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Is social support pre-treatment associated with prognosis for adults with depression in primary care?

Is social support pre-treatment associated with prognosis for adults with depression in primary care?
Is social support pre-treatment associated with prognosis for adults with depression in primary care?

OBJECTIVE: Depressed patients rate social support as important for prognosis, but evidence for a prognostic effect is lacking. We aimed to test the association between social support and prognosis independent of treatment type, and the severity of depression, and other clinical features indicating a more severe illness.

METHODS: Individual patient data were collated from all six eligible RCTs (n=2858) of adults seeking treatment for depression in primary care. Participants were randomized to any treatment and completed the same baseline assessment of social support and clinical severity factors. Two-stage random effects meta-analyses were conducted.

RESULTS: Social support was associated with prognosis independent of randomized treatment but effects were smaller when adjusting for depressive symptoms and durations of depression and anxiety, history of antidepressant treatment, and co-morbid panic disorder: percentage decrease in depressive symptoms at 3-4 months per z-score increase in social support =-4.14(95%CI: -6.91 to -1.29).Those with a severe lack of social support had considerably worse prognoses than those with no lack of social support: increase in depressive symptoms at 3-4 months =14.64%(4.25% to 26.06%).

CONCLUSIONS: Overall, large differences in social support pre-treatment were associated with differences in prognostic outcomes. Adding the Social Support scale to clinical assessments may be informative, but after adjusting for routinely assessed clinical prognostic factors the differences in prognosis are unlikely to be of a clinically important magnitude. Future studies might investigate more intensive treatments and more regular clinical reviews to mitigate risks of poor prognosis for those reporting a severe lack of social support.

depression, individual patient data meta-analysis, prognosis, social support, treatment outcome
1600-0447
392-405
Buckman, Joshua E J
72f4352d-7903-416f-82df-f69d90308129
Saunders, Rob
14f8666e-a131-4130-a7b1-a358d84d5cb2
O'Driscoll, Ciaran
17f26b26-596b-4ef1-a207-ae715498294e
Cohen, Zachary D
2ac2bcd9-b47b-458c-a241-cccd311c1e8a
Stott, Josh
45e95c0d-1c86-437e-bbb1-f8a3a484e240
Ambler, Gareth
3b9b18c5-1f7b-4608-b86f-30491d1c2418
Gilbody, Simon
6d135882-a8df-444c-85aa-980dddef45a5
Hollon, Steven D
faca54db-7076-4c3c-955e-03333b2e7a54
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Watkins, Edward
4474dca0-035b-4aba-b3fb-b6d7180abfb9
Wiles, Nicola
fcec2769-de78-4b86-b9c1-eab754a02837
Kessler, David
3659e526-e667-46cb-bd9c-02bce7d58d41
Chari, Nomsa
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White, Ian R
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Lewis, Glyn
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Pilling, Stephen
f8b9c11e-7720-493c-8739-7813980ff3e4
Buckman, Joshua E J
72f4352d-7903-416f-82df-f69d90308129
Saunders, Rob
14f8666e-a131-4130-a7b1-a358d84d5cb2
O'Driscoll, Ciaran
17f26b26-596b-4ef1-a207-ae715498294e
Cohen, Zachary D
2ac2bcd9-b47b-458c-a241-cccd311c1e8a
Stott, Josh
45e95c0d-1c86-437e-bbb1-f8a3a484e240
Ambler, Gareth
3b9b18c5-1f7b-4608-b86f-30491d1c2418
Gilbody, Simon
6d135882-a8df-444c-85aa-980dddef45a5
Hollon, Steven D
faca54db-7076-4c3c-955e-03333b2e7a54
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Watkins, Edward
4474dca0-035b-4aba-b3fb-b6d7180abfb9
Wiles, Nicola
fcec2769-de78-4b86-b9c1-eab754a02837
Kessler, David
3659e526-e667-46cb-bd9c-02bce7d58d41
Chari, Nomsa
9335ea63-7917-4b2d-8838-dd2c8b83095d
White, Ian R
f094d26e-f8b6-4df6-8a11-c60e5da7c956
Lewis, Glyn
11aed8f6-3905-455e-8e89-34147a5e5d26
Pilling, Stephen
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Buckman, Joshua E J, Saunders, Rob, O'Driscoll, Ciaran, Cohen, Zachary D, Stott, Josh, Ambler, Gareth, Gilbody, Simon, Hollon, Steven D, Kendrick, Tony, Watkins, Edward, Wiles, Nicola, Kessler, David, Chari, Nomsa, White, Ian R, Lewis, Glyn and Pilling, Stephen (2021) Is social support pre-treatment associated with prognosis for adults with depression in primary care? Acta Psychiatrica Scandinavica, 143 (5), 392-405. (doi:10.1111/acps.13285).

Record type: Article

Abstract

OBJECTIVE: Depressed patients rate social support as important for prognosis, but evidence for a prognostic effect is lacking. We aimed to test the association between social support and prognosis independent of treatment type, and the severity of depression, and other clinical features indicating a more severe illness.

METHODS: Individual patient data were collated from all six eligible RCTs (n=2858) of adults seeking treatment for depression in primary care. Participants were randomized to any treatment and completed the same baseline assessment of social support and clinical severity factors. Two-stage random effects meta-analyses were conducted.

RESULTS: Social support was associated with prognosis independent of randomized treatment but effects were smaller when adjusting for depressive symptoms and durations of depression and anxiety, history of antidepressant treatment, and co-morbid panic disorder: percentage decrease in depressive symptoms at 3-4 months per z-score increase in social support =-4.14(95%CI: -6.91 to -1.29).Those with a severe lack of social support had considerably worse prognoses than those with no lack of social support: increase in depressive symptoms at 3-4 months =14.64%(4.25% to 26.06%).

CONCLUSIONS: Overall, large differences in social support pre-treatment were associated with differences in prognostic outcomes. Adding the Social Support scale to clinical assessments may be informative, but after adjusting for routinely assessed clinical prognostic factors the differences in prognosis are unlikely to be of a clinically important magnitude. Future studies might investigate more intensive treatments and more regular clinical reviews to mitigate risks of poor prognosis for those reporting a severe lack of social support.

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More information

Accepted/In Press date: 1 February 2021
e-pub ahead of print date: 6 February 2021
Published date: 6 February 2021
Keywords: depression, individual patient data meta-analysis, prognosis, social support, treatment outcome

Identifiers

Local EPrints ID: 447138
URI: http://eprints.soton.ac.uk/id/eprint/447138
ISSN: 1600-0447
PURE UUID: ac421a94-10e1-49ec-a95b-a1ae9885c923
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381

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Date deposited: 04 Mar 2021 17:30
Last modified: 10 Jan 2022 02:41

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Contributors

Author: Joshua E J Buckman
Author: Rob Saunders
Author: Ciaran O'Driscoll
Author: Zachary D Cohen
Author: Josh Stott
Author: Gareth Ambler
Author: Simon Gilbody
Author: Steven D Hollon
Author: Tony Kendrick ORCID iD
Author: Edward Watkins
Author: Nicola Wiles
Author: David Kessler
Author: Nomsa Chari
Author: Ian R White
Author: Glyn Lewis
Author: Stephen Pilling

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