Poor health, poverty and minority status are major factors in depression

Preliminary results from the STAR-D project, one of the nation’s largest studies of depression, show that chronic depressive episodes are common and are associated with poorer physical health, lower quality of life, socioeconomic disadvantage and minority status.

Findings of this study highlight the common occurrence of chronic episodes of major depression and the range of factors that contribute to them in both psychiatric and primary care settings.

The analysis, which was published in the December issue of the journal Acta Psychiatric Scandinavica, identified baseline socioeconomic and clinical features associated with chronic depression in the first 1,500 participants enrolled in the STAR-D (Sequenced Treatment Alternatives to Relieve Depression), a large, multicenter outpatient study that will determine the most effective treatments for major depressive disorder.

Lead author on this preliminary report was William S. Gilmer, M.D., associate professor of psychiatry and behavioral sciences, medical director of the Asher Center for the Study and Treatment of Depressive Disorders and director of the Behavioral Pharmacology Program at Northwestern University Feinberg School of Medicine.

Gilmer and colleagues found that 21 percent of the study participants were experiencing chronic major depressive episodes on enrollment in the study.

Chronic episodes were associated with older age, less education, lower income, no private insurance, unemployment, larger number of general medical illnesses, lower physical quality of life, concurrent generalized anxiety disorder, fewer prior episodes of major depression and history of suicide attempts.

African Americans, Hispanics and patients receiving care in primary as opposed to psychiatric care settings experienced more chronicity.

“Clearly, the association of chronic depressions with co-occurring medical illnesses and treatment in primary care settings warrants further exploration,” Gilmer said.

Major depressive disorder is a common, usually recurrent and often chronic disorder that causes substantial disability and cost over $40 billion annually.

Although many treatments for depression have been shown to be effective, their actual acceptability, clinical benefit and burden of side effects seen in representative clinical settings are not well known.

Researchers from the Feinberg School; the University of Texas Southwestern Medical Center (the National Coordinating Center for the project); the University of Pittsburgh; the University of Kansas School of Medicine; and Massachusetts General Hospital collaborated with Gilmer on this analysis from the STAR-D study.

STAR-D is a seven-year project funded by the National Institute of Mental Health (N01MH90003). Fourteen universities participated as regional centers in the study and enrolled a total of 4,041 patients.

William T. McKinney, M.D., director of the Asher Center, co-directs with Gilmer the STAR-D regional center in Illinois. McKinney is the Norman and Helen Asher Professor of Psychiatry and Behavioral Sciences at the Feinberg School.