Increasing Choices or Decreasing Hope? Explaining the Rising Prevalence of Depression From a Decision-Making Perspective

Introduction

Depression is emerging as one of the major cause of concern in today’s world. The World Health Organization (WHO) had long predicted that in 2020, depression would be the second most prevalent disease affecting the whole world after ischaemic heart disease (WHO, 2001). Depression has been identified as a significant cause of disability and mortality and is most of the time associated with impairment in personal, social and occupational functioning (Lopez & Mathers, 2006; Saint Onge et al., 2014; WHO, 2020). According to the World Health Organization estimate, depression along with anxiety, are the two leading disorders among all the other mental illnesses and accounts for almost 25% of all health care visits across the world (Lambert, 2006). Despite the growth of both psychopharmacologic and psychotherapeutic treatments (Shim et al., 2011), the burden of depression continues to be on the rise with more than 264 million people affected globally (James et al., 2018; WHO, 2020). In such a situation, it becomes necessary to review the rising prevalence of depression over time.

In a paper ‘Depression as a disease of modernity: Explanations for increasing prevalence’, Hidaka (2012) has labelled depression along with some other chronic diseases like atherosclerosis, osteoporosis, type 2 diabetes mellitus, the “diseases of modernity”. He refers to Bowlby (1969, 1973) and outlines how Homo sapiens are best adapted to the Pleistocene hunter-gatherers’ lifestyle which is referred to as the Environment of Evolutionary Adaptiveness (EEA) (Barkow et al., 1992; Irons, 1998). According to him the stark difference between our modern industrialised lifestyle and that of the hunter-gatherer lifestyle followed in the EEA might help us understand the cause of such modern chronic diseases (Eaton et al., 2002; Omenn, 2010; Smith, 2002). He provides evidence for the rising rates of depression and talks about how contemporary society characterised by increasing competitiveness, loneliness and in-equitability might be responsible for the same. In line with the work done by Hidaka (2012), this paper reviews another contribution of the modern society: the significant increase in the number of choices available.

In this paper, we highlight how an increasing number of choices in today’s world might aid in the formation of pessimistic attribution style which is significantly implicated in the development of depression. We review some important issues and also put forward a few propositions in our attempt to understand the rising prevalence of depression. At the outset, we discuss how choices are increasing in the modern society and proceed by reviewing whether increasing choices are beneficial or detrimental. We further explore the relationship between choices, the consequent decision-making process and regret. We then discuss self-attribution and the causal dimension model of attribution and acknowledge its association with affective states. Not only confined to affected states, the causal dimensions of attribution have even been used to explain depression. Thus we accentuate the importance of cognitive theories in explaining depression in today’s world with particular focus on the attribution framework, and emphasize how increasing choices might lead to the formation of pessimistic attribution style. Lastly, we acknowledge the vital role played by culture and propose how it might moderate the relationship between increasing choices and depression.

Increasing choices in modern society

Globalisation has not only brought the world closer together but also provided an immense range of options to a vast number of people. “All over the world, people can choose to embrace globalised products and ideas—or not” (Colombier, 2017). People are no longer restricted to a limited number of options. All those options which seemed to be inaccessible at a particular time are now accessible. Moreover, the ease at which information is available has also substantially increased.

With the advent of technology and the internet, unlimited information is available at one’s disposal. To add to this, social media like Facebook, Twitter and Instagram are adding to the myriad of information by letting people know what others are wearing, where they are going, what they are eating at lunch or dinner, their vacation destinations, in which college they are studying or what job they are at. All this undoubtedly makes us more aware of other peoples’ lives but at the same time also makes us consider all the alternatives which are or which had been available to us.

Even in the local market, in the race to attract more consumers, companies are competing with each other to provide more and more options for the consumers to choose from. Whether it is different flavours of chips, jams, ice cream or even be it, various models of cars, they are ready to give the consumers a whole lot of options to choose from. Even in the job market, people look for other options, and job switching has also become increasingly prevalent. We have plenty of choices in almost all domains. Moreover, for years, psychologists have emphasised on the benefits of having choices (Peng, 2013). Choices instil a feeling of autonomy and freedom in the person (Roets et al., 2012), enhance their intrinsic motivation (de Charms, 1968; Deci, 1981; Deci & Ryan, 1985) and also provide a substantial amount of control in the hands of the person (Rotter, 1966; Taylor, 1989; Taylor & Brown, 1988). The human desire for having choices is also unlimited (Iyengar & Lepper, 2000). Therefore this gives the consumer independence to choose from by shifting the control entirely to them. However, a notable question arises, are they actually taking control by choosing from an array of options, or are they losing the satisfaction derived? We try to answer this question by reviewing the beneficial as well as the detrimental effects of choices and throw some light on the conflicting stance of choices.

Choices: Beneficial or detrimental?

Modern society believes in the saying, the more, the merrier. It provides innumerable options for us to choose from. For long, the beneficial effects of choices have been demonstrated by the psychologists. Various positive outcomes like increase in intrinsic motivation, control, life satisfaction, task performance (Deci, 1975, 1981; Deci & Ryan, 1985; Glass & Singer, 1972a, 1972b; Langer & Rodin, 1976; Rotter, 1966; Schulz & Hanusa, 1978; Taylor, 1989; Taylor & Brown, 1988) have been associated with providing multiple choices. Experiments, as well as empirical studies, have all pointed towards the beneficial effects of having a choice. Theories in social psychology like dissonance theory, attribution theory postulates that even illusionary perception of choice can have robust effects (Langer, 1975; Lefcourt, 1973; Lewin, 1952). Nevertheless, one thing that almost all these studies have in common is that nearly all of them have compared a fixed number of choices with that of no choice. In a laboratory experiment by Zuckerman et al. (1978), they measured intrinsic motivation across two conditions, one where choice among six options was provided as compared to another condition where no choice was provided. Results showed that intrinsic motivation was higher for the condition where choices were available as compared to the no-choice condition. Here, not only the number of options provided was fixed and very limited, but it was also put up against a no-choice situation. In contrast to this, neither does today’s world provide us with a fixed number of choices, nor are they so limited.

Iyengar and Lepper (1999, 2000) conducted various experiments in both field and laboratory settings to see the difference between providing a limited number of choices as compared to a large number of options. They found whether be it gourmet jams or chocolates, individuals are more likely to opt for them if a limited number of options are provided in contrast to being offered 20–30 variants of the same. Not only that, but they also found that post decisional satisfaction is much higher when the number of options provided is limited (Iyengar & Lepper, 1999, 2000). Having a large number of alternatives to choose from also impairs decision-making (Iyengar et al., 2006). The amount of information available about the options is also very crucial as when it increases along with the number of options available, due to the complexity people tend to resort to heuristics for simplifying their decision-making process (Payne, 1982; Payne et al., 1988; Timmermans, 1993; Wright, 1975). Thus, in a decision-making situation, a large number of choices may initially seem beneficial but can turn out to be discouraging at the end. It can not only impair decision-making but also lead to post decisional dissatisfaction among decision-makers. We further explore how this post decisional dissatisfaction might translate into regret and develop into self-blame.

Choices, decision-making and its relationship with regret

According to Zeelenberg and Pieters (2007), “Regret is the emotion that we experience when realising or imagining that our current situation would have been better if only we had decided differently” (p. 3). They further address regret as a “backward looking emotion” related to the unfavourable evaluation of a decision-making situation that is “coupled with a clear sense of self-blame” (p. 3). From the way Zeelenberg and Pieters (2007) describe regret, two things become very evident- one, regret occurs as a result of ‘unfavourable evaluation’ of the decision-making situation. Second, the emotion of regret is accompanied by self-blame. To explore this in further details, we review the state and the trait dimensions of regret, which can be experienced concerning a decision-making situation (Zeelenberg & Pieters, 2007). If a person feels that certain consequences were caused by one’s own bad choices, then that person might experience regret as an emotional state (Zeelenberg & Pieters, 2007). Here it is important to note that state regret arises as a result of ‘internal attribution’ made by the person in a decision-making situation. On the other hand, some people are more likely than others to compare their decision outcomes with what could have been if they had chosen a better alternative, thus having the disposition of feeling regret and being more regret prone (Delacroix & Jourdan, 2007; Schwartz et al., 2002; Zeelenberg & Pieters, 2007). Strong desire to undo the situation as well as counterfactual thoughts might worsen such situation by making the person regret all the more giving rise to self-blame (Davis et al., 1996).

We take the case of one particular decision-making style that has been associated with post decisional regret and decreased well-being to understand the link between choices, regret, self-blame and depression. Herbert Simon (1956) in the 1950s coined the term maximizing to explain the phenomenon where people in order to maximise utility, search all the options available and strive to choose the best possible alternative. On the other hand, people sometimes stop their search as soon as some criteria are met and no longer go through the other existing options. This phenomenon was termed as satisficing as here people aim for a satisfactory choice and not the best possible choice. Later on, in 2002, Schwartz categorised them as individual difference variables, claiming that some people are more likely to maximise while some people are satisficers by nature (Schwartz et al., 2002). In subsequent research, maximizers were found to have reduced subjective well-being (Peng et al., 2018), suffer from post decisional regret and generally dissatisfied with their choices (Iyengar et al., 2006). They were found to be usually unhappy (Mikkelson & Pauley, 2013; Roets et al., 2012; Schwartz et al., 2002) and ruminative in nature (Benjamin et al., 2012; Desmeules, 2002). Maximizers, in their attempt to reach the most optimum decision, often compare their choices with that of others becoming even more dissatisfied on finding out that someone else has chosen a more superior alternative. Subsequently, it has been seen that maximizers are more strongly associated with developing depression (Bruine de Bruin et al., 2016). Their decision-making and the ensuing dissatisfaction and regret arising from their choices push them towards developing depressive symptoms.

One main reason that aggravates the problem is the number of options they consider before making a decision. More the choices a person has, more the chances of regret over having chosen the wrong one. In fact, the negative affect experienced by the maximizers concerning the decision-making process is due to the choices available to them (Peng, 2013). Maximizers have this compulsion to go through all the available choices in order to select the best possible option among them. However, this task becomes increasingly difficult with increase in the number of options as it requires considerable time and effort and is also not always feasible due to cognitive limitations (Roets et al., 2012). More the choices available, more the difficulty associated with finding the best possible outcome. A counterfactual thought like “if I had chosen some other option, what might have been the consequence” intensifies and perpetuates the feeling of regret (Schwartz et al., 2002). Further, increasing the number of options available also enhances their standards of acceptability. Having a higher expectation, unavoidably leads to greater discontentment and repentance (Peng, 2013). All these studies on maximizers help us understand how a particular style of making a decision might end up affecting their well-being. Not only the style people adopt while making a decision but also the way people evaluate the decision situation and the decision outcome assumes a crucial role. The process by which people evaluate a situation or assign cause to a situation is termed as attribution. In the following section we discuss the focus of some of the major theories of attribution and explain how self-attribution is linked to affective states.

Self-attribution and its causal dimensions

The focus of the major theories of attribution can be divided under three categories: person-perception, object-perception and self-perception. Heider’s (1958) conceptualization of attribution and Jones and Davis (1965) Correspondence Inference Theory focuses on understanding and making inferences about others, i.e. person-perception. Daryl Bem (1965) in his theory of attribution proposed that just as people attempt to infer others behaviour, they also attempt to draw inferences about themselves, i.e. self-perception. Kelley (1967, 1971, 1973) integrated all the three forms of perception and propounded the Theory of Covariance in attribution. One thing that is common across all these theories of attribution is determining whether a particular behaviour is attributed to internal or dispositional factors or the external or situational factors. The different theories suggests different approaches to reach this particular conclusion. In the domain of self-perception, Kelley emphasised on the analysis of variance analogy for assessing the covariation between behaviour and internal factors and Bem on the other hand focused on the existence of reward or threat for inferring causation.

Bernard Weiner (1974, 1986) also focused on self-perception in framing his theory of attribution. According to Weiner, a person’s own attributions for explaining the success or failure in a particular event determines the amount of effort they are likely to exert in the future. Wiener put forward three causal dimensions, namely, locus, stability and controllability. The locus dimension deals with the internal or external perception of the cause of an event leading to internal or external attribution. In internal attribution, people tend to evaluate their behaviour in terms of personal factors like abilities, skills, traits, feelings, etc. On the other hand, in external attribution, factors that are beyond the control of an individual like situational factors, luck, nature of task, etc. are focused upon for evaluation. The stability dimension refers to the perception of a cause in terms of its duration. It can be either stable or unstable depending upon the duration of the cause. Stable attribution takes place when people evaluate a particular event or outcome tends to be persistent and not likely to change over time. In case of unstable attribution, an event is evaluated to be temporary in nature and likely to change over time. The controllability dimension emphasizes whether the cause of an event can be controlled by the person or not. Usually internal factors are seen to be more controllable in nature like skills, which can be improved by practice. External factors like luck, nature of task etc., cannot be controlled by the person. Thus a situation where a person has high autonomy and control, the person would make an internal attribution.

The causal beliefs specially related to the locus and controllability dimensions are known to be linked to affective states. Internal attribution of success is associated with pride whereas failure is associated with self-blame. In case of stable attribution in failure situation, the morale and expectations are greatly affected. As for the controllability, in case of failure if the control of the person on the situation was high, it would lead to the experience of guilt and shame. The concept of perceived control has been vehemently researched and many studies have reported that it has the capacity to influence behaviour (Thompson, 2002) and has also been associated with well-being (Skinner, 2007). Researchers have suggested that the beneficial effects of perceived control can only be obtained when the situation can be influenced and to “perceive control over a situation that is not amenable will ultimately cause distress and disappointment” (p.15, Fishman, 2014). Moreover, the causal dimensions of attribution have also been studied with respect to depression. A few cognitive theories of depression have even acknowledged its role in the aetiology of depression. It is time that we revisit those cognitive theories keeping in mind the burden of increasing choices in the present society and try to derive some meaning out of this amalgamation.

Revisiting some cognitive theories of depression to explore the relationship between attribution and depression

Emerging as one of the greatest threats to mental health, depression is primarily considered a mood disorder. However, defining depression solely based on the criteria of mood might be a substantial underestimation of its potential. There are many attributes which can be associated with depression other than significant changes in mood. Aaron Beck (1967), highlighted the importance of cognitive symptoms in depression and hypothesised that they might very well precede and give rise to the affective symptoms. Beck’s cognitive theory of depression till date holds a very significant position in explaining the aetiology of depression. He highlighted the importance of early childhood experiences and pointed out that these experiences are crucial in the formation of dysfunctional beliefs which again might get activated later in life in the presence of stressful conditions. Beck’s focus on experiences and stressful life events demonstrates the importance posed by situational as well as cognitive factors in explaining depression.

A prominent cognitive theory of depression that specifically focuses on attribution is the Reformulated Theory of Learned Helplessness proposed by Abramson et al. (1978). This theory is a reformulation of the theory of learned helplessness proposed by Seligman (1974). In the original theory, Seligman et al. (Maier et al., 1969; Overmier & Seligman, 1967) claimed that when initially exposed to uncontrollable events, dogs (later on also seen in humans, e.g. Hiroto, 1974) learn to become helpless even when exposed to controllable events thereafter. One main problem arising out of this theory was that when applied to humans, the theory did not differentiate between outcomes that are uncontrollable for all versus for some people. Moreover, neither did it distinguish between general and specific nor acute and chronic helplessness. Therefore the theory was reformulated by introducing the attribution framework to resolve its’ inadequacies. According to this framework, the kind of attribution people make in adverse situations is central to developing depression. They proposed three key dimensions of attribution, namely, internal vs external, global vs specific and stable vs unstable, having great similarity with Weiner’s causal dimensions. Here the global vs specific dimension was added which dealt with the perception of the cause of an event with respect to the context. In case of global attribution, people tend to generalize an outcome broadly to the other domains, specific attribution on the other hand is the evaluation of an outcome in a particular context or domain. In other words, in global attribution, failure or success is generalized to all the other life domains whereas in specific attribution, failure or success is considered in a specific context and limited to that particular event. People who consistently attribute adverse events in an internal, global and stable manner are said to develop a pessimistic attribution style. For example, if someone fails in a subject and attributes one’s failure to one’s own capabilities (internal), generalises it to all other domains in life “I am incapable in everything I do” (global) and also across time “I shall fail in all upcoming examinations” (stable), then that person has a pessimistic attribution style and is more likely to feel depressed. Later on, this theory was followed by the Theory of Hopelessness (Abramson et al., 1989). In this theory, a different subtype of depression, i.e. the hopelessness depression was identified, and the role of causal attribution was deemphasised. Precisely the internal vs external dimension was deemphasised in favour of the global vs specific and stable vs unstable dimensions (Moore & Fresco, 2007).

As highlighted by Beck (1967) as well as several other cognitive theorists (Ellis, 1962, 1984), cognitive biases play a major role in the development of depression. According to cognitive theorists, maladaptive emotions leading to depression are triggered by illogical, faulty and absolutistic thinking. The pessimistic attribution style is also a biased evaluation criteria one develops. The person starts thinking in an absolutistic way, generalizing failure in one domain to all the other domains and also across time. Moore and Fresco (2007) found that a pessimistic bias was evident among individuals who were at risk for depression. Luten et al. (1997), in two consecutive studies found pessimistic attribution style to be related to negative affect and depressed mood. They even found the use of pessimistic attribution style in case of loss, failure as well as threatening events. In another study by Fresco et al. (2006), they compared the attribution style of clinically depressed vs non-depressed patients for positive and negative life events. They found that clinically depressed patients were more likely to report negative events to be arising from internal, stable and global causes.

People, often seen as being a “product of their choices” are likely to base their self-evaluation on the decisions they make in their lives. Hence, the way people evaluate a decision-making situation and attribute causality for a decision made is of central importance. We thus emphasize on the attribution framework and apply it to decision-making situations to frame certain propositions. Although propounded a long time ago, the attribution framework delineated in the reformulated theory of helplessness and the hopelessness theory is still widely used when working on depression (e.g. Gao et al., 2018; Haeffel et al., 2005; Moore & Fresco, 2007; Perrone et al., 2016; Rodriguez et al., 2019).

Reviewing the attribution framework from an increased choice perspective

The process of attribution usually takes place after an outcome has occurred. The causal search is generated in an attempt to explain the particular outcome. According to Heider (1958), the search for causation helps in making sense of one’s daily life. This search has a higher likelihood of occurrence after an unexpected event or a failure (Wong & Weiner, 1981).They tend to initiate the process of attribution due to their stressful nature. Now with reference to a decision situation, as numerous choices have been reported to be a source of dissatisfaction among decision makers, it might subsequently increase the likelihood of an attribution process.

As is evident from the discussion in the above sections, choices instil a feeling of autonomy and control (Roets et al., 2012; Rotter, 1966; Taylor, 1989; Taylor & Brown, 1988). More the choices provided to a person, greater the autonomy and control, and greater the likelihood of that person to assume responsibility for the situation (Savani et al., 2011). Therefore, this increased autonomy and control might result in an internal attribution in a decision-making situation that involves a lot of choices. Moreover, in the last few years, we have witnessed a steady increase in the number of choices over time. Although this steady increase in choices may not directly lead to the development of stable attributions, but at the same time, such a possibility must not be overruled in the face of persistence of numerous choices over time in the modern society. Finally, to add to this, we can see that choices have flooded in almost every sphere, every domain of our lives, be it the consumer market, the job market, or be it even a vacation destination. This myriad of choices in almost all domains may further aggravate the issue leading to global attribution. Thus, in a decision-making situation, people might be more likely to attribute adverse consequences in an internal, stable and global manner in today’s society. Abramson et al. (1978) have called this the pessimistic style of attribution and have also considered it to be central for developing depression. Thus based on this review we draw the following propositions.

Proposition 1: Increasing choices might act as a potential risk for the formation of pessimistic attribution style as a result of the following:

OPEN IN VIEWER

Figure 1.

Increasing choices leading to the development of a pessimistic attribution style, which in turn might give rise to post decisional regret and self-blame, critical in developing depression.

Another crucial factor that must be taken into consideration in this context is how choices are perceived in a given culture. Some cultures are known to pay immense importance to choices as compared to others. In the next section we thus review how choices are perceived in different cultures and also analyse the prevalence of depression in these cultures for a better understanding.

Culture and the way people think about choices

When discussing an increased prevalence of depression in modern society, the effect of culture cannot be overlooked. Different societies perceive similar concepts in different ways. They attach different values and meanings to the concepts making it very difficult to generalise. So it becomes crucial to see how choices are perceived with reference to the culture. In societies like America, where choice is a core concept, i.e., where the existence of individual choices are considered crucial for personal happiness and well-being (Schwartz, 2000, 2004), people attach great value to the existence of choices. Due to this, “modern Americans have more choices than any other group of people ever has before” (p. 99, Schwartz, 2004). Abundant choices make Americans see themselves as free and independent agents and believe that they are more in control of the actions and outcomes in their lives and are also ready to take responsibility for it (Savani et al., 2011). Markus and Kitayama (2003) explain this understanding by using the disjoint model of agency. According to this model, “actions are freely chosen, contingent on one’s own preferences, intentions, [and] motives” (p. 7). Although a highly influential model, it has been seen to be applicable mostly in American culture and less in other cultures (e.g., Ji et al., 2000; Na & Kitayama, 2012; Savani et al., 2008, 2010; Stephens et al., 2009). This means the way Americans would perceive and evaluate a situation in the face of existing choices would be different from other cultures where choice is not given such importance.

In a study conducted simultaneously in U.S., Western Europe and China, it was seen that in societies where autonomy and control are greatly valued and thus choices are abundant (U.S. and Western Europe) maximizers face increased dissatisfaction and regret and end up having poor well-being. As compared to this, societies that place less priority on choice as a path to happiness (China), maximizing was found to be unrelated to well-being (Roets et al., 2012). Here it can be seen how culture is playing a significant role in affecting the well-being of people over and above dispositional traits.

In another research, conducted in America, it was observed that when choices were made salient, people tend to justify, even the inequality existing within the society. In a series of experiments conducted by Savani and Rattan (2012), they found that when participants were primed with the availability of choices, people considered the inequality existing in the society as justifiable as plenty of choices were available to both, the wealthy as well as the deprived communities. Americans were, many a time in previous research also found to overlook the societal constraints and think that people living in poverty were poor because of the bad choices they have made in their lives (Hanson & Hanson, 2006; Porter, 2013). Similarly, the choice framework also was found to influence the perception of gender inequality, where people were found to believe that equal opportunities exist for both the genders, and individual choices, not any other barriers, are responsible for women and their career path (Stephens & Levine, 2011). The choice framework has the ability to influence people to think that people are the product of their choices, thus ignoring other factors, including the situational constraints. On the other hand, in another study Savani et al. (2011) found that activating the concept of choice led to decreased empathy for a child living in poverty but only in Americans not in Indians. This indicates the influence culture has on choices. In America, as well as other countries where choice is considered to be a path leading to freedom and happiness, great importance is attached to the availability of choices in evaluating themselves as well as others. Thus, in such a society, if the number of choices available is humongous and unrestricted, it definitely would put a lot of pressure on the individual to choose wisely and correctly who would otherwise be implicated for the wrong choices made.

In an article by D’Costa titled “What does choice look like in today’s world?” at a Scientific American Blog Network, published as recently as 2016, the first line says “We live in the age of information, so why do we still make bad decisions? Or worse, no decisions?” This points towards the rising burden put upon people for not being able to make a fair decision despite the existence of so much information, so many options. In such a scenario the existence of multiple choices or the availability of information would more likely make individuals prone to blaming themselves in case of a wrong decision, thinking that despite the presence of several options they, however, have chosen the wrong option. In comparison, consider a given society where a limited number of choices are available, either due to the existence of some government policies or minimal impact of globalisation. In such a society, individuals would be more likely to evaluate themselves leniently, rationalising that they did not have much to choose from.

In a recent paper ‘Trends in depression prevalence in the USA from 2005 to 2015: widening disparities in vulnerable groups’ Weinberger et al. (2018), suggests an overall increase in the prevalence of depression in the USA over time. Mojtabai et al. (2016) have also reported an increase in the prevalence of depression in adolescents and young adults of the U.S. This shows, how not only have choices increased over time and across domains in a culture that places great importance to autonomy and control, the prevalence of depression has also gone up. To make a more robust claim, we searched for studies measuring the prevalence rates of depression in other countries. We found only a very few studies being conducted on estimating the prevalence rates of depression in recent times. One study conducted by Nishi et al. (2018) in Japan measured the trends in the prevalence of psychological distress. Although they did not look at depression per se, they measured “psychological distress associated with common mental disorders such as depression and anxiety disorders” (p. 208). They found a very slight increase in the prevalence of severe distress and no change in the prevalence of moderate distress in Japan. In another study conducted by Bretschneider et al. (2018) in Germany, on the prevalence rate of Major Depressive Disorder (MDD), the results “revealed no increase in overall 12-month MDD prevalence in Germany over a long period” (p. 9). They also state that the present results were in line with the findings of Global Burden of Disease Study reporting “no substantial change in MDD prevalence between 1990 and 2010, or 2005 and 2015 when adjusting for demographic changes.” All these studies point out that the prevalence of depression has increased mostly in the USA in the last decade. Moreover, the studies that we discuss here on the choice framework showing its detrimental effects have also been mainly seen to affect people in the USA and not in China or India. What we can conclude from all these findings is that cultures that place great importance to the existence of multiple choices are more likely than other cultures to evaluate other people as well as oneself in light of those existing choices. This would lead to an increased blaming of the decision-maker, be it someone else or oneself and might ultimately contribute towards developing depression. Thus from here, we draw our third and last proposition.

Proposition 3: Culture is likely to moderate the relationship between increasing choices and depression.

Conclusion

In today’s society, globalisation and technological advancement are reaching the zenith, demand for autonomy and control are also rising, information is being readily available, and producers are facing cut-throat competition. As a result of all these, the number of choices made available to us is bound to increase. In such a situation, it becomes imperative to understand the benefits, as well as the detrimental effects choices can have on an individual as well the society as a whole. Post decisional regret arising from having chosen the wrong option is predictable, but with an increase in the number of choices, it becomes difficult not to implicate oneself for having made a wrong choice. Furthermore, when choices flood all the aspects of life in this modern era, it also might bring with it the epidemic, depression.