Citation

Gilman SE, Fitzmaurice GM, Bruce ML, ten Have T, Glymour MM, Carliner H, Alexopoulos GS, Mulsant BH, Reynolds CF, Cohen A. Epidemiology 2013; 24(1): 14-22.

Affiliation

From the aDepartment of Society, Human Development and Health, Harvard School of Public Health, Boston, MA; bDepartment of Epidemiology, Harvard School of Public Health, Boston, MA; cDepartment of Psychiatry, Massachusetts General Hospital, Boston, MA; dDepartment of Psychiatry, Harvard Medical School, Boston, MA; eDepartment of Biostatistics, Harvard School of Public Health, Boston, MA; fDepartment of Psychiatry, Weill-Cornell Medical College, White Plains, NY; gDepartment of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, PA; hDepartment of Society, Human Development, and Health, Harvard School of Public Health; Boston, MA; iCenter for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; jDepartment of Psychiatry, University of Toronto, Toronto, Ontario, Canada; kDepartment of Psychiatry, University of Pittsburgh, Pittsburgh, PA; and lFaculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. †Deceased.

Copyright

(Copyright © 2013, Lippincott Williams and Wilkins)

DOI

10.1097/EDE.0b013e3182762403

PMID

23232609

Abstract

BACKGROUND:: Economic disadvantage is associated with depression and suicide. We sought to determine whether economic disadvantage reduces the effectiveness of depression treatments received in primary care. METHODS:: We conducted differential-effects analyses of the Prevention of Suicide in Primary Care Elderly: Collaborative Trial, a primary-care-based randomized, controlled trial for late-life depression and suicidal ideation conducted between 1999 and 2001, which included 514 patients with major depression or clinically significant minor depression. RESULTS:: The intervention effect, defined as change in depressive symptoms from baseline, was stronger among persons reporting financial strain at baseline (differential effect size = -4.5 Hamilton Depression Rating Scale points across the study period [95% confidence interval = -8.6 to -0.3]). We found similar evidence for effect modification by neighborhood poverty, although the intervention effect weakened after the initial 4 months of the trial for participants residing in poor neighborhoods. There was no evidence of substantial differences in the effectiveness of the intervention on suicidal ideation and depression remission by economic disadvantage. CONCLUSIONS:: Economic conditions moderated the effectiveness of primary-care-based treatment for late-life depression. Financially strained individuals benefited more from the intervention; we speculate this was because of the enhanced treatment management protocol, which led to a greater improvement in the care received by these persons. People living in poor neighborhoods experienced only temporary benefit from the intervention. Thus, multiple aspects of economic disadvantage affect depression treatment outcomes; additional work is needed to understand the underlying mechanisms.

Language: en