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Social inequalities in depression and suicidal ideation among older primary care patients

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Abstract

Purpose

Depression and suicide are major public health concerns, and are often unrecognized among the elderly. This study investigated social inequalities in depressive symptoms and suicidal ideation among older adults.

Methods

Data come from 1,226 participants in PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial), a large primary care-based intervention trial for late-life depression. Linear and logistic regressions were used to analyze depressive symptoms and suicidal ideation over the 2-year follow-up period.

Results

Mean Hamilton Depression Rating Scale (HDRS) scores were significantly higher among participants in financial strain [regression coefficient (b) = 1.78, 95 % confidence interval (CI) = 0.67–2.89] and with annual incomes below $20,000 (b = 1.67, CI = 0.34–3.00). Financial strain was also associated with a higher risk of suicidal ideation (odds ratio = 2.35, CI = 1.38–3.98).

Conclusions

There exist marked social inequalities in depressive symptoms and suicidal ideation among older adults attending primary care practices, the setting in which depression is most commonly treated. Our results justify continued efforts to understand the mechanisms generating such inequalities and to recognize and provide effective treatments for depression among high-risk populations.

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Acknowledgments

This work was supported by the National Institutes of Health grants MH83335, MH085944, and MH059366. Forest Pharmaceuticals provided free citalopram for the PROSPECT study. The authors sincerely appreciate the contributions of Ms. Kathleen McGaffigan for data management and statistical programming, and Ms. Rebecca Hawrusik for conducting literature reviews.

Conflict of interest

George S. Alexopoulos, M.D., receives research support from Forest; he serves on the speakers’ bureau for Forest, Lilly, Bristol Meyers Squibb, Astra Zeneca, Merck; and is a stockholder in Johnson & Johnson. Martha L. Bruce, Ph.D., M.P.H., has received financial compensation for consulting to Medispin, Inc., a medical education company. Benoit H. Mulsant, M.D., currently receives research support from the US National Institute of Mental Health, the Canadian Institutes for Health Research, Bristol-Myers Squibb, and Wyeth. During the past five years, he has also received research support or honoraria from Astra-Zeneca, Bristol-Myers Squibb, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Janssen, Lundbeck, Pfizer and Wyeth; he previously directly held stocks (all less than $10,000) of Akzo-Nobel, Alkermes, AstraZeneca, Biogen, Celsion, Elan, Eli Lilly, Forest, Orchestra Therapeutics, and Pfizer. Charles F. Reynolds III, M.D., receives pharmaceutical supplies from Forest Laboratories, BMS, Pfizer, and Lilly for his NIH sponsored research.

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Authors and Affiliations

  1. Department of Society, Human Development and Health, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    Stephen E. Gilman

  2. Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA

    Stephen E. Gilman

  3. Department of Psychiatry, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA, 02114, USA

    Stephen E. Gilman

  4. Department of Psychiatry, Weill-Cornell Medical College, 21 Bloomingdale Road, White Plains, NY, 10605, USA

    Martha L. Bruce & George S. Alexopoulos

  5. Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 423 Guardian Drive, Philadelphia, PA, 19104-6021, USA

    Thomas Ten Have

  6. Department of Psychiatry, Center for Addiction and Mental Health, University of Toronto, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada

    Benoit H. Mulsant

  7. Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburgh, PA, 15213, USA

    Charles F. Reynolds III

  8. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E−7HT, UK

    Alex Cohen

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  1. Stephen E. Gilman
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  2. Martha L. Bruce
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  3. Thomas Ten Have
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  4. George S. Alexopoulos
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  5. Benoit H. Mulsant
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  6. Charles F. Reynolds III
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  7. Alex Cohen
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Corresponding author

Correspondence to Stephen E. Gilman.

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T. T. Have: Deceased.

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Gilman, S.E., Bruce, M.L., Have, T.T. et al. Social inequalities in depression and suicidal ideation among older primary care patients. Soc Psychiatry Psychiatr Epidemiol 48, 59–69 (2013). https://doi.org/10.1007/s00127-012-0575-9

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  • DOI: https://doi.org/10.1007/s00127-012-0575-9

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