Influential descriptions of depression are often misleading

Recent work from Jani Kajanoja and Jussi Valtonen has highlighted the surprising prevalence of misleading information about depression on authoritative mental health websites. These descriptions, which often allude to depression as a cause of low mood, are at odds with the descriptive nature of this diagnosis, and could lead those who suffer it to misunderstand the reasons of their symptoms.

Diagnosing depression is done on the basis of symptoms, rather than underlying causes, as might be done for non-psychiatric diagnoses. For example, one can have a tumour, which causes a cough, fatigue, or weight loss. Yet you can both have these symptoms without having a tumour, or have a tumour and experience neither of them. A diagnosis of depression, on the other hand, is made precisely by its symptoms; as Kajanoja and Valtonen write in their new paper published in Psychopathology, one cannot be diagnosed with depression if they do not experience the symptom of depressed mood.

Despite this, descriptions of depression often imply or explicitly state that depression causes low mood and other symptoms, rather than describes them. In this new paper, the Finnish team set out to understand how widespread this issue is online.

Using the search terms "depression", "what is depression", "clinical depression", and "major depressive disorder", they collected the first 30 search results from medical professional, governmental, academic, and charity sector organisations offering information on mental health.

The descriptions these searches identified were then sorted into three categories: "causally explanatory" descriptions, in which depression was presented as causing symptoms (eg. "depression causes feelings of low mood"); "descriptive" descriptions, which presented depression as a cluster of symptoms with no named cause ("depression describes a pattern of symptoms including low mood and loss of pleasure"); and unclear usages, where the causal relationship was left unclear or unstated or a mix of language was used ("people with depression experience a low mood").

Most of the institutions analysed in the study (53%) explicitly described depression as causally explanatory, or used language that was both descriptive and causal. Sites using such descriptions included those managed by some of the most authoritative mental health organisations in the world, such as the World Health Organization, American Psychiatric Association, the National Institute of Mental Health, and the NHS. The remaining pages (46%) used unspecific language that was neither causal nor descriptive.

While differences here may seem purely semantic, the team argues that the understanding of depression conveyed on many sites is often "based on circular logic," which could leave those aiming to understand their low mood worse off. They reference recent research that found that emotional regulation is more successful when people were aware of the causes of their suffering – if educational material bills depression as causative, however, some of those with the condition may not look further to identify potentially-addressable causative factors.

That said, one limitation of the study is that it did not explore whether this concern plays out in everyday life. It remains unclear how significant such differences in language really are in impressing the true nature of depression on those who suffer from it. To mitigate this risk, however, the authors suggest that "information offered by mental health authorities should clearly state that psychiatric diagnoses are purely descriptive, and primarily intended as administrative and bureaucratic tools."

Read the paper in full:

Kajanoja, J., & Valtonen, J. (2024). A Descriptive Diagnosis or a Causal Explanation? Accuracy of Depictions of Depression on Authoritative Health Organization Websites. Psychopathology, 1–10. https://doi.org/10.1159/000538458