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Social Inequalities in Response to Antidepressant Treatment in Older Adults
Alex Cohen, PhD;
Patricia R. Houck, MSH;
Katalin Szanto, MD;
Mary Amanda Dew, PhD;
Stephen E. Gilman, ScD;
Charles F. Reynolds III, MD
Arch Gen Psychiatry. 2006;63:50-56.
Context We examined the relationship between socioeconomic status and response to treatment for depression among older adults.
Methods Secondary analysis of pooled data from the open-label phase of 2 National Institute of Mental Health–funded clinical trials of nortriptyline hydrochloride or paroxetine combined with interpersonal psychotherapy (N = 248). We used Cox proportional hazards regression analyses to examine the association between socioeconomic status, indexed by census tract median annual household income and the subject’s educational attainment, and treatment response and remission according to the Hamilton Depression Rating Scale. The association between socioeconomic status and suicidality or depressed mood reported at each week of treatment was examined using repeated-measures generalized logit models.
Results Subjects residing in middle-income census tracts were significantly more likely to respond to antidepressant treatment than subjects residing in low-income census tracts (adjusted hazard ratio, 1.80; 95% confidence interval [CI], 1.18-2.75]). Throughout the course of antidepressant treatment, subjects in the middle- and high-income census tracts were significantly less likely to report suicidal ideation (adjusted odds ratios, 0.48 [95% CI, 0.27-0.94] and 0.39 [95% CI, 0.16-0.94], respectively). No association was found between socioeconomic status and remission.
Conclusion Residence in a low-income census tract is associated with a less favorable course of depression among older adults receiving a combination of pharmacologic and psychosocial treatment.
Author Affiliations: Department of Social Medicine, Harvard Medical School (Dr Cohen), and Departments of Society, Human Development and Health and Epidemiology, Harvard School of Public Health (Dr Gilman), Boston, Mass; and Department of Psychiatry, Intervention Research Center for the Study of Late-Life Mood Disorders, University of Pittsburgh School of Medicine, Pittsburgh, Pa (Ms Houck and Drs Szanto, Dew, and Reynolds).
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