Depression may be harder to treat in people with high-status jobs than it is in people whose positions are on lower levels of the corporate ladder, a new study suggests.
Researchers studied how 650 people in Belgium, Italy, Israel and Austria responded to treatments for depression. About half (56 percent) of the 336 patients with high-status jobs didn’t experience fewer depressive symptoms after undergoing two rounds of different antidepressants and psychotherapy. About 40 percent of people with mid- to low-level jobs showed a poor response to the treatment, according to research presented last month at the European College of Neuropsychopharmacology Congress in Vienna.
Previous research and clinical trials have found that about one-third of people with depression generally don’t respond to their first antidepressant treatment. Some see their symptoms improve after a second round with a different type of antidepressant, but a considerable number of patients remain treatment-resistant.
The finding that high-status occupations are linked with a poorer chance of recovery is somewhat surprising. Most studies have looked at the prevalence of depression in different social classes, consistently finding that depression is more common among people with lower socioeconomic status. The new study suggests that even if people in occupations with higher status and wages are less likely to develop depression, they may be harder to treat when they do.
“A number of variables may explain these findings,” co-author Siegfried Kasper, a psychiatrist at the Medical University of Vienna, said in a press statement. “There may be specific working environment demands and stressors; people may find it difficult to accept or cope with illness, or to continue with medication; or there may be other factors, related for example to cognitive, personality and behavioral differences.”
Carol Landau, a clinical professor of psychiatry and medicine at Brown University who wasn’t involved in the study, said she agrees that the stress of being a high executive could potentially explain the findings.
“When you have a high-status job, you are probably more exposed to a lot more stress and responsibility,” she told The Huffington Post. “Although it seems to me that if you are a woman taking care of her children alone that may involve even more stress.”
Sleep deprivation and personality traits may affect how people respond to treatment, Landau added.
“A lot of folks who are in high-status jobs are extremely perfectionistic,” she said. “Medication will help a lot of things ― your appetite, sleep, concentration, and rumination to a certain extent ― but it’s not going to affect being self-critical.”
A perfectionistic executive may base his or her self-worth on how well business goals are met, meaning professional failures could take a personal toll.
“They’d get into self-criticism. They don’t say that ‘maybe I didn’t make that data point on dividend, but I’m still a good person overall,’” Landau said. “They are so focused on the perfectionism that they sort of lose the forest for the trees, and so they might respond poorly to any sense of failure.”
Sleep is another factor that often gets overlooked in research but could influence how well people respond to treatment, Landau said. One recent study in the Journal of Clinical Psychiatry found that people who slept for two or more hours a night compared to their peers were twice as likely to respond to antidepressants.
“I’m willing to guess executives get less sleep than other people,” Landau said.
More research is needed to understand what factors truly drive the professional gap recovery. But for now, these findings suggest that clinicians may need to take into account the occupational level of their patients, the researchers said.