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Socioeconomic indicators of treatment prognosis for adults with depression: A Systematic Review and Individual Patient Data Meta-analysis

Socioeconomic indicators of treatment prognosis for adults with depression: A Systematic Review and Individual Patient Data Meta-analysis
Socioeconomic indicators of treatment prognosis for adults with depression: A Systematic Review and Individual Patient Data Meta-analysis

Importance: Socioeconomic factors are associated with the prevalence of depression, but their associations with prognosis are unknown. Understanding this association would aid in the clinical management of depression.

Objective: To determine whether employment status, financial strain, housing status, and educational attainment inform prognosis for adults treated for depression in primary care, independent of treatment and after accounting for clinical prognostic factors.

Data Sources: The Embase, International Pharmaceutical Abstracts, MEDLINE, PsycINFO, and Cochrane (CENTRAL) databases were searched from database inception to October 8, 2021.

Study Selection: Inclusion criteria were as follows: randomized clinical trials that used the Revised Clinical Interview Schedule (CIS-R; the most common comprehensive screening and diagnostic measure of depressive and anxiety symptoms in primary care randomized clinical trials), measured socioeconomic factors at baseline, and sampled patients with unipolar depression who sought treatment for depression from general physicians/practitioners or who scored 12 or more points on the CIS-R. Exclusion criteria included patients with depression secondary to a personality or psychotic disorder or neurologic condition, studies of bipolar or psychotic depression, studies that included children or adolescents, and feasibility studies. Studies were independently assessed against inclusion and exclusion criteria by 2 reviewers.

Data Extraction and Synthesis: Data were extracted and cleaned by data managers for each included study, further cleaned by multiple reviewers, and cross-checked by study chief investigators. Risk of bias and quality were assessed using the Quality in Prognosis Studies (QUIPS) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tools, respectively. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses-Individual Participant Data (PRISMA-IPD) reporting guidelines.

Main Outcomes and Measures: Depressive symptoms at 3 to 4 months after baseline.

Results: This systematic review and individual patient data meta-analysis identified 9 eligible studies that provided individual patient data for 4864 patients (mean [SD] age, 42.5 (14.0) years; 3279 women [67.4%]). The 2-stage random-effects meta-analysis end point depressive symptom scale scores were 28% (95% CI, 20%-36%) higher for unemployed patients than for employed patients and 18% (95% CI, 6%-30%) lower for patients who were homeowners than for patients living with family or friends, in hostels, or homeless, which were equivalent to 4.2 points (95% CI, 3.6-6.2 points) and 2.9 points (95% CI, 1.1-4.9 points) on the Beck Depression Inventory II, respectively. Financial strain and educational attainment were associated with prognosis independent of treatment, but unlike employment and housing status, there was little evidence of associations after adjusting for clinical prognostic factors.

Conclusions and Relevance: Results of this systematic review and meta-analysis revealed that unemployment was associated with a poor prognosis whereas home ownership was associated with improved prognosis. These differences were clinically important and independent of the type of treatment received. Interventions that address employment or housing difficulties could improve outcomes for patients with depression.

2168-6238
E1 - E11
Buckman, Joshua E.J.
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Saunders, Rob
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Stott, Joshua
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Cohen, Zachary D.
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Arundell, Laura-Louise
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Eley, Thalia C.
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Hollon, Steven D.
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Kendrick, Tony
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Ambler, Gareth
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Watkins, Edward
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Gilbody, Simon
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Kessler, David
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Wiles, Nicola
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Richards, David
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Brabyn, Sally
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Littlewood, Elizabeth
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DeRubeis, Robert J
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Lewis, Glyn
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Pilling, Stephen
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Buckman, Joshua E.J.
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Saunders, Rob
14f8666e-a131-4130-a7b1-a358d84d5cb2
Stott, Joshua
80bc99ca-a7c6-4280-84d6-81f009f963a6
Cohen, Zachary D.
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Arundell, Laura-Louise
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Eley, Thalia C.
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Hollon, Steven D.
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Kendrick, Tony
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Ambler, Gareth
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Watkins, Edward
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Gilbody, Simon
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Kessler, David
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Wiles, Nicola
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Richards, David
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Brabyn, Sally
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Littlewood, Elizabeth
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DeRubeis, Robert J
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Lewis, Glyn
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Pilling, Stephen
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Buckman, Joshua E.J., Saunders, Rob, Stott, Joshua, Cohen, Zachary D., Arundell, Laura-Louise, Eley, Thalia C., Hollon, Steven D., Kendrick, Tony, Ambler, Gareth, Watkins, Edward, Gilbody, Simon, Kessler, David, Wiles, Nicola, Richards, David, Brabyn, Sally, Littlewood, Elizabeth, DeRubeis, Robert J, Lewis, Glyn and Pilling, Stephen (2022) Socioeconomic indicators of treatment prognosis for adults with depression: A Systematic Review and Individual Patient Data Meta-analysis. JAMA Psychiatry, E1 - E11. (doi:10.1001/jamapsychiatry.2022.0100).

Record type: Review

Abstract

Importance: Socioeconomic factors are associated with the prevalence of depression, but their associations with prognosis are unknown. Understanding this association would aid in the clinical management of depression.

Objective: To determine whether employment status, financial strain, housing status, and educational attainment inform prognosis for adults treated for depression in primary care, independent of treatment and after accounting for clinical prognostic factors.

Data Sources: The Embase, International Pharmaceutical Abstracts, MEDLINE, PsycINFO, and Cochrane (CENTRAL) databases were searched from database inception to October 8, 2021.

Study Selection: Inclusion criteria were as follows: randomized clinical trials that used the Revised Clinical Interview Schedule (CIS-R; the most common comprehensive screening and diagnostic measure of depressive and anxiety symptoms in primary care randomized clinical trials), measured socioeconomic factors at baseline, and sampled patients with unipolar depression who sought treatment for depression from general physicians/practitioners or who scored 12 or more points on the CIS-R. Exclusion criteria included patients with depression secondary to a personality or psychotic disorder or neurologic condition, studies of bipolar or psychotic depression, studies that included children or adolescents, and feasibility studies. Studies were independently assessed against inclusion and exclusion criteria by 2 reviewers.

Data Extraction and Synthesis: Data were extracted and cleaned by data managers for each included study, further cleaned by multiple reviewers, and cross-checked by study chief investigators. Risk of bias and quality were assessed using the Quality in Prognosis Studies (QUIPS) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tools, respectively. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses-Individual Participant Data (PRISMA-IPD) reporting guidelines.

Main Outcomes and Measures: Depressive symptoms at 3 to 4 months after baseline.

Results: This systematic review and individual patient data meta-analysis identified 9 eligible studies that provided individual patient data for 4864 patients (mean [SD] age, 42.5 (14.0) years; 3279 women [67.4%]). The 2-stage random-effects meta-analysis end point depressive symptom scale scores were 28% (95% CI, 20%-36%) higher for unemployed patients than for employed patients and 18% (95% CI, 6%-30%) lower for patients who were homeowners than for patients living with family or friends, in hostels, or homeless, which were equivalent to 4.2 points (95% CI, 3.6-6.2 points) and 2.9 points (95% CI, 1.1-4.9 points) on the Beck Depression Inventory II, respectively. Financial strain and educational attainment were associated with prognosis independent of treatment, but unlike employment and housing status, there was little evidence of associations after adjusting for clinical prognostic factors.

Conclusions and Relevance: Results of this systematic review and meta-analysis revealed that unemployment was associated with a poor prognosis whereas home ownership was associated with improved prognosis. These differences were clinically important and independent of the type of treatment received. Interventions that address employment or housing difficulties could improve outcomes for patients with depression.

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Accepted/In Press date: 8 January 2022
e-pub ahead of print date: 9 March 2022
Additional Information: Publisher Copyright: © 2022 American Medical Association. All rights reserved. Copyright: Copyright 2022 Elsevier B.V., All rights reserved.

Identifiers

Local EPrints ID: 456095
URI: http://eprints.soton.ac.uk/id/eprint/456095
ISSN: 2168-6238
PURE UUID: 8ded219a-f7ef-4c3b-9fc0-d3118879d2b1
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381

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Date deposited: 26 Apr 2022 14:49
Last modified: 27 Apr 2022 01:40

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Contributors

Author: Joshua E.J. Buckman
Author: Rob Saunders
Author: Joshua Stott
Author: Zachary D. Cohen
Author: Laura-Louise Arundell
Author: Thalia C. Eley
Author: Steven D. Hollon
Author: Tony Kendrick ORCID iD
Author: Gareth Ambler
Author: Edward Watkins
Author: Simon Gilbody
Author: David Kessler
Author: Nicola Wiles
Author: David Richards
Author: Sally Brabyn
Author: Elizabeth Littlewood
Author: Robert J DeRubeis
Author: Glyn Lewis
Author: Stephen Pilling

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