Abstract
ObjectiveDepressed 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.MethodsIndividual 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.ResultsSocial 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%).ConclusionsOverall, 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.
Highlights
The majority of adults treated for depression will not remit with the first treatment they receive.[1,2] There is a lack of evidence to guide clinicians on what information can be gathered pre-treatment to better inform prognosis for depressed patients.[3,4] Such knowledge can aid the future clinical management of the patient's condition, and many clinicians and patients want to know what the patient's prognosis is.[5]Studies asking patients about the things they consider to be important to their short-term and longer-term prognoses have highlighted social support as a key factor.[6]
The present study found an association between social support and prognosis independent of a range of treatments offered to adults seeking treatment for depression in primary care
In the five studies that used the Beck Depression Inventory (BDI-II) at 3–4 months, prior to adjusting for the severity factors the Beck Depression Inventory 2nd Edition (BDI-II) scores were approximately 5 points higher at 3–4 months for those with a severe lack of social support compared to no lack of social support
Summary
The majority of adults treated for depression will not remit with the first treatment they receive.[1,2] There is a lack of evidence to guide clinicians on what information can be gathered pre-treatment to better inform prognosis for depressed patients.[3,4] Such knowledge can aid the future clinical management of the patient's condition, and many clinicians and patients want to know what the patient's prognosis is.[5]Studies asking patients about the things they consider to be important to their short-term and longer-term prognoses have highlighted social support as a key factor.[6]. There are a number of proposed mechanisms by which better social support might help mitigate against depression, for example perceiving oneself as belonging to Summations
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