People who are unemployed, or do not have secure housing, have worse depression symptoms compared to their more socially advantaged peers
Addressing employment and housing needs – along with treatment to depression – can be helpful in supporting the mental health of people who are socioeconomically disadvantaged.
Combining the evidence of nine studies, including 4,864 participants who had been treated for depression, where data was available on socioeconomic factors such as jobs and housing, researchers found that unemployed patients had worse depression outcomes.
After three to four months of treatment, unemployed patients had 28% worse depression symptoms than those who were employed. Homeowners’ depression symptoms were 18% better than for people who were homeless or living in hostels or with family and friends.
Talking therapy or antidepressants were less effective for unemployed people with depression
A study led by UCL researchers, published in JAMA Psychiatry, found that people who were unemployed, or had less secure housing, had worse outcomes even when compared to people who had similar severity or number of symptoms of depression when they began their treatment.
Following the initial few months of treatment amongst employed and unemployed patients, the researchers noticed that the gaps between groups widened greatly, as after nine to 12 months, unemployed patients had 37% worse symptoms than employed patients.
Adjusting for other factors known to influence treatment outcomes such as: mental illness characteristics, in addition to age, gender, marital status, physical health conditions, and social support, they also reviewed whether financial strain or educational attainment were associated with treatment efficacy.
Financial strain and educational attainment did not carry a significant effect for the study, nor did those factors explain the links with employment and housing status.
While the treatments for depression varied between the studies – including a few common antidepressants, cognitive behavioural therapy (CBT), computerised CBT, structured physical activity, collaborative care and other options – the results were consistently worse for those people without jobs or secure housing.
Social disadvantage can worsen people’s mental health
Lead author Dr Joshua Buckman (UCL Psychology & Language Sciences and Camden & Islington NHS Foundation Trust) said: “We found that people who are unemployed or live in less secure housing have a poorer outcome when treated for depression. Additional support to access employment or housing could also lead to improvement in mental health.
“From our findings, we cannot confirm whether helping to improve people’s work and housing situations would improve their mental health directly, or if it would set them up to be more able to engage in treatment. For example, it might make it easier to turn up to all of their appointments if they can stay in the same accommodation regularly without having to move out of the area.
“We hope that further research will shed more light on how best to support the mental health needs of people experiencing social disadvantage.”
Senior co-author Professor Stephen Pilling (UCL Psychology & Language Sciences) said: “Clinicians can easily ask their patients about housing status and employment, and our findings suggest that this should then inform their treatment plans.
“If possible, a referral for support in finding secure housing or employment may be beneficial, or else by knowing that such patients are less likely to get better, clinicians might consider a more intensive treatment or additionally prioritise a follow-up appointment soon after starting treatment to see if it is having the desired effect.”
Co-author Professor Glyn Lewis (UCL Psychiatry and Camden & Islington NHS Foundation Trust) said: “Social disadvantage can increase people’s risk of mental ill health, so it is particularly concerning that on top of that higher underlying risk, people without jobs or secure housing are also less likely to recover from depression.”
