Outcomes of treatment for depression were found, in a systematic review and meta-analysis, to depend on socioeconomic characteristics. These findings were published in JAMA Psychiatry.
Publication databases were searched through October 2021 for randomized clinical trials of treatments for unipolar depression. Only studies that reported information about socioeconomic factors were included. Improvement of the Revised Clinical Interview Schedule (CIS-R) depression scores at 3 to 4 months were evaluated on the basis of employment status, financial strain, housing status, and educational attainment.
A total of 9 studies comprising 4,864 patients met the inclusion criteria. The patients were aged mean 42.5 (SD, 14.0) years and 67.4% were women.
At 3 to 4 months, depressive symptom scores were 47.3% (95% CI, 38.4%-56.8%) higher among patients who were unemployed compared with those employed. After adjusting for other demographic features and depressive disorder characteristics, depression scores remained 27.6% (95% CI, 19.6%-36.1%) higher among the unemployed cohort.
Patients who were struggling financially had scores 30.2% (95% CI, 18.5%-43.2%) higher than those who were not in financial peril, however, this was attenuated after accounting for depressive disorder characteristics and employment status (5.2%; 95% CI, -3.0% to 14.1%).
Compared with homeowners, those who were tenants (25.8%; 95% CI, 18.1%-34.0%) or had other housing status (35.0%; 95% CI, 16.9%-56.0%) had higher symptom scores. After adjusting for depressive disorder characteristics and employment status, the tenants had scores 9.5% (95% CI, 2.2%-17.4%) higher and other housing status, 17.6% (95% CI, 6.4%-30.0%) higher. Differences were attenuated after adjusting for financial status and social support.
For every lower educational qualification, unadjusted depression scores were 6.5% (95% CI, 2.1%-11.1%) higher. After adjusting for prognostic factors, the effect from lower education was attenuated (1.0%; 95% CI, -3.2% to 5.5% per unit decreased in qualification).
All underlying studies were conducted in the United Kingdom. It remains unclear whether these findings are generalizable to other regions or populations.
The study authors concluded, “Findings of this systematic review and meta-analysis of individual patient data suggest that patients in primary care with depression who were socioeconomically disadvantaged (ie, those who were unemployed, struggling financially, not homeowners, or had no formal educational qualifications) had poorer prognoses regardless of the type of treatment they received and the severity of depression. Our results highlight employment and housing status as being clinically important as the outcomes were larger than previous estimates of proportional minimal clinically important differences for patients with depression.”
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. Published online March 9, 2022. doi:10.1001/jamapsychiatry.2022.0100