High occupational level is associated with poor response to the treatment of depression: A replication study.

Major depressive disorder (MDD) is a leading cause of disability and inability to work. There is evidence that occupational factors may precipitate a MDD episode and interfere with the recovery process. In a previous investigation, we found that those employed in high occupational levels had a worse outcome after treatment for depression (Mandelli et al., 2016). The aim of the present study was to further investigate response to treatments for depression according to occupational status on an independent sample of MDD patients. Six hundred and forty-seven (647) subjects with a stable working occupation were taken from a larger independent sample of MDD patients evaluated for response and resistance to treatment for depression, after at least one adequate treatment trial. Three broad occupational categories were considered: 'manager', 'white-collar', 'blue-collar' and 'self-employed'. Managers had the highest rate of non-response and resistance to treatments. White-collar workers also had high non-response and resistance rates. At the opposite, Blue-collar workers had significantly lower rates of non-response and resistance. Self-employed were in between White- and Blue-collar workers and did not significantly differ from the other occupational categories. The findings of this replication study substantially support our previous observations. MDD patients employed in high-middle occupations may have a less favorable outcome after standard treatments of depression. Working stressful condition and other psychosocial factors at work should be investigated more closely in relation to treatment outcomes in MDD.