Ethics of etiology ERQ

What is MDD?

↦ Major Depressive Disorder is a persistent mood disorder involving low mood, cognitive distortions, and impaired functioning for at least two weeks. It has complex biological, cognitive, and environmental etiologies.

Etiology of MDD (definition)

↦ Etiology refers to the origins and causes of a disorder. In MDD, key etiological perspectives include cognitive explanations (faulty thinking) and biological explanations (genes such as 5-HTT interacting with stress).

Why ethics matter in etiology research

↦ Studies on depression often involve vulnerable individuals, genetic testing, sensitive personal data, and potential psychological harm. Ethical considerations ensure protection, informed consent, privacy, and minimize long-term consequences of participating.

What is the cognitive etiology of MDD?

↦ Beck proposed that MDD results from faulty information processing, negative schemas, and irrational patterns of thought that distort interpretations of the self, world, and future.

What is the genetic etiology of MDD?

↦ Genetic etiology suggests that variations in genes such as 5-HTT influence vulnerability to depression. These genes interact with environmental stressors in a diathesis-stress model.

Aim of Beck et al. (1974)

↦ To investigate whether patients with MDD exhibit characteristic cognitive distortions during therapy sessions.

Participants in Beck et al. (1974)

↦ 50 MDD patients (34 female, 16 male, ages 18-48, mostly middle-upper class), compared with 31 matched non-depressed psychotherapy patients.

Procedure of Beck et al. (1974)

↦ Clinical interviews conducted with both groups; participants shared spontaneous thoughts; some kept diaries; therapists recorded verbal statements and compared cognitive themes across groups.

Results of Beck et al. (1974)

↦ MDD patients showed persistent cognitive distortions: anticipation of failure, fear of rejection, self-blame, negative self-schemas ("I am unlovable"), and automatic negative thoughts viewed as accurate.

Conclusion of Beck et al. (1974)

↦ Depressed individuals display stable, automatic, and uncontrollable cognitive distortions that contribute to emotional dysfunction, supporting the cognitive etiology of MDD.

Ethical concerns: Beck et al. — vulnerability

↦ Participants were clinically depressed, meaning they were a vulnerable population with reduced autonomy and heightened risk of psychological harm.

Ethical concerns: Beck et al. — psychological harm

↦ Discussing painful thoughts in interviews could worsen symptoms; recalling distressing experiences risks increased rumination or emotional instability without guaranteed support.

Ethical concerns: Beck et al. — confidentiality

↦ Patients shared deeply personal thoughts and diaries; breaches of confidentiality could cause stigma, social harm, or damage to relationships.

Ethical concerns: Beck et al. — dual roles

↦ Therapists were also researchers, which can compromise voluntary participation and the right to withdraw due to perceived dependence on the therapist.

Ethical strengths of Beck et al.

↦ Real therapy context provided naturalistic, low-deception data; clinical setting implies some level of support available; qualitative data enhances understanding of cognitive symptoms.

Aim of Caspi et al. (2003)

↦ To investigate whether a polymorphism in the serotonin transporter gene (5-HTT) moderates the relationship between stressful life events and the development of depression.

Participants in Caspi et al.

↦ 847 26-year-olds from a longitudinal study, grouped by genotype: (1) two short alleles, (2) one short + one long allele, (3) two long alleles.

Procedure of Caspi et al. — overview

↦ Participants reported stressful life events from ages 21-26 using a life-history calendar; depression symptoms measured using a Diagnostic Interview Schedule; correlations tested between gene type, stress, and depression.

Results of Caspi et al. — findings

↦ Individuals with two short 5-HTT alleles exhibited more depressive symptoms after stress compared with individuals with long alleles. Childhood maltreatment predicted adult depression only in those with short alleles.

Conclusion of Caspi et al.

↦ The 5-HTT gene does not directly cause depression, but increases vulnerability to stress. The long allele appears protective. Gene-environment interactions shape susceptibility to MDD.

Ethical concerns: Caspi — genetic privacy

↦ Genetic data is highly sensitive; revealing genotype may affect self-concept, family relationships, reproductive decisions, or insurability. Participants require robust data protection.

Ethical concerns: Caspi — psychological harm

↦ Learning one has a "risk allele" may cause anxiety, fatalistic thinking, or self-stigmatization ("I am genetically defective"), especially without genetic counselling.

Ethical concerns: Caspi — informed consent complexity

↦ Participants cannot fully understand long-term implications of genetic testing (e.g., future policy changes, misuse of data, impact on family members).

Ethical concerns: Caspi — family implications

↦ Genetic information about one person can reveal information about relatives, raising issues of secondary consent and familial privacy.

Ethical concerns: Caspi — stigma and labeling

↦ Genetic vulnerability to mental illness may reinforce stereotypes, discrimination, or social exclusion if confidentiality is breached.

Ethical strengths of Caspi et al.

↦ No deception used; natural experiment avoided direct manipulation; large sample increases anonymity; data was collected within an ongoing longitudinal study with established procedures.

Holistic ethical issue: vulnerability of participants

↦ Both cognitive and genetic etiology studies often involve individuals with depression or high genetic risk, who may have impaired decision-making capacity and require heightened protection. Beck's participants were actively depressed; Caspi's participants faced lifelong consequences of genetic knowledge.

Holistic ethical issue: privacy and confidentiality

↦ Cognitive studies risk exposing personal thoughts or trauma, while genetic studies risk disclosing inherited vulnerabilities. Caspi's genetic data could affect participants' families, while Beck's therapy data contained intimate self-beliefs.

Holistic ethical issue: psychological harm

↦ Beck's interviews may trigger distress or rumination; Caspi's genetic results may lead to anxiety, fatalism, or altered identity. Both types of research challenge the IB principle of minimizing harm.

Holistic ethical issue: informed consent challenges

↦ In cognitive studies, depressed patients may feel pressured or dependent on therapists. In genetic studies, participants cannot anticipate long-term consequences of having their genetic risk analysed.

Holistic ethical issue: stigma and labeling

↦ Beck's findings might reinforce stereotypes about depressed individuals being "irrational thinkers." Caspi's results risk genetic determinism or blame. Both require careful communication to avoid reinforcing stigma.

Holistic ethical conclusion

↦ Research into the etiology of MDD provides valuable scientific and clinical insights, but raises significant ethical issues involving harm, vulnerability, privacy, and stigmatization. Ethical safeguards—genetic counselling, strict confidentiality, therapeutic support, and fully informed consent—are essential. Ultimately, the benefits of understanding MDD must be balanced with careful protection of participants' mental and emotional well-being.