Socioeconomic factors associated with prognosis in adults with depression

Independent of treatment, socioeconomic factors such as employment are closely associated with prognosis for adults with depression, according to a systematic review and meta-analysis published in JAMA Psychiatry.

“Socioeconomic factors have been associated with increased prevalence of depression; however, associations with prognosis have rarely been investigated,” Joshua E.J. Buckman, PhD, of the Centre for Outcomes Research and Effectiveness in the research department of clinical, educational and health psychology at University College London, and colleagues wrote.

Researchers sought to determine if socioeconomic issues like employment status, financial strain, housing status and education have an impact on the prognosis for adults with depression, independent of treatment and after accounting for clinical prognostic factors.

The study pulled data from The Embase, International Pharmaceutical Abstracts, MEDLINE, PsycINFO and Cochrane (CENTRAL) databases from inception of each through Oct. 8, 2021.

Nine randomized, clinical studies were included, which utilized the Revised Clinical Interview Schedule (CIS-R). A total of 4,864 patients (mean age, 42.5 years; 67.4% women) were included.

Each study measured socioeconomic factors at baseline and sampled patients with unipolar depression who sought treatment for depression from primary care outlets or who scored 12 or more points on the CIS-R. Studies were independently assessed against inclusion and exclusion criteria by 2 reviewers, when looking for incidence of depressive symptoms at 3 to 4 months after baseline.

Results showed that two-stage random-effects meta-analysis end point depressive symptom scale scores were 28% higher (95% CI, 20-36%) for patients who were unemployed compared with those who were employed. Likewise, results showed scores were 18% lower (95% CI, 6-30%) for homeowners than for patients residing in alternate accommodations or who were homeless.

Financial strain and educational attainment were associated with prognosis independent of treatment, but unlike employment and housing status, little evidence was found of associations after adjustment for clinical prognostic factors.

“Obtaining support for such problems may be as effective as more conventional treatments for depression and addressing these needs may make it easier for patients to engage in and benefit from psychotherapy or pharmacotherapy for depression,” Buckman and colleagues wrote.