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dc.contributor.authorBuckman, JEJ
dc.contributor.authorSaunders, R
dc.contributor.authorStott, J
dc.contributor.authorCohen, ZD
dc.contributor.authorArundell, L-L
dc.contributor.authorEley, TC
dc.contributor.authorHollon, SD
dc.contributor.authorKendrick, T
dc.contributor.authorAmbler, G
dc.contributor.authorWatkins, E
dc.contributor.authorGilbody, S
dc.contributor.authorKessler, D
dc.contributor.authorWiles, N
dc.contributor.authorRichards, D
dc.contributor.authorBrabyn, S
dc.contributor.authorLittlewood, E
dc.contributor.authorDeRubeis, RJ
dc.contributor.authorLewis, G
dc.contributor.authorPilling, S
dc.date.accessioned2022-07-27T09:27:58Z
dc.date.issued2022-03-09
dc.date.updated2022-07-27T08:24:28Z
dc.description.abstractImportance: Socioeconomic factors are associated with the prevalence of depression, but their associations with prognosis are unknown. Understanding this association would aid in the clinical management of depression. Objective: To determine whether employment status, financial strain, housing status, and educational attainment inform prognosis for adults treated for depression in primary care, independent of treatment and after accounting for clinical prognostic factors. Data Sources: The Embase, International Pharmaceutical Abstracts, MEDLINE, PsycINFO, and Cochrane (CENTRAL) databases were searched from database inception to October 8, 2021. Study Selection: Inclusion criteria were as follows: randomized clinical trials that used the Revised Clinical Interview Schedule (CIS-R; the most common comprehensive screening and diagnostic measure of depressive and anxiety symptoms in primary care randomized clinical trials), measured socioeconomic factors at baseline, and sampled patients with unipolar depression who sought treatment for depression from general physicians/practitioners or who scored 12 or more points on the CIS-R. Exclusion criteria included patients with depression secondary to a personality or psychotic disorder or neurologic condition, studies of bipolar or psychotic depression, studies that included children or adolescents, and feasibility studies. Studies were independently assessed against inclusion and exclusion criteria by 2 reviewers. Data Extraction and Synthesis: Data were extracted and cleaned by data managers for each included study, further cleaned by multiple reviewers, and cross-checked by study chief investigators. Risk of bias and quality were assessed using the Quality in Prognosis Studies (QUIPS) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tools, respectively. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses-Individual Participant Data (PRISMA-IPD) reporting guidelines. Main Outcomes and Measures: Depressive symptoms at 3 to 4 months after baseline. Results: This systematic review and individual patient data meta-analysis identified 9 eligible studies that provided individual patient data for 4864 patients (mean [SD] age, 42.5 (14.0) years; 3279 women [67.4%]). The 2-stage random-effects meta-analysis end point depressive symptom scale scores were 28% (95% CI, 20%-36%) higher for unemployed patients than for employed patients and 18% (95% CI, 6%-30%) lower for patients who were homeowners than for patients living with family or friends, in hostels, or homeless, which were equivalent to 4.2 points (95% CI, 3.6-6.2 points) and 2.9 points (95% CI, 1.1-4.9 points) on the Beck Depression Inventory II, respectively. Financial strain and educational attainment were associated with prognosis independent of treatment, but unlike employment and housing status, there was little evidence of associations after adjusting for clinical prognostic factors. Conclusions and Relevance: Results of this systematic review and meta-analysis revealed that unemployment was associated with a poor prognosis whereas home ownership was associated with improved prognosis. These differences were clinically important and independent of the type of treatment received. Interventions that address employment or housing difficulties could improve outcomes for patients with depression.en_GB
dc.description.sponsorshipWellcome Trusten_GB
dc.description.sponsorshipMQ Foundationen_GB
dc.description.sponsorshipRoyal College of Psychiatristsen_GB
dc.description.sponsorshipNational Institute for Health Research (NIHR)en_GB
dc.description.sponsorshipUniversity College Londonen_GB
dc.description.sponsorshipVanderbilt Universityen_GB
dc.description.sponsorshipUniversity of Southamptonen_GB
dc.description.sponsorshipUniversity of Exeteren_GB
dc.description.sponsorshipUniversity of Yorken_GB
dc.description.sponsorshipAlzheimer’s Societyen_GB
dc.description.sponsorshipMaudsley NHS Foundation Trusten_GB
dc.description.sponsorshipKing’s College Londonen_GB
dc.format.extent406-416
dc.format.mediumPrint
dc.identifier.citationVol. 79(5), pp. 406-416en_GB
dc.identifier.doihttps://doi.org/10.1001/jamapsychiatry.2022.0100
dc.identifier.grantnumber201292/Z/16/Zen_GB
dc.identifier.grantnumberMQDS16/72en_GB
dc.identifier.grantnumberAS-PG-18-013en_GB
dc.identifier.urihttp://hdl.handle.net/10871/130410
dc.identifierORCID: 0000-0002-8821-5027 (Richards, David)
dc.identifierResearcherID: B-4807-2009 (Richards, David)
dc.language.isoenen_GB
dc.publisherAmerican Medical Association (AMA)en_GB
dc.relation.urlhttps://www.ncbi.nlm.nih.gov/pubmed/35262620en_GB
dc.rights© 2022 Buckman JEJ et al. This is an open access article distributed under the terms of the CC-BY License.en_GB
dc.subjectAdolescenten_GB
dc.subjectAdulten_GB
dc.subjectAnxietyen_GB
dc.subjectChilden_GB
dc.subjectDepressionen_GB
dc.subjectDepressive Disorder, Majoren_GB
dc.subjectFemaleen_GB
dc.subjectHumansen_GB
dc.subjectMaleen_GB
dc.subjectPrognosisen_GB
dc.subjectSocioeconomic Factorsen_GB
dc.titleSocioeconomic Indicators of Treatment Prognosis for Adults With Depression: A Systematic Review and Individual Patient Data Meta-analysisen_GB
dc.typeArticleen_GB
dc.date.available2022-07-27T09:27:58Z
dc.identifier.issn2168-622X
exeter.place-of-publicationUnited States
dc.descriptionThis is the final version. Available on open access from the American Medical Association via the DOI in this recorden_GB
dc.identifier.eissn2168-6238
dc.identifier.journalJAMA Psychiatryen_GB
dc.relation.ispartofJAMA Psychiatry, 79(5)
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/en_GB
dcterms.dateAccepted2022-01-08
dc.rights.licenseCC BY
rioxxterms.versionVoRen_GB
rioxxterms.licenseref.startdate2022-03-09
rioxxterms.typeJournal Article/Reviewen_GB
refterms.dateFCD2022-07-27T09:20:42Z
refterms.versionFCDVoR
refterms.dateFOA2022-07-27T09:27:59Z
refterms.panelAen_GB


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© 2022 Buckman JEJ et al. This is an open access article distributed under the terms of the CC-BY License.
Except where otherwise noted, this item's licence is described as © 2022 Buckman JEJ et al. This is an open access article distributed under the terms of the CC-BY License.