title: Social inequalities in depression and suicidal ideation among older primary care patients.
abstract: OBJECTIVE
  Depression and suicide are major public health concerns, and are often unrecognized among the elderly. This study investigated social inequalities in depressive symptoms and suicidal ideation among older adults.
  
  
  METHODS
  Data come from 1,226 participants in PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial), a large primary care-based intervention trial for late-life depression. Linear and logistic regressions were used to analyze depressive symptoms and suicidal ideation over the 2-year follow-up period.
  
  
  RESULTS
  Mean Hamilton Depression Rating Scale (HDRS) scores were significantly higher among participants in financial strain [regression coefficient (b) = 1.78, 95 % confidence interval (CI) = 0.67-2.89] and with annual incomes below $20,000 (b = 1.67, CI = 0.34-3.00). Financial strain was also associated with a higher risk of suicidal ideation (odds ratio = 2.35, CI = 1.38-3.98).
  
  
  CONCLUSIONS
  There exist marked social inequalities in depressive symptoms and suicidal ideation among older adults attending primary care practices, the setting in which depression is most commonly treated. Our results justify continued efforts to understand the mechanisms generating such inequalities and to recognize and provide effective treatments for depression among high-risk populations.
authors.affiliation: Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA. sgilman@hsph.harvard.edu
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Gilman
authors.forename: Martha L
authors.initials: ML
authors.lastname: Bruce
authors.forename: Thomas
authors.initials: T
authors.lastname: Ten Have
authors.forename: George S
authors.initials: GS
authors.lastname: Alexopoulos
authors.forename: Benoit H
authors.initials: BH
authors.lastname: Mulsant
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: Alex
authors.initials: A
authors.lastname: Cohen
mesh_terms: D000367:Age Factors; D000368:Aged; D000375:Aging / Q000523:psychology*; D003863:Depression / Q000150:complications / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010361:Patients / Q000706:statistics & numerical data; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012307:Risk Factors; D012944:Social Support; D012959:Socioeconomic Factors; D059020:Suicidal Ideation; D014481:United States / Q000453:epidemiology