Study: Socioeconomic factors influence response to depression treatment

Patients with depression who have lower incomes and education and are from minority groups tend to have worse treatment outcomes even when equal access to treatment, according to research from the University of Cincinnati.  

The collaborative research across the colleges at UCSD was published in the Journal of Psychiatric Services, under the supervision of Dr. Jeffrey Mills and Dr. Jeffrey Straun.

The research team analyzed data from a very large clinical trial known as CO-MED that included 665 patients seeking treatment for depression. In the randomized trial, all patients had the same access to treatment without differences due to health insurance or income.

After controlling for gender, age and type of treatment after 12 weeks of treatment with antidepressant medication in the study, the team's analysis found that non-white patients improved 11.3% less than white patients, and those who were unemployed saw 6.6% less improvement compared to white patients. employed, compared to patients in the 75th percentile of the income distribution, patients with incomes at the 25th percentile reduced the improvement by 4.8%.

Stron noted that the results are still preliminary, but he was particularly interested in discovering that patients without a college degree had a 9.6% lower improvement compared to college graduates.

"We think of these things in terms of access, we think of them in terms of income inequality, and I realize education aligns with those, but just having a college degree while controlling for all of these other factors still has a huge impact," Stone added.

Researchers studied the effect of a combination of socioeconomic factors, where individual factors are often correlated. Non-white, unemployed, unemployed patients without a degree with income in the 25th percentile had 26% less improvement compared to white patients, and employees with a college degree and income. in the 75th percentile.

Dr. Mills said the findings do not negate the fact that lack of access has an impact on treatment outcomes, but show the importance of including patients' home environment when analyzing treatment efficacy.

Mills added, "If you are going home in an affluent neighborhood with highly educated parents or spouse, you can be said to be in a much better environment for treatment to be effective than if you were going to a poor neighborhood with other problems."

According to Stron, other research indicates that patients in resource-poor settings may be affected by more chronic variable stress, which means stress.

“It just comes down to the impact of all of these things, as well as possibly having relatives or children with fewer educational resources or other job-related stresses or other health issues, and you still face the same barriers in terms of accessibility, cost and support there,” Stron added.

According to the researchers, the study findings have the potential to influence clinical trials by designing studies that pay better attention to socioeconomic variables that may have previously been overlooked.

"When we don't control for these variables, which we don't often do in our clinical trials due to differences in population, we may miss discovering an effective treatment because its effect is blocked, so it could jeopardize our treatment development by not taking these into account," Stron said. factors."

The study notes that clinicians must acknowledge that a patient's social and economic environment may influence their ability to improve with treatment when measuring progress and formulating future treatment plans.

According to Mills, the research has important implications when formulating and implementing economic policy such as the recently passed infrastructure bill or ongoing discussions about a minimum wage. He said, "The impact of policy on an individual's social and economic environment, and thus his mental health, is not taken into account." .

Mill explained that a person who works with a higher wage has a chance of improving his socio-economic status and environment, and therefore he is certainly less likely to develop mental health problems. If they receive treatment.

Two researchers with different disciplines in different faculties within a university worked on the study together, with the aim of bringing the benefit of so-called team science, an interdisciplinary approach to research.

Structure explained that traditional interdisciplinary research is often like a psychiatrist and neurologist and in medical school working together on a project, whereas with Mills he worked as a team, across disciplines and involving entirely separate sets of experiences, concepts, and approaches.

Mills said he had previously seen colleagues expecting close cooperation who had never published a paper together because their skills were so similar and they didn't need each other to move forward.

Going forward, the researchers want to continue the research by combining data from other depression trials to produce stronger results with a larger data set.

Source: medicalexpress