Socioeconomic status and anxiety as predictors of antidepressant treatment response and suicidal ideation in older adults.
BACKGROUND
Separate reports from the maintenance treatment for late-life depression (MTLD) trials have shown that low socioeconomic status (SES) and anxiety symptoms at the time of treatment initiation predict lower levels of response to antidepressant treatment and higher levels of suicidal ideation in older adults.


OBJECTIVE
To determine whether SES and anxiety independently contribute to worse treatment outcomes, as indicated by persistence of depressive symptoms during treatment and the persistence of suicidal ideation. Consistent with prior evidence that sociodemographic factors and clinical history are both prognostic of depression treatment efficacy, we hypothesized that SES and pre-existing anxiety symptoms will both predict lower levels of response to treatment and higher levels of suicidal ideation.


METHODS
Secondary analyses of data from the MTLD trials.


RESULTS
Regression analyses which controlled for comorbid anxiety indicated that residents of middle- and high-income census tracts were more likely to respond to treatment (HR, 1.63; 95%CI, 1.08-2.46) and less likely to report suicidal ideation during treatment (OR, 0.51; 95%CI, 0.28-0.90) than residents of low income census tracts. The same regression models indicated that pre-existing anxiety symptoms were independently related to lower treatment response (HR, 0.73; 95%CI, 0.60-0.89) and higher risk of suicidal ideation (OR, 1.45; 95%CI, 0.98-2.14).


CONCLUSIONS
These findings demonstrate the importance of treating anxiety symptoms during the course of treatment for late-life depression and, at the same time, addressing barriers to treatment response related to low SES.
Cohen
Alex
A
Dept. of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. alex.cohen@lshtm.ac.uk
Gilman
Stephen E
SE
Houck
Patricia R
PR
Szanto
Katalin
K
Reynolds
Charles F
CF
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D001007:Anxiety / Q000139:chemically induced*; D002986:Clinical Trials as Topic; D015897:Comorbidity; D000075202:Contraindications; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D012923:Social Class; D013405:Suicide / Q000523:psychology*; D011795:Surveys and Questionnaires
D000928:Antidepressive Agents