Abstract
Objective
Depressed patients rate social support as important for prognosis, but evidence for a prognostic effect is lacking. We aimed to test the association between social support and prognosis independent of treatment type, and the severity of depression, and other clinical features indicating a more severe illness.
Methods
Individual patient data were collated from all six eligible RCTs (n = 2858) of adults seeking treatment for depression in primary care. Participants were randomized to any treatment and completed the same baseline assessment of social support and clinical severity factors. Two‐stage random effects meta‐analyses were conducted.
Results
Social support was associated with prognosis independent of randomized treatment but effects were smaller when adjusting for depressive symptoms and durations of depression and anxiety, history of antidepressant treatment, and comorbid panic disorder: percentage decrease in depressive symptoms at 3–4 months per z‐score increase in social support = −4.14(95%CI: −6.91 to −1.29). Those with a severe lack of social support had considerably worse prognoses than those with no lack of social support: increase in depressive symptoms at 3–4 months = 14.64%(4.25% to 26.06%).
Conclusions
Overall, large differences in social support pre‐treatment were associated with differences in prognostic outcomes. Adding the Social Support scale to clinical assessments may be informative, but after adjusting for routinely assessed clinical prognostic factors the differences in prognosis are unlikely to be of a clinically important magnitude. Future studies might investigate more intensive treatments and more regular clinical reviews to mitigate risks of poor prognosis for those reporting a severe lack of social support.
Depressed patients rate social support as important for prognosis, but evidence for a prognostic effect is lacking. We aimed to test the association between social support and prognosis independent of treatment type, and the severity of depression, and other clinical features indicating a more severe illness.
Methods
Individual patient data were collated from all six eligible RCTs (n = 2858) of adults seeking treatment for depression in primary care. Participants were randomized to any treatment and completed the same baseline assessment of social support and clinical severity factors. Two‐stage random effects meta‐analyses were conducted.
Results
Social support was associated with prognosis independent of randomized treatment but effects were smaller when adjusting for depressive symptoms and durations of depression and anxiety, history of antidepressant treatment, and comorbid panic disorder: percentage decrease in depressive symptoms at 3–4 months per z‐score increase in social support = −4.14(95%CI: −6.91 to −1.29). Those with a severe lack of social support had considerably worse prognoses than those with no lack of social support: increase in depressive symptoms at 3–4 months = 14.64%(4.25% to 26.06%).
Conclusions
Overall, large differences in social support pre‐treatment were associated with differences in prognostic outcomes. Adding the Social Support scale to clinical assessments may be informative, but after adjusting for routinely assessed clinical prognostic factors the differences in prognosis are unlikely to be of a clinically important magnitude. Future studies might investigate more intensive treatments and more regular clinical reviews to mitigate risks of poor prognosis for those reporting a severe lack of social support.
| Original language | English |
|---|---|
| Pages (from-to) | 392-405 |
| Number of pages | 14 |
| Journal | Acta Psychiatrica Scandinavica |
| Volume | 143 |
| Issue number | 5 |
| Early online date | 6 Feb 2021 |
| DOIs | |
| Publication status | Published - May 2021 |
Bibliographical note
Funding Information:The authors would like to thank Professor Robert J DeRubeis for his contribution to gaining funding for the wider project that this study is a part of, and helping write the general protocol which this study was based upon. The studies that make up the Dep‐GP IPD database and are included here were funded by 1. COBALT: This research was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (project number 06/404/02). 2. GENPOD: Medical Research Council and supported by the Mental Health Research Network. 3. IPCRESS: BUPA Foundation. 4. MIR: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project 11/129/76) and supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. 5. PANDA: NIHR Programme Grant for Applied Research (RP‐PG‐0610‐10048). 6. TREAD: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme.
Funding Information:
This work was supported by the Wellcome Trust through a Clinical Research Fellowship to JB (201292/Z/16/Z), Medical Research Council (for IRW: MC_UU_12023/21), MQ Foundation (for ZC: MQDS16/72), the Higher Education Funding Council for England, the National Institute of Health Research (NIHR), NIHR University College London Hospitals Biomedical Research Centre (RS, CO?D, and SP), University College London (NC, GA, and GL), Vanderbilt University (SDH), University of Southampton (TK), University of Exeter (EW), and University of York (SG). NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (NW: The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care). Alzheimer's Society (grant code: 457 (AS-PG-18-013) for JS). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. The authors would like to thank Professor Robert J DeRubeis for his contribution to gaining funding for the wider project that this study is a part of, and helping write the general protocol which this study was based upon. The studies that make up the Dep-GP IPD database and are included here were funded by 1. COBALT: This research was funded by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme (project number 06/404/02). 2. GENPOD: Medical Research Council and supported by the Mental Health Research Network. 3. IPCRESS: BUPA Foundation. 4. MIR: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme (project 11/129/76) and supported by the NIHR Biomedical Research Centre at University Hospitals Bristol NHS Foundation Trust and the University of Bristol. 5. PANDA: NIHR Programme Grant for Applied Research (RP-PG-0610-10048). 6. TREAD: National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme.
Funding Information:
This work was supported by the Wellcome Trust through a Clinical Research Fellowship to JB (201292/Z/16/Z), Medical Research Council (for IRW: MC_UU_12023/21), MQ Foundation (for ZC: MQDS16/72), the Higher Education Funding Council for England, the National Institute of Health Research (NIHR), NIHR University College London Hospitals Biomedical Research Centre (RS, CO’D, and SP), University College London (NC, GA, and GL), Vanderbilt University (SDH), University of Southampton (TK), University of Exeter (EW), and University of York (SG). NIHR Biomedical Research Centre at the University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol (NW: The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care). Alzheimer's Society (grant code: 457 (AS‐PG‐18‐013) for JS). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Publisher Copyright:
© 2021 The Authors. Acta Psychiatrica Scandinavica published by John Wiley & Sons Ltd.
Keywords
- depression
- social support
- prognosis
- treatment outcome
- individual patient data meta‐analysis