title: High occupational level is associated with poor response to treatment of depression.
abstract: Depression may be complicated by work-related stress and, in turn, depression is a leading cause of disability in workplaces. Though available effective treatments, only one third of patients reach full remission after a first treatment trial and nearly half of the patients are non-responders. Occupational level has been found to be a reliable predictor of health outcome in the general population. In the present study we tested the potential association of occupational level of those in work with response to treatment of depression in a large multinational sample. Major depressive disorder patients (n=654) stratified in three occupational levels (high, middle, low) were considered for the present study. Response to last treatment for current episode and treatment resistant depression, defined as non-response to 2 or more previous adequate treatment trials, were considered the outcome variables. Depressed patients from the high occupational level had a higher level of educational achievement. They showed a significantly poorer response to the last treatment with lower remission rates and more treatment resistance than the other occupational level groups. They were treated less with Serotonin Reuptake Inhibitors (SRIs). Potential confounding factors did not influence the main effect. The present findings indicate that those working at a high occupational level may be a risk factor for poor response to medication for depression and this has potential implications for clinicians and their patients, for future research, for employers and for public policy.
authors.affiliation: Service of Psychiatry, Department of Biomedical and Neuromotor sciences, University of Bologna, V.le C. Pepoli 5, 40123 Bologna, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Mandelli
authors.affiliation: Service of Psychiatry, Department of Biomedical and Neuromotor sciences, University of Bologna, V.le C. Pepoli 5, 40123 Bologna, Italy. Electronic address: alessandro.serretti@unibo.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Serretti
authors.affiliation: Laboratoire de Psychologie Médicale, Université Libre de Bruxelles and PsyPluriel, Brussels, Belgium.
authors.forename: Daniel
authors.initials: D
authors.lastname: Souery
authors.affiliation: Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Julien
authors.initials: J
authors.lastname: Mendlewicz
authors.affiliation: Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Kasper
authors.affiliation: Imperial College, University of London, London, UK.
authors.forename: Stuart
authors.initials: S
authors.lastname: Montgomery
authors.affiliation: Expert Platform on Mental Health, Focus on Depression Tel-Aviv University, Israel.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zohar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001317:Austria / Q000453:epidemiology; D001530:Belgium / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004351:Drug Resistance; D004522:Educational Status; D004651:Employment / Q000145:classification / Q000523:psychology; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D000073397:Occupational Stress / Q000503:physiopathology* / Q000523:psychology; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Depression; Treatment response; Workplace