Adults diagnosed with major depressive disorder (MDD) who were unemployed, had less than a college education, or who were not White responded slower to treatment than their White, employed, or college-educated counterparts. The researchers that reached these conclusions published their findings in Psychiatric Services.

The researchers evaluated socioeconomic data from the 2011 Combining Medications to Enhance Depression Outcomes (CO-MED) study. The randomized controlled trial recruited 665 adults aged 18 to 75 years old. Participants received 1 of 3 antidepressant treatments for 12 weeks. While the initial CO-MED study evaluated the effectiveness of combination antidepressant therapy compared with monotherapy, the researchers of the current study looked at the socioeconomic data to see whether it affects treatment success.

The researchers chose this study because unlike other observational studies, where access to care varied among people with MDD, the CO-MED participants had equal, consistent access to care. They used patient data to examine the impacts of educational achievement, income, employment status, and race-ethnicity on treatment responses among patients with MDD.

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Not having a college education (β = 0.410 ± 0.205, CrI 50.009–0.811, P = 0.045), being unemployed (β = 0.4906 0.182, CrI 50.133–0.848, P = 0.007), and being non-White (β = 0.75360.193, CrI 50.374–1.131, P = 0.001) were all associated with slower and less improvement compared with the opposite characteristics. The characteristics associated with the worst improvement were being non-White (11.3%) and not having a college degree (9.6%).

The researchers’ findings show social determinants of health have a significant effect on treatment response and “these effects are independent of access to care, cost of medication, insurance coverage, and quality of care,” the researchers state. How much a patient’s depression symptoms improve is thought to be tied to the medication, but this study shows other factors play a role.

The researchers admit they could not examine all socioeconomic factors and they had a limited number of observations. Future clinical trials should measure these socioeconomic factors and incorporate them analytically,” they state. “Additionally, to optimize treatment outcomes for adults with depression, we must leverage socioeconomic variables as potential predictors of outcomes to inform treatment selection, monitoring, and delivery.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Mills JA, Suresh V, Chang L, et al. Socioeconomic predictors of treatment outcomes among adults with major depressive disorder. Psychiatr Serv. Published online March 31, 2022. doi:10.1176/

This article originally appeared on Psychiatry Advisor