Socioeconomic factors affect response to depression treatment
Cross-college collaboration highlights importance of patients' home environments

Date:
April 15, 2022
Source:
University of Cincinnati
Summary:
A new research study shows how socioeconomic factors affect
outcomes for patients being treated for depression even when
receiving equal access to care.



FULL STORY ========================================================================== Patients seeking treatment for depression who have lower income and
education and those who are members of minority populations tend to have
worse treatment outcomes even when receiving equal access to treatment, according to new research from the University of Cincinnati.


==========================================================================
Led by Jeffrey Mills, PhD, and Jeffrey Strawn, MD, the UC cross-college collaborative research was recently published in the journal Psychiatric Services.

Strawn, professor in the Department of Psychiatry and Behavioral
Neuroscience in UC's College of Medicine and a UC Health adolescent psychiatrist, said that previous research has concluded that people
seeking treatment for depression with lower income and less education have worse outcomes because of a lack of access to quality health care, but
it is hard to isolate socioeconomic factors as they are often intertwined.

The research team analyzed data from a very large clinical trial known as
CO- MED that enrolled 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.

Study results After controlling for sex, age and treatment type following
12 weeks of antidepressant medication treatment in the study, the team's analysis found patients who were non-white improved 11.3% less compared
to white patients.

Those who were unemployed saw 6.6% less improvement compared to employed patients. Compared to patients in the 75th percentile of income
distribution, patients having income at the 25th percentile reduced
improvement by 4.8%.



========================================================================== Strawn noted the findings are still preliminary, but he was particularly interested to find that patients without a college degree had 9.6%
less improvement compared to college graduates.

"We think about these things in terms of access, we think about them
in terms of income inequality, and I realize that education does track
with those, but just having a college degree while controlling for all
of these other factors still had a significant impact," said Strawn.

The researchers also examined the effect of the combination of
socioeconomic factors, since the individual factors are often correlated,
Mills said.

Patients who were non-white, unemployed with no degree and had income
in the 25th percentile had 26% less improvement compared to patients
who were white, employed with a college degree and had income in the
75th percentile.

Mills said that the findings do not negate the fact that a lack of access
makes an impact on treatment outcomes, but it does show the importance of including a patients' home environment when analyzing the effectiveness
of treatment.

"If you're going home to a wealthy neighborhood with highly educated
parents or spouse, then you're arguably in a much better environment for
the treatment to be effective than if you're going to a poor neighborhood
with other problems," said Mills, professor of economics in UC's Carl
H. Lindner College of Business.



========================================================================== Strawn said other research suggests patients in resource-poor environments
may be affected by greater chronic variable stress, meaning high stress in
a pattern that is intermittent and difficult to predict. Other studies
suggest chronic variable stress has a worse effect on patients than
chronic sustained stress that is more steady, he said.

"So this is, 'I was able to pay my rent this month, but I'm not sure that
I will be able to next month. And I have a job right now, but I don't
know that I will next month,'" Strawn said. "So it's just the impact of
all those things as well as maybe having relatives or kids who have fewer educational resources or other job-related stress, or potentially other
health problems, and you're still running into those same barriers in
terms of access and cost and support there." Research application The
study findings have the potential to impact clinical trials by designing studies that pay better attention to socioeconomic variables that may
have been previously overlooked, Strawn said.

"When we don't control for these variables, which we often do not in
our clinical trials because of differences in populations, we may miss detecting an effective treatment because its effect is obscured," Strawn
said. "So it can potentially jeopardize our treatment development by
not accounting for these factors." Strawn said those treating patients
every day can use the knowledge from the study in a more straightforward approach. While removing barriers of access to treatment is important,
he said clinicians must also acknowledge that a patient's socioeconomic environment may be affecting their ability to get better with treatment
when measuring progress and crafting future treatment plans.

Mills said the research also has important implications when crafting and implementing economic policy, such as the recently passed infrastructure
bill or ongoing discussions on the minimum wage. The impact of a policy
on an individual's socioeconomic environment, and subsequently their
mental health, is not typically considered, he said.

"Someone employed at a higher wage has a chance to improve their
socioeconomic status and environment, and so they're definitely less
likely to get mental health problems," he said. "If people with higher socioeconomic status do get mental health problems, what we're showing is they're more likely to improve if they get treatment." Team science In
the past, two researchers with different specialties in different colleges within a university may have never worked together on research like this,
but the collaboration shows the benefit of what is called team science,
a transdisciplinary approach to research.

Strawn explained that traditional multidisciplinary research often looks
like a psychiatrist, a neurologist and a psychologist all within the
College of Medicine working together on a project. While that has its
place, team science works across disciplines and involves completely
separate sets of expertise, concepts and approaches.

"We think of multidisciplinary as being kind of the fruit salad where
you have your grapes and your bananas, but everything is still distinct," Strawn said.

"And then you have your transdisciplinary, where things are really
blended and it's difficult to tell whose contributions are whose. That's probably more like the fruit smoothie of disciplinary integration. I think that's hopefully what we've achieved." Mills said he has previously
seen colleagues expected to closely collaborate who never published a
paper together because their skill sets were too similar and they did
not need each other to move forward. Alternatively, Mills and Strawn
have interest in each other's field and bring varying, complementary
skill sets to the research.

"It's further than just multidisciplinary, because if I get together
with my colleagues, we still have had very similar training. We use
the same jargon, we have similar ideas," Mills said. "There's not the
same cross pollination in stepping out of your field and thinking about
other topics and giving each other ideas and concepts that you may not
have thought about." Moving forward, the researchers want to continue
the research by combining data from other depression trials to produce
more powerful results with a larger dataset.


========================================================================== Story Source: Materials provided by University_of_Cincinnati. Original
written by Tim Tedeschi. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Jeffrey A. Mills, Vikram Suresh, Lenisa Chang, Taryn Mayes, Paul E.

Croarkin, Madhukar H. Trivedi, Jeffrey R. Strawn. Socioeconomic
Predictors of Treatment Outcomes Among Adults With Major Depressive
Disorder. Psychiatric Services, 2022; DOI: 10.1176/appi.ps.202100559 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/04/220415112155.htm

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