According to a study published in European Neuropsychopharmacology, individuals who work at a higher occupational level may respond less favorably to treatment for depression.

The authors of the study explain that depression is a leading cause of disability in the workplace, and that work-related stresses may complicate symptoms of depression. Previous research has found that occupational level is a reliable predictor of health outcomes in the general population, and that low social and economic status are associated with greater risk for depression. But the effectiveness of depression treatment for different occupational levels has not been as well studied.

In this study, the authors used a large multinational sample to test the potential association between occupational level and response outcomes of depression treatment regimens.

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Laura Mandelli, PhD, of the University of Bologna, and colleagues studied 654 patients diagnosed with major depressive disorder (MDD) and stratified them in 3 occupational levels: high, middle and low. The researchers looked at the patients’ response to the last treatment for their current episode of depression and noted instances of treatment resistance. Treatment resistance was defined as a lack of response to 2 or more previous adequate-treatment trials. Treatment consisted of pharmacology — selective serotonin reuptake inhibitors (SSRIs) for most of the patients, but also other pharmaceuticals — and/or psychotherapy.

Results showed that patients with depression who had a high occupational level were significantly poorer responders to their last treatment, had lower remission rates and had higher rates of treatment resistance than participants in the other 2 occupational level groups.

The authors adjusted for any potential confounding factors. However, it was noted that treatment for the patients in the higher occupational level group was less likely to include an SSRI. The researchers also noted that the patients in the higher occupational level group had higher educational levels, and speculated that such patients may be more prone to request nondrug treatment. Generally, effective treatment for depression includes a combination of pharmacology and psychotherapy.


Mandelli L, Serretti A, Souery D, et al. High Occupational Level Is Associated with Poor Response to Treatment of Depression. Eur Neuropsychopharmacol. 2016 August;26(8):1320-6.

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