllable.
Critics, though, argue that the biologi-
cal model does not necessarily reduce
stigma (Farina et al., 1978; Read &
Harre, 2001). For example, Farina et al.
(1978) found that both the biological
model and the psychological model
equally reduce stigma towards the men-
tally ill. Additionally, the biological
model has been implicated with contri-
buting to stigma, specically, the viewing
of mental patients as more unpredictable
and more violent (Read & Harre, 2001;
Read & Law, 1999). Viewing depression
as biologically based, and therefore un-
controllable, may thus contribute to
negative beliefs about depression and
fear of those who are depressed. Addi-
tionally, viewing depression in this way
may lead to dehumanization. For exam-
ple, Mehta & Farina (1997) found a
tendency to be indierent towards the
feelings of mental patients when a
biological perspective was employed.
However, there are problems with this
argument as well. Read & Harre (2001)
and Farina et al. (1978) only demon-
strated the biological model to be in-
eective in reducing stigma; they did not
nd the psychological model to be any
more eective. Furthermore, all the
studies cited examined mental illness as
a whole rather than depression. The
common prototype of mental illness is
not necessarily a depressed individual, so
while these studies implicate criterion
that may lead to the stigmatization of
depression, they are by no means con-
clusive.
In sum, we are in a situation where a
biological perspective of depression is
being thrust upon the public, but there is

no reason to believe that this provides a
complete portrayal of depression or will
necessarily yield positive outcomes. The
present study employed a survey to
examine public beliefs concerning the
causes of depression and the relationship
between particular etiological perspec-
tives and empowerment, treatment pre-
ferences, and stigma.
Method
Participants
Participants included 44 female and 22
male Wesleyan University students ran-
ging in age from 18 to 22. Twenty-nine
participants identied themselves as hav-
ing had depression, and 11 participants
identied themselves as being currently
depressed. Thirty-one students from an
introductory psychology class completed
the survey in order to fulll 1 hour of
course credit. Another 35 university
students responded to yers asking for
volunteers for a study on attitudes
towards depression, and received no
credit for their participation.
Materials
The survey was constructed to examine
four aspects of attitudes towards depres-
sion: perceived etiology, degree of em-
powerment, preferred treatment, and
stigma towards depressed people. Re-
sponses to all of these questions were
assessed using seven-point scales ranging
from of 7 3 to 3.
To assess perceived etiology, partici-
pants were asked to rate whether a given
factor was a cause of depression
(7 3 = denitely not a cause; 3 = de-
nitely a cause). Choices were given to
reect a large range of possible biological
(e.g. genetic or inherited predisposition),
psychological (e.g. poor cognitive out-
Etiological paradigms of depression 555
look on the world), environmental (e.g.
general stress), and personal explanations
of depression (e.g. lack of will power). To
assess treatment preferences, participants
were asked to rate the perceived eec-
tiveness of antidepressants and psy-
chotherapy (7 3 = denitely ineective;
3 = denitely eective).
Empowerment was assessed in terms of
beliefs concerning whether depressed
people are to blame for their condition,
the degree to which depression could be
treated by oneself, and how likely one is
to seek treatment. Participants were rst
asked to rate their agreement with the
statement people with depression have
themselves to blame for their depression,
( 7 3 = strongly disagree; 3 = strongly
agree). Participants were also asked
how eective it is to deal with depression
alone ( 7 3 = denitely ineective;
3 = denitely eective). Finally, to assess
how likely one was to seek help, partici-
pants were asked to rate how likely they
would be to seek help from seven various
individuals including a psychiatrist, a
family doctor, a psychologist, signicant
other, friend, parent, and self ( 7 3 = de-
nitely would not seek help from;
3 = denitely would seek help from).
Since these seven individuals provide a
large range of help-seeking options,
responses to these items were averaged
together to generate an overall measure
of help-seeking behavior.
To assess stigma associated with de-
pression, participants rst rated their
agreement with the statement people
with depression take more from a rela-
tionship than they give back,
( 7 3 = strongly disagree; 3 = strongly
agree). Participants were also asked to
rate the likelihood that a depressed
person, compared to a non-depressed
person, would be violent and have poor
556 Benjamin Goldstein & Francine Rosselli
friendships (7 3 = denitely less likely;
3 = denitely more likely). To assess
potential positive characteristics asso-
ciated with depression, participants were
also asked to rate the likelihood that a
depressed person, compared to a non-
depressed person, would be understand-
ing of others feelings, easy to talk to, and
a caring person (7 3 = denitely less
likely; 3 = denitely more likely). Re-
sponses to these three items were aver-
aged together to form one index of
positive beliefs (Chronbachs a = 0.71).
Another potential indication of stigma is
desired social distance from an indivi-
dual. To assess this, participants were
asked to rate the desirability (7 3 = de-
nitely less desirable; 3 = denitely more
desirable) of dating, marrying, living
with, and working on a project with a
depressed, as compared to a non-de-
pressed, individual. In addition, partici-
pants used the same scale to rate the
desirability of having a depressed, as
compared to a non-depressed, individual
as a parent, child, sibling, and friend.
Responses to these items were averaged
together to generate a desired social
distance score (Chronbachs a = 0.87).
Procedure
Participants completed the survey in
groups of 5 to 20. Participants were given
as much time as they needed to complete
the survey and were informed that they
could skip any questions that they did
not feel comfortable answering. After
completion of the survey, participants
were thanked and fully debriefed.
Results
Perceived etiology
An exploratory factor analysis was run
on the items assessing the perceived
causes of depression. Three factors (Ei-
genvalues 4 1.00) were identied ac-
counting for 60.75% of the variance. As
can be seen from the factor loadings in
Table 1, the three factors appear to
represent biological, psychological, and
environmental explanations of depres-
sion.
Mean responses to these three factors
were entered into a repeated measures
ANOVA, which yielded a reliable eect,
F(2,130) = 26.38, p5 0.001. Follow-up
paired samples t-tests revealed that the
biology factor (M = 2.07) was endorsed
more strongly than the psychology factor
(M = 1.14), t(65) = 5.99, p5 0.001
two-tailed, the environment factor
(M = 1.87) was endorsed more strongly
than the psychology factor, t(65) = 5.68,
p5 0.001 two-tailed, and there was a
trend towards endorsing the biology
factor more than the environment factor
t(65) = 1.68, p5 0.097, two-tailed.
Perceived etiology, empowerment,
treatment, and stigma
A series of regression analyses were
performed to determine if etiological
preference predicted treatment prefer-
ence, empowerment, and/or stigma. The
three etiological factors were entered
simultaneously as predictor variables.
Initial analyses also included gender
and direct experience with depression as
predictor variables, but as these variables
produced no reliable eects, they were
removed from subsequent analyses. The
dependent variables included three mea-
sures of empowerment (blame for depres-
sion, eectiveness of dealing alone, and
the help-seeking index), two measures of
treatment preferences (eectiveness of
anti-depressants and eectiveness of psy-
chotherapy), and ve measures of stigma
(take more than give in relationships,
 Etiological paradigms of depression 557

Table 1: Etiology factor loadings

Factors
Survey item Biology Psychology Environment
Chemical/hormone imbalance 0.838* 7 0.216 0.021
Genetic predisposition 0.775* 7 0.335 7 0.035
Biological changes 0.635* 0.450 0.211
Lack of will power 7 0.140 0.830* 0.085
Melancholic personality 0.032 0.785* 0.343
Poor cognitive outlook 7 0.177 0.781* 0.298
Helplessness/hopelessness 7 0.080 0.648* 7 0.071
Lack of social support 7 0.197 0.553* 7 0.025
General stress 0.167 0.105 0.840*
Negative life event 0.098 0.000 0.728*
Expecting too much 7 0.370 0.242 0.603*
* Designates highest loading.

violent, poor friendships, the positive
belief index, and the social distance
index).
As can be seen from the standardized
regression coecients presented in Table
2, acceptance of the biology factor was
associated with greater empowerment in
the form of greater help-seeking behavior
and less of a belief that depressed people
are to blame for their condition. Also,
endorsing this model was associated with
increased acceptance of eectiveness of
psychotherapy as a treatment for depres-
sion. However, it did not predict in-
creased acceptance of the eectiveness of
antidepressants. Finally, endorsement of
the biological factor was associated with
positive beliefs about depressed people.
Endorsing the psychology model pre-
dicted greater acceptance in the eective-
ness of dealing with depression by
oneself. However, endorsing this model
also predicted an acceptance of the belief
that depressed people are to blame for
their condition. It also led to increased
stigma in the form of greater desired
social distance as well as stronger agree-
ment with the beliefs that depressed
people have poor friendships and take
more than they give in relationships.
Finally, greater agreement with the
environmental model of depression was
associated with reduced desired social
distance and less agreement that de-
pressed people are to blame for their
condition. It was also associated with an
increased belief that depressed people are
more violent than non-depressed people.
Discussion
The purpose of this study was to assess
lay beliefs concerning the etiology of
depression and to examine the relation-
ship between such beliefs and empower-
ment, treatment preferences, and
stigmatization of depressed individuals.
The results suggest that participants
recognized three dierent etiologies of
depression: biological factors, psychol-
ogy/personality factors, and environmen-
tal factors. The biological model included
beliefs that depression stems from che-
mical or hormone imbalances, biological
558 Benjamin Goldstein & Francine Rosselli

Table 2: Regression analyses of etiology factors on measures of empowerment, treatment

preferences, and stigma

Predictors: etiology factors

Dependent variables Biology (b) Psychology (b) Environment (b)
Empowerment
Depressed to blame 7 0.322** 0.359** 7 0.261*
Deal alone 7 0.152 0.290* 7 0.067
Seek help 0.299* 7 0.116 0.041
Treatment preferences
Psychotherapy 0.290* 7 0.119 0.087
Antidepressants 0.201 7 0.041 0.093
Stigma
Violent 7 0.075 0.062 0.316*
Poor friendships 0.012 0.356** 7 0.082
Take more than give 7 0.328** 0.293* 7 0.030
Positive behaviors 0.245* 7 0.134 7 0.003
Social distance 7 0.059 7 0.361** 0.291*
* p5 0.05, ** p5 0.01.

changes in the brain or nervous system,
and a genetic or inherited predisposition.
These were the expected characteristics of
the biological model and are consistent
with publicized biologically-based repre-
sentations of depression (e.g. NAMI,
2002). The psychology/personality fac-
tors included lack of will power, melan-
cholic personality, poor cognitive
outlook, learned helplessness/hopeless-
ness, and lack of social support. This
factor thus reects both current psycho-
logical theories (e.g. cognitive outlook,
learned helplessness/hopelessness) and
personality based explanations (e.g. lack
of will power, melancholic personality).
The only surprising element of this factor
is the lack of social support, which
might be expected to be part of the
environmental factor. However, this item
did have a lower factor loading than the
rest of the items. Finally, the environ-
ment factor included general stress,
negative life events, and expecting too
much of ones self. Aside from the lack
of the social support item not loading on
this factor, this factor was expected and
incorporates most of the environmental
explanations of depression.
Endorsement of the biological model
generally led to empowerment. Consis-
tent with Kuyken et al. (1992) and
Gammel & Stoppard (1999), participants
who expressed greater acceptance of the
biological model were less likely to blame
depressed individuals for their condition.
However, inconsistent with Fisher &
Farina (1979), who found that the
psychosocial model led to greater help-
seeking behavior than the biological
model, endorsement of the biological
model in the present study predicted
greater help-seeking behavior. It is pos-
sible that the rise of more eective
antidepressants has led people who en-
dorse the biological model to believe that
one can treat depression, and therefore
believe treatment should be sought.

Interestingly, though, the biological
model did not predict greater acceptance
of the eectiveness of antidepressants,
but was associated with stronger beliefs
in the eectiveness of psychotherapy.
This nding is possibly due to peoples
bias against pharmaceuticals (Anger-
meyer & Matschinger, 1996, 1999; An-
germeyer et al., 1999; Jorm et al., 1997)
and seems to contradict the eorts of
pharmaceutical companies and insurance
companies, who hope that acceptance of
the biological model will lead to a
preference for antidepressants over ther-
apy. Finally, endorsing a biological
model had a moderately positive impact
on stigma. This contradicts Read &
Harre (2001) and Farina et al. (1978),
who argued that the biological model
does not eectively reduce stigma. En-
dorsing this model decreased the belief
that depressed people take more than
they give in relationships and increased
acceptance of positive beliefs about
depression. This seems to support NA-
MIs stance that promoting the biologi-
cal model leads to a reduction in stigma.
However, it is interesting to note that
endorsing this model had no impact on
measures of desired social distance,
suggesting that it may not wholly reduce
stigma.
Gammel & Stoppard (1999) argued
that a psychological model would lead to
depressed people believing that they can
help themselves. This appeared to be the
case, as endorsing the psychological
model of etiology predicted agreement
with the eectiveness of dealing with
depression alone. This also seems to
support the argument that medicalizing
a problem undermines personal respon-
sibility, while not medicalizing a problem
can improve feelings of personal respon-
sibility and control (Sayce, 2000). How-
Etiological paradigms of depression 559
ever, the psychological model of
depression also has the potential to lead
to blaming depressed people for their
condition and thereby increase stigma
associated with depression. This ap-
peared to be the case. Respondents who
showed greater endorsement of the
psychological model also showed a great-
er tendency to blame depressed people
for their condition. These respondents
also felt that depressed people detract
from relationships and have poor friend-
ships. Considering this, it is not surpris-
ing that holding a psychological model
of depression also predicted greater
desired social distance from a depressed
person. This supports the claim of anti-
stigma organizations who argue that a
psychological model will lead to more
stigma. It is a little surprising that
endorsement of a psychological model
of depression did not predict endorsing
the eectiveness of psychotherapy, which
aims to work on the individuals psy-
chology. It is possible that psychother-
apy has become so associated with the
use of antidepressants that these indivi-
duals are reluctant to endorse either.
However, this nding is consistent with
the idea that depressed people should
help themselves. This issue obviously
warrants further research.
Finally, endorsing the environmental
model produced mixed results. On the
one hand endorsing this model predicts
two very important positive results:
decreased blame and decreased desired
social distance. However, endorsing this
model also led to an increased belief that
depressed people are violent, a very
disturbing negative nding.
This study thus identied three dier-
ent models of perceived etiology, each of
which is associated with a dierent
pattern of associated beliefs concerning
560 Benjamin Goldstein & Francine Rosselli
empowerment, treatment preferences,
and stigma. The three etiology factors
were all distinct and signicantly dier-
ent from one another, suggesting a lack
of integration among the three models.
However, it is important to note that all
measures of etiology had positive endor-
sement, indicating that while participants
recognized biological factors as a pri-
mary cause of depression, they also
appear to recognize that multiple factors
contribute to depression.
Future research should examine the
structure and implications of such a
multi-factorial model. Does endorsing
multiple models lead to a best of all
worlds situation? For example, one could
argue, my personal identity has aected
how Ive been treated socially, and this
has altered my biology. This may have
the potential to avoid both the sense of
powerlessness and stigma that a single
factor model entails. Unfortunately, the
limited sample size of the current study
did not allow for a closer examination of
this issue.
There are further limitations that
should be noted. Most importantly, all
of the results are correlational. While this
study shows, for example, that endorsing
the biological model predicts greater
help-seeking behavior, we cannot be
certain that acceptance of the model
causes greater help-seeking behavior.
Future research should attempt to assess
these issues in an experimental design. It
would be interesting to determine
whether persuading people to accept
one of the etiological models has the
same impact on empowerment, treatment
preference, and stigma. In its defense,
this study was designed to be more
exploratory and try to illuminate some
of the underlying issues surrounding
etiological preference.
Furthermore, only one specic theore-
tical model was assessed in the regression
analyses. Undoubtedly, dierent models
are possible. For example, Sirey et al.
(2001) found that stigma can aect help-
seeking behavior. It is also possible that
treatment preference predicts ones pre-
ferred etiological model. It is important
to recognize the complexity of this issue.
However, this study was mainly con-
cerned with the prediction of treatment
preference, empowerment, and stigma
based on etiological perspective, so only
these specic relationships were assessed.
Finally, this study addressed three
specic aspects of the inuence of ones
etiological perspective in regards to
depression. Undoubtedly, there are other
dimensions that etiological perspective
can impact. For example, although we
did look at the relationship between
etiological perspective and treatment
preferences, the current moral debate
surrounding the use of antidepressants
(Kramer, 1993) was not assessed. Nor
did we examine the potential underlying
motivations behind endorsement of a
particular perspective or treatment pre-
ference. Furthermore, while this study
focused on attitudes, it would also be
helpful to examine how etiological per-
spective impacts actual behavior, as
previous research has shown that atti-
tudes are not always predictive of beha-
vior (Fazio & Roskos-Ewoldsen, 1994).
This study serves as a reminder that
there is a need to be aware of information
presented in the media. This research was
inspired to a large extent by the current
societal push towards viewing depression
as a biologically based illness. At present,
there are many messages being conveyed
to the public about the nature of depres-
sion and the majority of these messages
emphasize the biological causes of depres-

sion. This movement clearly benets
particular interest groups. For example,
it consolidates the power of psychiatrists
(Szasz, 1987) and increases prots for
pharmaceutical and insurance compa-
nies. In addition, some advocates of this
view argue that conceptualizing depres-
sion as a biologically based illness reduces
stigma. This study was an attempt to
document lay beliefs concerning the
causes of depression and to examine the
potential implications of those beliefs.
We did nd that our college student
sample recognized distinct biological, psy-
chological, and environmental causes of
depression. Unfortunately, none of the
models was clearly superior to the others.
While the biological model did appear to be
related to increased help-seeking behavior
and reduction of some stigma beliefs, it did
not help in one of the most important areas
of stigma reduction, desired social dis-
tance. The psychological model, while it
was associated with increased stigma as
dened by negative beliefs and increased
social distance, did have the benet of
improving the belief that one can help
oneself. The environmental model was
associated with reduced blame and social
distance, but was also associated with
increased negative beliefs.
These ndings could have public policy
implications. If one wants to increase
help-seeking behavior and reduce stigma,
it appears that advocating the biological
model would be an eective strategy.
Furthermore, the biological model does
not appear to direct people toward
antidepressants as some fear. This seems
to indicate that the biological movement
is not all together a bad thing, as there
are some advantages associated with the
biological perspective. However, there is
a cost associated with it. The fears of
Szasz (1961), Keen (2000), and others,
Etiological paradigms of depression 561
are legitimate, as the biological model
does reduce the belief that people can
help themselves.
In conclusion, we have shown that the
etiological model one endorses is signi-
cantly related to issues of empowerment,
treatment preference, and stigma. In
addition, this study demonstrates that
examining the models people use to
conceptualize depression is a valuable area
of research. Undoubtedly, more work is
needed in this area, as our conceptualiza-
tion of an idea, like depression, can greatly
impact our understanding of that idea and
inuence further beliefs.
References
Angermeyer, M.C. & Matschinger, H. (1996).
Public attitudes towards psychiatric treatment.
Acta Psychiatrica Scandinavica, 94, 326 336.
Angermeyer, M.C. & Matschinger, H. (1999). Lay
beliefs about mental disorders: A comparison
between the western and eastern parts of
Germany. Social Psychiatry & Psychiatric
Epidemiology, 34, 275 281.
Angermeyer, M.C., Matschinger, H. & Riedel-
Heller, S.G. (1999). Whom to ask for help in
case of mental disorder? Preferences of the lay
public. Social Psychiatry & Psychiatric Epide-
miology, 34, 202 210.
Arkar, H. & Eker, D. (1994). Eect of psychiatric
labels on attitudes towards mental illness in a
Turkish sample. The International Journal of
Social Psychiatry, 40, 205 213.
Corrigan, P.W., River, P., Lundin, R.K., Wa-
sowski, K.U., Campion, J., Mathisen, J.,
Goldstein, H., Bergman, M., Gagnon, C. &
Kubiak, M.A. (2000). Stigmatizing attribu-
tions about mental illness. Journal of Commu-
nity Psychology, 28, 91 102.
Coyne, J.C. (1987). Depression, biology, marriage
and marital therapy. Journal of Marital &
Family Therapy, 13, 393 407.
Coyne, J.C., Gallo, S.M., Klinkman, M.S. &
Calarco, M.M. (1998). Eects of recent and
past major depression and distress on self-
concept and coping. Journal of Abnormal
Psychology, 107, 86 96.
562 Benjamin Goldstein & Francine Rosselli
Esses, V.M. & Beaufoy, S.L. (1994). Determinants
of attitudes toward people with disabilities.
Journal of Social Behavior and Personality, 9,
43 64.
Farina, A., Fisher, J.D., Getter, H. & Fischer,
E.H. (1978). Some consequences of changing
peoples views regarding the nature of mental
illness. Journal of Abnormal Psychology, 87,
272 279.
Fazio, R.H. & Roskos-Ewoldsen, D.R. (1994).
Acting as we feel: When and how attitudes
guide behavior. In S. Shavitt & T.C. Brock
(eds), Persuasion: Psychological insights and
perspectives (pp. 71 93). Boston: Allyn and
Bacon.
Fisher, J.D. & Farina, A. (1979). Consequences of
beliefs about the nature of mental disorders.
Journal of Abnormal Psychology, 88, 320 327.
Furnham, A. & Malik, R. (1994). Cross-cultural
beliefs about depression.. The International Mehta, S. & Farina, A. (1997). Is being sick
Journal of Social Psychiatry, 40, 106 123.
Gammell, D.J. & Stoppard, J.M. (1999). Womens
experience of treatment of depression: Medi-
calization or empowerment? Canadian Psy-
chology, 40, 112 128.
Hirschfeld, R.M. (1998). American health care
systems and depression: The past, present and
the future. The Journal of Clinical Psychiatry,
59[suppl. 20]: 5 10.
Jones, E.E., Farina, A., Hastorf, A.H., Markus,
H., Miller, D.T. & Scott, R.A. (1984). Social
stigma: The psychology of marked relation-
ships. New York: W.H. Freeman and Com-
pany.
Jorm, A.F., Korten, A.E., Jacomb, P.A., Chris-
tensen, H. & Henderson, S. (1999). Attitudes
towards people with mental illness: A survey
of the Australian public and health profes-
sionals. Australian and New Zealand Journal of
Psychiatry, 33, 77 83.
Jorm, A.F., Korten, A.E., Rodgers, B., Pollitt, P.,
Jacomb, P.A., Christensen, H. & Jiao, Z.
(1997). Belief systems of the general public
concerning the appropriate treatments for
mental disorders. Social Psychiatry and Psy-
chiatric Epidemiology, 32, 468 473.
Keen, E. (2000). Chemicals for the mind: Psycho-
pharmacology and human consciousness. West-
port, CT: Praeger.
Kramer, P.D. (1993). Listening to Prozac. New
York: Viking.
Kurihara, T., Kato, M., Sakamoto, S., Reverger,
R. & Kitamura, T. (2000). Public attitudes
towards the mentally ill: A cross-cultural study
between Bali and Tokyo. Psychiatry and
Clinical Neurosciences, 54, 547 552.
Kuyken, W., Brewin, C.R., Power, M.J. &
Furnham, A. (1992). Causal beliefs about
depression in depressed patients, clinical psy-
chologists, and lay persons. British Journal of
Medical Psychology, 65, 257 268.
Link, B.G., Phelan, J.C., Bresnahan, M., Stueve,
A. & Pescosolido, B.A. (1999). Public concep-
tions of mental illness: Labels, causes, danger-
ousness, and social distance. American Journal
of Public Health, 89, 1328 1333.
Mayville, E. & Penn, D.L. (1998). Changing
societal attitudes toward persons with severe
mental illness. Cognitive and Behavioral Prac-
tice, 5, 241 253.
really better? Eect of the disease view of
mental disorder on stigma. Journal of Social
and Clinical Psychology, 16, 405 419.
Mulatu, M.S. (1999). Perceptions of mental and
physical illnesses in north-western Ethiopia:
Causes, treatments, and attitudes. Journal of
Health Psychology, 4, 531 549.
National Alliance for the Mentally Ill. (2002).
Understanding major depression. What you
need to know about this medical illness [Bro-
chure]. Arlington, VA.
Olfson, M., Marcus, S.C., Druss, B., Elinson, L.,
Tanielian, T. & Pincus, H.A. (2002). National
trends in the outpatient treatment of depres-
sion. Journal of the American Medical Associa-
tion, 287, 203 209.
Paykel, E.S., Hart, D. & Priest, R.G. (1998).
Changes in public attitudes to depression
during the Defeat Depression Campaign.
British Journal of Psychiatry, 173, 519 522.
Read, J. & Harre, N. (2001). The role of biological
and genetic causal beliefs in the stigmatisation
of mental patients. Journal of Mental Health,
10, 223 235.
Read, J. & Law, A. (1999). The relationship of
causal beliefs and contact with users of mental
health services to attitudes to the mentally ill.
International Journal of Social Psychiatry, 45,
216 229.

Sayce, L. (2000). From psychiatric patient to
citizen. Overcoming discrimination and social
exclusion. New York: St. Martins Press, Inc.
Sirey, J.A., Bruce, M.L., Alexopoulos, G.S.,
Perlick, D.A., Raue, P., Friedman, S.J. &
Meyers, B.S. (2001). Perceived stigma as a
predictor of treatment discontinuation in
young and older outpatients with depression.
American Journal of Psychiatry, 158, 479 481.
Skaer, T.L., Sclar, D.A., Robison, L.M. & Galin,
R.S. (2000). Trend in the use of antidepressant
pharmacotherapy and diagnosis of depression
in the US. CNS Drugs, 14, 473 481.
Etiological paradigms of depression 563
Szasz, T.S. (1961). The myth of mental illness:
Foundations of a theory of personal conduct.
New York: Paul B. Hoeber, Inc.
Szasz, T.S. (1987). Insanity: The idea and its
consequences. New York: John Wiley & Sons.
Wyatt, R.C. & Livson, N. (1994). The not so great
divide? Psychologists and psychiatrists take
stands on the medical and psychosocial models
of mental illness. Professional Psychology:
Research and Practice, 25, 120 131.
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