What Do Patients Think about the Cause of Their Mental Disorder? A Qualitative and Quantitative Analysis of Causal Beliefs of Mental Disorder in Inpatients in Psychosomatic Rehabilitation

BACKGROUND: Patients' causal beliefs about their mental disorders are important for treatment because they affect illness-related behaviours. However, there are few studies exploring patients' causal beliefs about their mental disorder.

OBJECTIVES: (a) To qualitatively explore patients' causal beliefs of their mental disorder, (b) to explore frequencies of patients stating causal beliefs, and (c) to investigate differences of causal beliefs according to patients' primary diagnoses.

METHOD: Inpatients in psychosomatic rehabilitation were asked an open-ended question about their three most important causal beliefs about their mental illness. Answers were obtained from 678 patients, with primary diagnoses of depression (N = 341), adjustment disorder (N = 75), reaction to severe stress (N = 57) and anxiety disorders (N = 40). Two researchers developed a category system inductively and categorised the reported causal beliefs. Qualitative analysis has been supplemented by logistic regression analyses.

RESULTS: The causal beliefs were organized into twelve content-related categories. Causal beliefs referring to "problems at work" (47%) and "problems in social environment" (46%) were most frequently mentioned by patients with mental disorders. 35% of patients indicate causal beliefs related to "self/internal states". Patients with depression and patients with anxiety disorders stated similar causal beliefs, whereas patients with reactions to severe stress and adjustment disorders stated different causal beliefs in comparison to patients with depression.

LIMITATIONS: There was no opportunity for further exploration, because we analysed written documents.

CONCLUSIONS: These results add a detailed insight to mentally ill patients' causal beliefs to illness perception literature. Additionally, evidence about differences in frequencies of causal beliefs between different illness groups complement previous findings. For future research it is important to clarify the relation between patients' causal beliefs and the chosen treatment.