An international study has found that having a high status job means that you are less likely to respond to standard treatment with medications for depression. These results, which may have implications for clinicians and their patients, employers and public policy, are presented at the ECNP Congress in Vienna*.
Up to a third of patients who receive drug treat for depression do not respond to treatment. Knowing which groups don’t respond could help clinicians understand which treatments are appropriate to which person. In the case of workers, it may also enable employers to take steps to ease stressful conditions. Although there is a wealth of research showing that low social and economic status is associated with a greater risk of depression, there has been little work focusing on how occupational levels respond to treatment.
A group of international researchers from Belgium, Italy, Israel and Austria enlisted 654 working adults attending clinics for depression, and classified their work according to occupational level. 336 (51.4%) held high occupational level jobs, 161 (24.6%) middle-level, and 157 (24%) low level. Around two-thirds of the patients were female (65.6%), which reflects the normal gender difference in reported depression. Most patients were treated with SRIs (Serotonin Reuptake Inhibitors), although other pharmaceutical agents were also used, as well as psychotherapy. Those in the higher levels were found to have received fewer SRIs and more psychotherapy.
On analysing results after treatment, they found that 55.9% in the highest occupational group were resistant to treatment. In contrast, only 40.2% of the middle-level workers remained treatment resistant, and 44.3 of the low-level workers. This difference was also reflected in the degree of remission, with only around one in 6 in remission in the higher status group, as against around one in 4 for the other groups.
Commenting, Professor Siegfried Kasper (Vienna, Austria) said “Though these findings should be considered preliminarily, they indicate that high occupational levels may be a risk factor for poor response to treatment. A number of variables may explain these findings. For example, there may be specific working environment demands and stressors; people may find it difficult to accept or cope with illness, or to continue with medication; or there may be other factors, related for example to cognitive, personality and behavioural differences”.
Co-worker Professor Joseph Zohar (ECNP Past-President, Tel-Hashomer, Israel) said; “This shows that the need for precise prescribing is not only related to the symptoms and genetics but also to occupational level; one might need to prescribe different medication for the same disorder and need to take into account the occupational level in order to reach optimum effect”.
Professor Eduard Vieta (ECNP Executive Committee member and Chair of the Department of Psychiatry and Psychology, Hospital Clinic, University of Barcelona), commented:
"The results of this study might sound counterintuitive, but people with highly demanding jobs are subject to a lot of stress, and when they breakdown with depression it may be particularly difficult to cope with their previous life. An alternative explanation, which cannot be ruled out given the naturalistic design of the study, is that high-status job patients may be more prone to request psychosocial treatments without the support of pharmacotherapy. The ideal treatment of depression is, in general, the combination of both pharmacotherapy and psychotherapy."
*A paper based on this work is published in European Neuropsychopharmacology, July 2016. http://dx.doi.org/10.1016/j.euroneuro.2016.05.002. See notes for details.
The research was funded by the Expert Platform on Mental Health focus on Depression (EPD).
ENDSNotes for editorsPlease mention the European College of Neuropsychopharmacology Congress in any stories which result from this press release.
The European College of Neuropsychopharmacology (ECNP)The ECNP is an independent scientific association dedicated to the science and treatment of disorders of the brain. It is the largest non-institutional supporter of applied and translational neuroscience research and education in Europe. Website: www.ecnp.eu
The annual ECNP Congress takes place from 17th to 20th September in Vienna. It is Europe’s premier scientific meeting for disease-oriented brain research, annually attracting between 4,000 and 6,000 neuroscientists, psychiatrists, neurologists and psychologists from around the world. Congress website: http://www.ecnp-congress.eu/This presentation contains material from the following peer-reviewed article in European Neuropsychopharmacology, August 2016, Volume 26, Issue 8, Pages 1320–1326)- available from press officer.
High occupational level is associated with poor response to treatment of depression, Laura Mandelli, Alessandro Serretti, Daniel Souery, Julien Mendlewicz, Siegfried Kasper, Stuart Montgomery, Joseph Zohar http://dx.doi.org/10.1016/j.euroneuro.2016.05.002
CONGRESS ABSTRACT: High occupational level is associated with poor response to treatment of depression (presented Tuesday 20th 12.15-13.45)L. Mandelli1 A. Serretti2 D. Souery3 J. Mendlewicz4 S. Kasper5 S. Montgomery6 J. Zohar71University of Bologna, Department of Biomedical and Neuromotor Sciences- Psychiatric Service, Bologna, Italy 2University of Bologna, Dep. of Biomedical and Neuromotor Sciences, Bologna, Italy 3Université Libre de Bruxelles and PsyPluriel, Laboratoire de Psychologie Médicale-, Brussels, Belgium 4Université Libre de Bruxelles, 3 Université Libre de Bruxelles, Brussels, Belgium 5Medical University of Vienna, Department of Psychiatry and Psychotherapy, Vienna, Austria 6University of London, Imperial College, London, United Kingdom 7Chaim Sheba Medical Center, Chaim Sheba Medical Center, Tel-Hashomer, IsraelBackground and Aims: Depression may be complicated by work-related stress in many cases and, in turn, depression is a leading cause of disability in workplaces. Though available effective treatments, only one third of patients reach full remission after a first treatment trial and nearly half of the patients are resistant to treatments. Socioeconomic status (SES) has been found to be a reliable predictor of health outcome, including response to antidepressant treatments. Occupational level (OL) is conceptually different from SES. OL refers to the stratification in which people are grouped into a set of hierarchical occupational categories, which differ for skills, responsibility, earnings, entry qualifications, prestige as well as psychosocial factors in the working environment. OL has also been associated to treatment outcome in major depression, but to date the consistency of this association is unclear. Since the relevant impact of depression in workplaces, the investigation on the potential relationship between OL and treatment outcome deserve further investigation. In the present study we tested a potential relationship between OL and response to treatment of depression and treatment resistant depression in a large multinational sample of depressed working patients.Methods: Major depressive patients (n = 654) who received at least one adequate treatment trial and stratified in three occupational levels (high, middle, low) were considered for the present study. For the purpose of the present study, we considered only patients aged 18 or more, and being employed at the moment of the evaluations. Being unemployed, without occupation, student, stockholder, invalid or infirm represented an exclusion criteria, together with diagnosis of Bipolar disorder or Schizophrenia spectrum disorder. Response to last treatment for current episode, based on clinical judgment and Hamilton depressive scores ≤17, and treatment resistant depression defined as non-response to 2 or more previous adequate treatment trials were considered the outcome variables. Socio-demographic and clinical variables such as age, gender, education and additional psychotherapy were controlled as potential confounders.Results: Depressed subjects in high-occupational level, though being younger, more educated and more likely treated with additional psychotherapy, showed a poorer response to last treatment and higher rates of treatment resistant depression, as compared to patients in middle- and low-occupational levels. Socio-demographic and treatment-related factors did not influence the results.Conclusions: Though present findings should be considered preliminarily, they indicate that high occupation may be a risk factor for poor treatment outcome. A number of mediating variables may explain these findings, from specific working environment demands and stressors, poor illness acceptance and drugs compliance, difficulty in adapting to lower functional levels and recognizing improvements, to underlying neurobiologically–based cognitive, personality and behavioral differences. More research is required to establish these findings and to understand the causal mediating variables. Policy, employers and clinicians overall should be more sensitive to mental health in workplaces and recognize the working environment as a risk factor as well as potential setting for mental health promotion.
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