Unemployment, Housing Instability Linked With Worse Depression Treatment Outcomes

Unemployment and unstable housing status are associated with worse prognosis outcomes for adults with depression, regardless of treatment type, after adjusting for clinical prognostic factors. Researchers published their findings in JAMA Psychiatry.

“Obtaining support for such problems may be as effective as more conventional treatments for depression, and addressing these needs may make it easier for patients to engage in and benefit from psychotherapy or pharmacotherapy for depression,” wrote lead and corresponding author Joshua E. J. Buckman, PhD, of University College London in England, and coauthors. “This may be particularly important at present given concerns of increased vulnerability owing to the effect of the COVID-19 pandemic on employment and housing.”

The systematic review and meta-analysis included nine randomized clinical trials spanning 4864 participants. Researchers were interested in whether certain socioeconomic factors—employment status, financial strain, housing status, and educational attainment—affected outcomes 3 to 4 months after adults started depression treatment in primary care. 

Depressive symptom scale scores were 28% higher for unemployed patients than for employed patients, the meta-analysis found, and 18% lower for patients who were homeowners than for patients who were living with family or friends, in hostels, or were homeless. The percentages were equivalent to 4.2 points for unemployment and 2.9 points for housing instability on the Beck Depression Inventory II.

Financial strain and educational attainment were also associated with prognosis independent of treatment, the study showed. But unlike employment and housing status, the associations diminished upon adjustment for clinical prognostic factors.

“Future studies may investigate the optimal order with which to offer support for employment or housing, as well as more intensive conventional treatment strategies, including longer follow-up, for the management of depression in adults that present with clinical indicators of poorer prognosis,” researchers wrote.

—Jolynn Tumolo


Buckman JEJ, Saunders R, Stott J, et al. Socioeconomic indicators of treatment prognosis for adults with depression: a systematic review and individual patient data meta-analysis. JAMA Psychiatry. 2022;79(5):406-416. doi: 10.1001/jamapsychiatry.2022.0100