Abstract
Objectives: The aim of the present study was to evaluate, using serotonin transporter genotyping as an example, the preparedness of individuals from an urban general population identified with hypothetical genetic risk for a depressive disorder to moderate risk through cognitive or behavioural intervention. It also evaluated endorsement of genetic and environmental causal attributions of mental illness.
Method: A qualitative approach using focus group methodology was selected as most appropriate because these issues are relatively unexplored. Participants (n=36) aged ≥18 years from metropolitan Sydney discussed their understanding of the role of genetic and environmental risk factors in mental illness and attitudes towards pre-symptomatic interventions based on genetic risk information.
Results: Thirty-six participants attended four focus groups involving 8-10 participants per group. Participants predominantly viewed genetic risk factors for depression as predisposing rather than causal, with environmental risk factors acting as triggers. Hypothetical identification with a genetic variant suggesting predisposition to depression prompted strong interest in seeking further information about predictive genetic testing from medical professionals, willingness to reduce life stress, drugs and alcohol intake, willingness to increase exercise, and willingness to undertake cognitive and behavioural interventions at a pre-symptomatic stage. Mixed views prevailed as to whether stress was a modifiable risk factor. Preventive intervention at a presymptomatic stage of depression was viewed negatively in a minority of participants due to a fatalistic attitude towards a genetic predisposition and attitudes that intervention was futile in the absence of symptoms.
Conclusions: There is a likely public demand for preventive mental health interventions for healthy people on the basis of genetic susceptibility if predictive genetic testing becomes available in psychiatry. The findings have implications for general practitioner and public education about predictive genetic testing for susceptibility to common multifactorial disorders for at-risk groups.
Acknowledgements
We thank Dr Nadine Kasparian for training in the use of QSR N6 software, Dr Catriona Bonfiglioli for advice on methodology, and study participants who gave their time. This study was supported by a 2006 Australian National Health and Medical Research Council (NHMRC) Public Health PhD scholarship (455414), an NHMRC Career Development Award (350989) and 2008 NHMRC Program Grant (510135).