Social inequalities in response to antidepressant treatment in older adults.
BACKGROUND
We examined the relationship between socioeconomic status and response to treatment for depression among older adults.


METHODS
Secondary analysis of pooled data from the open-label phase of 2 National Institute of Mental Health-funded clinical trials of nortriptyline hydrochloride or paroxetine combined with interpersonal psychotherapy (N = 248). We used Cox proportional hazards regression analyses to examine the association between socioeconomic status, indexed by census tract median annual household income and the subject's educational attainment, and treatment response and remission according to the Hamilton Depression Rating Scale. The association between socioeconomic status and suicidality or depressed mood reported at each week of treatment was examined using repeated-measures generalized logit models.


RESULTS
Subjects residing in middle-income census tracts were significantly more likely to respond to antidepressant treatment than subjects residing in low-income census tracts (adjusted hazard ratio, 1.80; 95% confidence interval [CI], 1.18-2.75]). Throughout the course of antidepressant treatment, subjects in the middle- and high-income census tracts were significantly less likely to report suicidal ideation (adjusted odds ratios, 0.48 [95% CI, 0.27-0.94] and 0.39 [95% CI, 0.16-0.94], respectively). No association was found between socioeconomic status and remission.


CONCLUSIONS
Residence in a low-income census tract is associated with a less favorable course of depression among older adults receiving a combination of pharmacologic and psychosocial treatment.
Cohen
Alex
A
Department of Social Medicine, Harvard Medical School, Boston, MA 02115, USA. alex_cohen@hms.harvard.edu
Houck
Patricia R
PR
Szanto
Katalin
K
Dew
Mary Amanda
MA
Gilman
Stephen E
SE
Reynolds
Charles F
CF
D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D019352:Censuses; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D004522:Educational Status; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D011287:Prejudice; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011613:Psychotherapy / Q000379:methods; D012044:Regression Analysis; D012923:Social Class; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000928:Antidepressive Agents