Social Class and Work Functioning in Treatment for Depression

Objective: This study examined work functioning across three treatments for depression in relation to social class. Methods: The study was based on data available from the National Institute of Mental Health Treatment of Depression Collaborative Research Program (1982 to 1986). Participants included 239 patients with major depressive disorder. Primary measures included the work functioning domain on the Social Adjustment Scale, the Hollingshead Two-Factor Index of Social Position, and family income. Analyses used hierarchical linear modeling to test the association of social class with work functioning over the course of treatment. Results: Social class was positively associated with improvement in work functioning across all three treatments for depression. Conclusions: These findings suggest that there may be limitations in the use of empirically supported treatments with depressed patients from a lower social class, because their improvement rates in work functioning were less than those of middle-class persons with depression, even though they were treated with the same modalities. (Psychiatric Services 61: 718-721, 2010)