Socioeconomic Factors May Influence Treatment Prognosis for Depression

Clinical factors, such as depression severity and comorbidities, may affect prognosis of patients being treated for depression. However, few studies have investigated the association between socioeconomic characteristics and prognosis. In a meta-analysis, investigators examined the association between socioeconomic factors and the prognosis for patients treated for depression.

The analysis included only studies of patients who obtained treatment from their primary care providers so that the results would be generalizable to clinical practice. The studies were randomized clinical trials with participants aged ≥16 years with unipolar depression. In all of the studies included in the analysis, researchers used the Revised Clinical Interview Schedule for diagnosis at baseline and analyzed depressive symptoms by the Beck Depression Inventory II, the Patient Health Questionnaire, or the General Health Questionnaire. The study interventions were physical activity, cognitive behavioral therapy, or medication. All studies had ≥1 measures of socioeconomic status.

The primary outcome was depressive symptoms 3 to 4 months after the baseline assessment. Secondary outcomes were depressive symptoms at later time points. Analyses were adjusted by clinical prognostic factors, such as symptom severity and duration.

In all, 9 studies with 4864 patients from the United Kingdom were included in the analysis. The studies had moderate heterogeneity for the primary outcome. After adjusting for clinical factors and demographic variables, unemployed patients had 28% higher scores for depressive symptoms after 3 to 4 months. This association between unemployment and depressive symptom scores was independent of the type of treatment. Similar results were found for up to 1 year after baseline.

After adjustment for clinical characteristics and employment status, participants who were homeowners had 18% lower scores at 3 to 4 months after baseline compared with participants who were living with others or in hostels, or who were homeless. Similar results were seen at later time points.

In contrast, financial strain was not associated with prognosis after adjustment for clinical characteristics and employment status. Educational attainment was also not associated with depressive symptom scores after baseline after adjustment for clinical prognostic factors.

These results showed that treatment prognosis was worse for patients who were unemployed and better for patients who were homeowners after adjusting for clinical prognostic factors. The investigators thought that these effects of unemployment and home ownership were above the threshold for minimally important clinical differences based on published estimates.

Employment status and home ownership “are easy to assess and doing so during the pretreatment phase could help to inform future management of depression,” suggested the investigators.

One potential methodologic concern that they described was the use of adjustments for clinical prognostic factors that could be related to sociodemographic factors, such as disease severity. Adjustment for disease severity could potentially lead to an underestimation of the relevance of socioeconomic factors on prognosis.

Source

Buckman JEJ, Saunders R, Stott J, et al. Socioeconomic indicators of treatment prognosis for adults with depression: a systematic review and individual patient data meta-analysis. JAMA Psychiatry. 2022;79(5):406-416.