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Antidepressants, social adversity and outcome of depression in general practice

Antidepressants, social adversity and outcome of depression in general practice
Antidepressants, social adversity and outcome of depression in general practice
Background: The role of current social risk factors in moderating the impact of antidepressant medication has not previously been explored.

Method: In a RCT of SSRIs of general practice patients with mild to moderate depression (HDRS 12–19) two social indices of aversive experience were developed on the basis of prior research. First, the Life Events and Difficulties Schedule (LEDS) was used twice to document: i) recent stressful experience prior to baseline, and ii) after baseline and before follow up at 12 weeks both stressful and positive experiences, taking account of ‘fresh start’ and ‘difficulty-reduction’ events. Second, an index of unemployment-entrapment at baseline was developed for the current project. The HDRS was used to measure outcome as a continuous score and as a cut-point representing improvement below score 8.

Results: Each social index (LEDS and Unemployment-entrapment) was associated with a lower chance of remission at 12 weeks and each was required to model remission along with treatment arm. However there was no interaction: the degree of increased remission for those randomised to SSRIs plus supportive care compared to that for those with supportive care alone was the same regardless of social context.

Limitations: Dating of remission was not as thorough as in previous work with the LEDS. Detailed examination of positive experiences suggested the large majority were not the result of remitting symptoms, but it is impossible to rule this out altogether.

Conclusions: Remission rates among patients in aversive social contexts are consistently much lower irrespective of treatment. There is thus a need to evaluate the efficacy of alternative more socially focussed interventions for depressive conditions likely to take a chronic course in general practice.
antidepressants, SSRIs, depression, outcome depression, social adversity, general practice
0165-0327
239-246
Brown, George W.
10ef8339-7d58-408c-8886-2a47ee64a08c
Harris, Tirril O.
1fa1c272-70f6-48b0-bc8f-5f5150b93688
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Chatwin, Judy
c828a7b0-e6c6-4229-b7b3-384feb083b76
Craig, Tom K.J.
6c78fdbb-3b85-40a3-b205-248b3b894f31
Kelly, Vikki
fe394c7d-ede9-4395-b308-8b2267d3680f
Mander, Helen
761f102f-8321-4214-afbb-febbddd81f94
Ring, Adele
86d2bf44-d516-4509-8128-2e3d3f8834b4
Wallace, Vuokko
126dc408-35c0-46ca-96bd-81f311a4ba9e
Uher, Rudolf
10eb52e7-9ad1-4757-a3d6-2fd524431037
Moore, M.
1be81dad-7120-45f0-bbed-f3b0cc0cfe99
(on behalf of the THREAD study group)
Brown, George W.
10ef8339-7d58-408c-8886-2a47ee64a08c
Harris, Tirril O.
1fa1c272-70f6-48b0-bc8f-5f5150b93688
Kendrick, Tony
c697a72c-c698-469d-8ac2-f00df40583e5
Chatwin, Judy
c828a7b0-e6c6-4229-b7b3-384feb083b76
Craig, Tom K.J.
6c78fdbb-3b85-40a3-b205-248b3b894f31
Kelly, Vikki
fe394c7d-ede9-4395-b308-8b2267d3680f
Mander, Helen
761f102f-8321-4214-afbb-febbddd81f94
Ring, Adele
86d2bf44-d516-4509-8128-2e3d3f8834b4
Wallace, Vuokko
126dc408-35c0-46ca-96bd-81f311a4ba9e
Uher, Rudolf
10eb52e7-9ad1-4757-a3d6-2fd524431037
Moore, M.
1be81dad-7120-45f0-bbed-f3b0cc0cfe99

Brown, George W., Harris, Tirril O., Kendrick, Tony, Chatwin, Judy, Craig, Tom K.J., Kelly, Vikki, Mander, Helen, Ring, Adele, Wallace, Vuokko, Uher, Rudolf and Moore, M. , (on behalf of the THREAD study group) (2010) Antidepressants, social adversity and outcome of depression in general practice. Journal of Affective Disorders, 121, 239-246. (doi:10.1016/j.jad.2009.06.004). (PMID:9589602)

Record type: Article

Abstract

Background: The role of current social risk factors in moderating the impact of antidepressant medication has not previously been explored.

Method: In a RCT of SSRIs of general practice patients with mild to moderate depression (HDRS 12–19) two social indices of aversive experience were developed on the basis of prior research. First, the Life Events and Difficulties Schedule (LEDS) was used twice to document: i) recent stressful experience prior to baseline, and ii) after baseline and before follow up at 12 weeks both stressful and positive experiences, taking account of ‘fresh start’ and ‘difficulty-reduction’ events. Second, an index of unemployment-entrapment at baseline was developed for the current project. The HDRS was used to measure outcome as a continuous score and as a cut-point representing improvement below score 8.

Results: Each social index (LEDS and Unemployment-entrapment) was associated with a lower chance of remission at 12 weeks and each was required to model remission along with treatment arm. However there was no interaction: the degree of increased remission for those randomised to SSRIs plus supportive care compared to that for those with supportive care alone was the same regardless of social context.

Limitations: Dating of remission was not as thorough as in previous work with the LEDS. Detailed examination of positive experiences suggested the large majority were not the result of remitting symptoms, but it is impossible to rule this out altogether.

Conclusions: Remission rates among patients in aversive social contexts are consistently much lower irrespective of treatment. There is thus a need to evaluate the efficacy of alternative more socially focussed interventions for depressive conditions likely to take a chronic course in general practice.

Full text not available from this repository.

More information

Published date: 2010
Additional Information: Michael Moore is part of the THREAD study group
Keywords: antidepressants, SSRIs, depression, outcome depression, social adversity, general practice
Organisations: Primary Care & Population Sciences

Identifiers

Local EPrints ID: 68834
URI: http://eprints.soton.ac.uk/id/eprint/68834
ISSN: 0165-0327
PURE UUID: 7d2335e2-a0c6-44ab-af7b-2e3bde60a3d7
ORCID for Tony Kendrick: ORCID iD orcid.org/0000-0003-1618-9381
ORCID for M. Moore: ORCID iD orcid.org/0000-0002-5127-4509

Catalogue record

Date deposited: 05 Oct 2009
Last modified: 19 Nov 2019 01:54

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