title: Influence of sociodemographic and socioeconomic features on treatment outcome in RCTs versus daily psychiatric practice.
abstract: OBJECTIVE
  Sociodemographic and socioeconomic characteristics of participants in antidepressant and psychotherapy efficacy trials (AETs and PETs) for major depressive disorder (MDD) may limit the generalizability of the results. We compared trial participants with daily practice patients. We subsequently assessed the influence of socio-demographic and socioeconomic status on treatment outcome in daily practice.
  
  
  METHODS
  Data on daily practice patients were derived through routine outcome monitoring (ROM). We included 626 patients with MDD according to the MINIplus. Distributions of age, gender, race, marital status and employment status were compared with participants in 63 selected AETs and PETs. Influence of these features on treatment outcome was explored through multivariate regression analysis.
  
  
  RESULTS
  Trial participants were older, more often male (diff. 4 %, p = 0.05), white (diff. 4 %, p < 0.001) and not married (diff. 7 %, p = 0.003). Although significant, most differences were relatively small. However, the difference in employment status was striking: 34 % of the ROM patients were currently working versus 68 % of the trial participants (diff. 34 %, p < 0.001). Being employed contributed to a positive treatment outcome: OR 1.8 for response [50 % reduction of Montgomery Asberg Rating Scale for Depression (MADRS)], OR 1.9 for remission (MADRS ≤10).
  
  
  CONCLUSIONS
  Employment status should be taken into account while interpreting results from randomized controlled trials and as predictor of treatment success in daily practice.
authors.affiliation: Department of Psychiatry, Leiden University Medical Center/Rivierduinen, Albinusdreef 2, PO Box 9600, 2300 RC, Leiden, The Netherlands. rosalind.van.der.lem@hetdok.nl
authors.forename: R
authors.initials: R
authors.lastname: van der Lem
authors.forename: P M
authors.initials: PM
authors.lastname: Stamsnieder
authors.forename: N J A
authors.initials: NJ
authors.lastname: van der Wee
authors.forename: T
authors.initials: T
authors.lastname: van Veen
authors.forename: F G
authors.initials: FG
authors.lastname: Zitman
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy; D003156:Community Mental Health Services / Q000379:methods / Q000706:statistics & numerical data; D003865:Major Depressive Disorder / Q000628:therapy*; D004651:Employment / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D011569:Psychiatric Status Rating Scales; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012923:Social Class; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents