People without jobs or with less secure housing have worse outcomes when treated for depression with talk therapy or antidepressants, compared to more socially advantaged peers, according to a study by researchers from UCL.
The authors of the new study published in JAMA Psychiatry say addressing employment and housing needs can be helpful alongside treatments for depression in supporting the mental health of socioeconomically disadvantaged people.
The researchers combined evidence from nine studies, which included a total of 4,864 people who had been treated for depression, where data was available on socio-economic factors such as employment and housing.
They found that after three to four months of treatment, unemployed patients had 28% worse symptoms of depression than those who worked. Homeowners’ depression symptoms were 18% better than people who were homeless or living in hostels or with family and friends.*
Lead author Dr Joshua Buckman (UCL Psychology & Language Sciences and Camden & Islington NHS Foundation Trust) said: “We found that people who are unemployed or who live in less secure accommodation have worse outcomes when being treated for depression. Additional support to access employment or housing could also lead to improved mental health.
“Based on our results, we cannot confirm whether helping to improve people’s working and housing conditions would directly improve their mental health, or whether it would make them more likely to undergo treatment. For example, it may be easier to keep all of their appointments if they can stay in the same place regularly without having to move.
“We hope that further research will provide insight into how best to meet the mental health needs of socially disadvantaged people.”
People who were unemployed or had less secure housing had worse outcomes, even compared to people who had a similar severity or number of symptoms when they started treatment. The researchers adjusted for other factors known to influence treatment outcomes, such as a range of mental illness characteristics, in addition to age, sex, marital status and, in most studies , physical health conditions and social support.
They also looked at whether financial hardship or education was associated with treatment effectiveness, but found no significant effect for either factor, and these factors did not explain neither are the links with employment and housing status.
After the first few months of treatment, the differences between the groups continued to widen, as after nine to 12 months the unemployed patients had 37% more severe symptoms than the employed patients.
Treatments for depression given varied somewhat across studies, including a few common antidepressants, cognitive behavioral therapy (CBT), computerized CBT, structured physical activity, collaborative care, and other options, but outcomes were consistently worse for people without jobs or secure housing. .
Co-lead author Professor Stephen Pilling (UCL Psychology & Language Sciences) said: “Clinicians can easily ask their patients about housing status and employment, and our findings suggest this should then inform their plans for processing. If possible, a referral for support in finding secure housing or employment may be beneficial, or knowing that these patients are less likely to get better, clinicians could consider more intensive treatment or give priority to a follow-up appointment soon after starting treatment to see if it is having the desired effect.
Co-author Professor Glyn Lewis (UCL Psychiatry and Camden & Islington NHS Foundation Trust) said: “Social disadvantage can increase the risk of mental illness, so it is of particular concern that in addition to this underlying risk higher, those without a job or in secure housing are also less likely to recover from depression.
The study was funded by Wellcome with support from the MQ Foundation, Royal College of Psychiatrists, National Institute of Health Research (NIHR), NIHR Biomedical Research Centers at University College London Hospitals and South London and Maudsley NHS Foundation Trust and King’s College London and the Alzheimer Society, and involved researchers from UCL, Camden & Islington NHS Foundation Trust, UCLA, King’s College London, Vanderbilt University and the Universities of Southampton, Exeter , York, Bristol and Pennsylvania.
* Renters performed worse than homeowners, but better than people living in other less secure housing situations.
The title of the article
Socioeconomic indicators of treatment prognosis for adults with depression: a systematic review and meta-analysis of individual patient data
Publication date of articles
March 9, 2022
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