Skip to main content
SpringerLink
Log in

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

  • ORIGINAL PAPER
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alexopoulos GS, Katz IR, Bruce ML, Heo M, Ten Have T, Raue P, Bogner HR, Schulberg HC, Mulsant BH, Reynolds CF 3rd (2005) Remission in depressed geriatric primary care patients: a report from the PROSPECT study. Am J Psychiatry 162:718–724

    Article  PubMed  Google Scholar 

  2. Andreescu C, Lenze EJ, Dew MA, Begley AE, Mulsant BH, Dombrovski AY, Pollock BG, Stack J, Miller MD, Reynolds CF (2007) Effect of comorbid anxiety on treatment response and relapse risk in late-life depression: controlled study. Br J Psychiatry 190:344–349

    Article  PubMed  Google Scholar 

  3. Arean PA, Gum AM, Tang L, Unutzer J (2007) Service Use and Outcomes Among Elderly Persons With Low Incomes Being Treated for Depression. Psychiatr Serv 58:1057–1064

    Article  PubMed  Google Scholar 

  4. Berkman LF, Macintyre S (1997) The measurement of social class in health studies: old measures and new formulations. IARC Sci Publ:51–64

    Google Scholar 

  5. Bernal M, Haro JM, Bernert S, Brugha T, de Graaf R, Bruffaerts R, Lepine JP, de Girolamo G, Vilagut G, Gasquet I, Torres JV, Kovess V, Heider D, Neeleman J, Kessler R, Alonso J (2007) Risk factors for suicidality in Europe: results from the ESEMED study. J Affect Disord 101:27–34

    Article  PubMed  CAS  Google Scholar 

  6. Blazer DG (2003) Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci 58:249–265

    PubMed  Google Scholar 

  7. Braveman PA, Cubbin C, Egerter S, Chideya S, Marchi KS, Metzler M, Posner S (2005) Socioeconomic status in health research: one size does not fit all. JAMA 294:2879–2888

    Article  PubMed  CAS  Google Scholar 

  8. Brown GW, Harris TO (1978) Social origins of depression: A study of psychiatric disorder in women. Tavistock, London

    Google Scholar 

  9. Brown GW, Harris T (1986) Stressor, vulnerability and depression: a question of replication. Psychol Med 16:739–744

    PubMed  CAS  Google Scholar 

  10. Brown GW, Bifulco A, Harris TO (1987) Life events, vulnerability and onset of depression: some refinements. Br J Psychiatry 150:30–42

    Article  PubMed  CAS  Google Scholar 

  11. Brugha TS, Bebbington PE, MacCarthy B, Sturt E, Wykes T, Potter J (1990) Gender, social support and recovery from depressive disorders: a prospective clinical study. Psychol Med 20:147–156

    PubMed  CAS  Google Scholar 

  12. Casey PR, Dunn G, Kelly BD, Birkbeck G, Dalgard OS, Lehtinen V, Britta S, Ayuso-Mateos JL, Dowrick C (2006) Factors associated with suicidal ideation in the general population: five-centre analysis from the ODIN study. Br J Psychiatry 189:410–415

    Article  PubMed  Google Scholar 

  13. Caspi A, Sugden K, Moffitt TE, Taylor A, Craig IW, Harrington H, McClay J, Mill J, Martin J, Braithwaite A, Poulton R (2003) Influence of life stress on depression: moderation by a polymorphism in the 5-HTT gene. Science 301:386–389

    Article  PubMed  CAS  Google Scholar 

  14. Cohen A, Houck PR, Szanto K, Dew MA, Gilman SE, Reynolds CFIII (2006) Social inequalities in response to antidepressant treatment in older adults. Arch Gen Psychiatry 63:50–56

    Article  PubMed  Google Scholar 

  15. Conwell Y, Duberstein PR, Caine ED (2002) Risk factors for suicide in later life. Biol Psychiatry 52:193–204

    Article  PubMed  Google Scholar 

  16. Cox DR (1972) Regression models and life-tables. J R Stat Soc: Ser B (Methodol) 34:187–220

    Google Scholar 

  17. Derogatis LR, Melisaratos N (1983) The Brief Symptom Inventory: an introductory report. Psychol Med 13:595–605

    PubMed  CAS  Google Scholar 

  18. Dew MA, Reynolds CF 3rd, Houck PR, Hall M, Buysse DJ, Frank E, Kupfer DJ (1997) Temporal profiles of the course of depression during treatment: predictors of pathways toward recovery in the elderly. Arch Gen Psychiatry 54:1016–1024

    PubMed  CAS  Google Scholar 

  19. Dohrenwend BP (2000) The role of adversity and stress in psychopathology: some evidence and its implications for theory and research. J Health Soc Behav 41:1–19

    Article  PubMed  CAS  Google Scholar 

  20. Dohrenwend BP, Dohrenwend BS (1969) Social status and psychological disorder; a causal inquiry. Wiley-Interscience, New York

    Google Scholar 

  21. Frank E, Prien RF, Jarrett RB, Keller MB, Kupfer DJ, Lavori PW, Rush AJ, Weissman MM (1991) Conceptualization and rationale for consensus definitions of terms in major depressive disorder: Remission, recovery, relapse, and recurrence. Arch Gen Psychiatry 48:851–855

    PubMed  CAS  Google Scholar 

  22. Griffin JM, Fuhrer R, Stansfeld SA, Marmot M (2002) The importance of low control at work and home on depression and anxiety: do these effects vary by gender and social class? Soc Sci Med 54:783–798

    Article  PubMed  Google Scholar 

  23. Gum AM, Arean PA, Bostrom A (2007) Low-income depressed older adults with psychiatric comorbidity: secondary analyses of response to psychotherapy and case management. Int J Geriatr Psychiatry 22:124–130

    Article  PubMed  Google Scholar 

  24. Hamilton M (1960) A rating scale for depression. J Neurol Neurosurg Psychiatry 23:56–62

    Article  PubMed  CAS  Google Scholar 

  25. Hirschfeld RM, Russell JM, Delgado PL, Fawcett J, Friedman RA, Harrison WM, Koran LM, Miller IW, Thase ME, Howland RH, Connolly MA, Miceli RJ (1998) Predictors of response to acute treatment of chronic and double depression with sertraline or imipramine. J Clin Psychiatry 59:669–675

    PubMed  CAS  Google Scholar 

  26. Hybels CF, Blazer DG, Steffens DC (2005) Predictors of partial remission in older patients treated for major depression: the role of comorbid dysthymia. Am J Geriatr Psychiatry 13:713–721

    PubMed  Google Scholar 

  27. Isaacs SL, Schroeder SA (2004) Class - the ignored determinant of the nation’s health. N Engl J Med 351:1137–1142

    Article  PubMed  CAS  Google Scholar 

  28. Jeste ND, Hays JC, Steffens DC (2006) Clinical correlates of anxious depression among elderly patients with depression. J Affect Disord 90:37–41

    Article  PubMed  Google Scholar 

  29. Kendler KS, Karkowski LM, Prescott CA (1998) Stressful life events and major depression: risk period, long-term contextual threat, and diagnostic specificity. J Nerv Ment Dis 186:661–669

    Article  PubMed  CAS  Google Scholar 

  30. Kessler RC, Neighbors HW (1986) A new perspective on the relationships among race, social class, and psychological distress. J Health Soc Behav 27:107–115

    Article  PubMed  CAS  Google Scholar 

  31. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS, National Comorbidity Survey R (2003) The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 289:3095–3105

    Article  PubMed  Google Scholar 

  32. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62:617–627

    Article  PubMed  Google Scholar 

  33. Kraemer HC, Wilson GT, Fairburn CG, Agras WS (2002) Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry 59:877–883

    Article  PubMed  Google Scholar 

  34. Kraemer HC, Frank E, Kupfer DJ (2006) Moderators of treatment outcomes: clinical, research, and policy importance. JAMA 296:1286–1289

    Article  PubMed  CAS  Google Scholar 

  35. Lenze EJ (2003) Comorbidity of depression and anxiety in the elderly. Curr Psychiatry Rep 5:62–67

    Article  PubMed  Google Scholar 

  36. Lenze EJ, Mulsant BH, Shear MK, Schulberg HC, Dew MA, Begley AE, Pollock BG, Reynolds CF 3rd (2000) Comorbid anxiety disorders in depressed elderly patients. Am J Psychiatry 157:722–728

    Article  PubMed  CAS  Google Scholar 

  37. Link BG, Phelan JC (1995) Social conditions as fundamental causes of disease. J Health Soc Behav 35:80–94

    Article  Google Scholar 

  38. Lorant V, Deliege D, Eaton W, Robert A, Philippot P, Ansseau M (2003) Socioeconomic inequalities in depression: a meta-analysis. Am J Epidemiol 157:98–112

    Article  PubMed  CAS  Google Scholar 

  39. Lorant V, Croux C, Weich S, Deliege D, Mackenbach J, Ansseau M (2007) Depression and socio-economic risk factors: 7-year longitudinal population study. Br J Psychiatry 190:293–298

    Article  PubMed  Google Scholar 

  40. Marmot MG, Kogevinas M, Elston MA (1987) Social/economic status and disease. Annu Rev Public Health 8:111–135

    Article  PubMed  CAS  Google Scholar 

  41. Miranda J, Chung JY, Green BL, Krupnick J, Siddique J, Revicki DA, Belin T (2003) Treating depression in predominantly low-income young minority women. JAMA 290:57–65

    Article  PubMed  Google Scholar 

  42. Monroe SM, Simons AD (1991) Diathesis-stress theories in the context of life stress research: Implications for the depressive disorders. Psychol Bull 110:406–425

    Article  PubMed  CAS  Google Scholar 

  43. Mulder RT, Joyce PR, Frampton CM, Luty SE, Sullivan PF (2006) Six months of treatment for depression: outcome and predictors of the course of illness. Am J Psychiatry 163:95–100

    Article  PubMed  Google Scholar 

  44. Muntaner C, Eaton WW, Diala C, Kessler RC, Sorlie PD (1998) Social class, assets, organizational control and the prevalence of common groups of psychiatric disorders. Soc Sci Med 47:2043–2053

    Article  PubMed  CAS  Google Scholar 

  45. Reynolds CF 3rd, Frank E, Perel JM, Imber SD, Cornes C, Miller MD, Mazumdar S, Houck PR, Dew MA, Stack JA, Pollock BG, Kupfer DJ (1999) Nortriptyline and interpersonal psychotherapy as maintenance therapies for recurrent major depression: A randomized controlled trial in patients older than 59 years. JAMA 281:39–45

    Article  PubMed  CAS  Google Scholar 

  46. Reynolds CF 3rd, Dew MA, Pollock BG, Mulsant BH, Frank E, Miller MD, Houck PR, Mazumdar S, Butters MA, Stack JA, Schlernitzauer MA, Whyte EM, Gildengers A, Karp J, Lenze E, Szanto K, Bensasi S, Kupfer DJ (2006) Maintenance treatment of major depression in old age. N Engl J Med 354:1130–1138

    Article  PubMed  CAS  Google Scholar 

  47. Rickels K, Jenkins BW, Zamostien B, Raab E, Kanther M (1968) Pharmacotherapy in neurotic depression: Differential population responses. J Nerv Ment Dis 145:475–485

    Google Scholar 

  48. Roberts RE, Lee ES (1993) Occupation and the prevalence of major depression, alcohol, and drug abuse in the United States. Environ Res 61:266–278

    Article  PubMed  CAS  Google Scholar 

  49. Ross LE, Campbell VLS, Dennis C-L, Blackmore ER (2006) Demographic Characteristics of Participants in Studies of Risk Factors, Prevention, and Treatment of Postpartum Depression. Can J Psychiatry 51:704–710

    PubMed  Google Scholar 

  50. Schieman S, Plickert G (2007) Functional limitations and changes in levels of depression among older adults: a multiple-hierarchy stratification perspective. J Gerontol B Psychol Sci Soc Sci 62:S36–S42

    PubMed  Google Scholar 

  51. Spillmann M, Borus JS, Davidson KG, Worthington JJ 3rd, Tedlow JR, Fava M (1997) Sociodemographic predictors of response to antidepressant treatment. Int J Psychiatry Med 27:129–136

    PubMed  CAS  Google Scholar 

  52. Steffens DC, McQuoid DR (2005) Impact of symptoms of generalized anxiety disorder on the course of late-life depression. Am J Geriatr Psychiatry 13:40–47

    PubMed  Google Scholar 

  53. Summerfelt WT, Meltzer HY (1998) Efficacy vs. effectiveness in psychiatric research. Psychiatr Serv 49:834–835

    PubMed  CAS  Google Scholar 

  54. Trivedi MH, Rush AJ, Wisniewski SR, Nierenberg AA, Warden D, Ritz L, Norquist G, Howland RH, Lebowitz B, McGrath PJ, Shores-Wilson K, Biggs MM, Balasubramani GK, Fava M, STAR*D Study Team (2006) Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: Implications for clinical practice. Am J Psychiatry 163:28–40

    Article  PubMed  Google Scholar 

  55. U.S. Census Bureau (2004) State and County QuickFacts: Allegheny County, Pennsylvania

    Google Scholar 

  56. Whyte EM, Dew MA, Gildengers A, Lenze EJ, Bharucha A, Mulsant BH, Reynolds CF (2004) Time course of response to antidepressants in late-life major depression: therapeutic implications. Drugs Aging 21:531–554

    Article  PubMed  CAS  Google Scholar 

  57. Wilson KC, Chen R, Taylor S, McCracken CF, Copeland JR (1999) Socio-economic deprivation and the prevalence and prediction of depression in older community residents. The MRC-ALPHA Study. Br J Psychiatry 175:549–553

    Article  PubMed  CAS  Google Scholar 

  58. Zeger SL, Liang KY (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42:121–130

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported in part by grants P30 MH71944, RO1 MH43832, RO1 MH37869, R25 MH60473, P60 MD000207-03, and R03 MH083335 from the National Institute of Mental Health. Conflict of interest statement Dr. Reynolds receives research support (in the form of drug supplies only) from GlaxoSmithKline, Forest Pharmaceuticals, Pfizer, Eli Lilly & Co., and Bristol-Meyers Squibb for his NIH sponsored activities. The other authors do not have interests that might be affected by the publication of this paper.

Author information

Authors and Affiliations

  1. Dept. of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK

    Alex Cohen PhD

  2. Dept. of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA

    Stephen E. Gilman ScD

  3. Dept. of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    Stephen E. Gilman ScD

  4. Intervention Research Center for the Study of Late-Life Mood Disorders, Thomas Detre Hall of the Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, PA, USA

    Patricia R. Houck MSH, Katalin Szanto MD & Charles F. Reynolds III MD

Authors
  1. Alex Cohen PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen E. Gilman ScD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Patricia R. Houck MSH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Katalin Szanto MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Charles F. Reynolds III MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alex Cohen PhD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cohen, A., Gilman, S.E., Houck, P.R. et al. Socioeconomic status and anxiety as predictors of antidepressant treatment response and suicidal ideation in older adults. Soc Psychiat Epidemiol 44, 272–277 (2009). https://doi.org/10.1007/s00127-008-0436-8

Download citation

  • Received:

  • Revised:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-008-0436-8

Keywords

Search

Navigation