Socioeconomic status and anxiety as predictors of antidepressant treatment response and suicidal ideation in older adults

  • Alex Cohen
  • Stephen E. Gilman
  • Patricia R. Houck
  • Katalin Szanto
  • Charles F. ReynoldsIII
ORIGINAL PAPER

DOI: 10.1007/s00127-008-0436-8

Cite this article as:
Cohen, A., Gilman, S.E., Houck, P.R. et al. Soc Psychiat Epidemiol (2009) 44: 272. doi:10.1007/s00127-008-0436-8

Abstract

Background

Separate reports from the maintenance treatment for late-life depression (MTLD) trials have shown that low socioeconomic status (SES) and anxiety symptoms at the time of treatment initiation predict lower levels of response to antidepressant treatment and higher levels of suicidal ideation in older adults.

Aim

To determine whether SES and anxiety independently contribute to worse treatment outcomes, as indicated by persistence of depressive symptoms during treatment and the persistence of suicidal ideation. Consistent with prior evidence that sociodemographic factors and clinical history are both prognostic of depression treatment efficacy, we hypothesized that SES and pre-existing anxiety symptoms will both predict lower levels of response to treatment and higher levels of suicidal ideation.

Method

Secondary analyses of data from the MTLD trials.

Results

Regression analyses which controlled for comorbid anxiety indicated that residents of middle- and high-income census tracts were more likely to respond to treatment (HR, 1.63; 95%CI, 1.08–2.46) and less likely to report suicidal ideation during treatment (OR, 0.51; 95%CI, 0.28–0.90) than residents of low income census tracts. The same regression models indicated that pre-existing anxiety symptoms were independently related to lower treatment response (HR, 0.73; 95%CI, 0.60–0.89) and higher risk of suicidal ideation (OR, 1.45; 95%CI, 0.98–2.14).

Conclusion

These findings demonstrate the importance of treating anxiety symptoms during the course of treatment for late-life depression and, at the same time, addressing barriers to treatment response related to low SES.

Keywords

socioeconomic status late-life depression comorbid anxiety social determinants of health response to antidepressant treatment 

Copyright information

© Steinkopff Verlag Darmstadt 2008

Authors and Affiliations

  • Alex Cohen
    • 1
  • Stephen E. Gilman
    • 2
    • 3
  • Patricia R. Houck
    • 4
  • Katalin Szanto
    • 4
  • Charles F. ReynoldsIII
    • 4
  1. 1.Dept. of Epidemiology and Population HealthLondon School of Hygiene and Tropical MedicineLondonUK
  2. 2.Dept. of Society, Human Development and HealthHarvard School of Public HealthBostonUSA
  3. 3.Dept. of EpidemiologyHarvard School of Public HealthBostonUSA
  4. 4.Intervention Research Center for the Study of Late-Life Mood Disorders, Thomas Detre Hall of the Western Psychiatric Institute and ClinicUniversity of PittsburghPittsburghUSA

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