Influence of sociodemographic and socioeconomic features on treatment outcome in RCTs versus daily psychiatric practice

  • R. van der Lem
  • P. M. Stamsnieder
  • N. J. A. van der Wee
  • T. van Veen
  • F. G. Zitman
Original Paper



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.


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.


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).


Employment status should be taken into account while interpreting results from randomized controlled trials and as predictor of treatment success in daily practice.


Major depressive disorder Randomized controlled trial Sociodemographic status Socioeconomic status Patient selection 



Mrs. R. van der Lem (first author) has received a research grant from ZonMW (Grant Number 100-002-026), an independent research fund from the Dutch Government.

Conflict of interest

The authors have no financial or personal conflict of interest.

Supplementary material

127_2012_624_MOESM1_ESM.doc (37 kb)
Supplementary material 1 (DOC 37 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • R. van der Lem
    • 1
    • 3
  • P. M. Stamsnieder
    • 2
  • N. J. A. van der Wee
    • 1
    • 4
  • T. van Veen
    • 1
  • F. G. Zitman
    • 1
  1. 1.Department of PsychiatryLeiden University Medical Center/RivierduinenLeidenThe Netherlands
  2. 2.Kern HuisartsenpraktijkenDuivenThe Netherlands
  3. 3.Het DokRotterdamThe Netherlands
  4. 4.Leiden Institute for Brain and CognitionLeidenThe Netherlands

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