Support and undermining in interpersonal relationships are associated with symptom improvement in a trial of antidepressant medication

Abstract

The purpose of this study was to investigate the relationships of chronic stress, social undermining, and social support with symptom reduction and remission in depressed patients treated with antidepressant medication (citalopram), and to determine whether these relationships were moderated by ethnicity. A sample of 301 treatment-seeking adult patients with non-psychotic depression, including 169 African American and 132 Caucasian men and women, were enrolled in an eight week, dose-escalation clinical trial. Intent-to-treat analyses indicated that, consistent with expectations, more baseline social support was associated with greater symptom reduction and higher likelihood of remission, especially at higher levels of social undermining. Additionally, increases in social support from baseline to last visit were associated with more symptom reduction and higher likelihood of remission. However, contrary to expectations, higher levels of baseline social undermining were associated with more symptom reduction in Caucasians, but not in African Americans. Results supported the treatment-enhancing effect of available social support at the beginning of treatment and over the course of treatment. Efforts to enhance social support for patients on antidepressants should be considered as part of comprehensive treatment.

Trial registration: ClinicalTrials.gov NCT00047671.

Figures

Figure 1

Adjusted mean pre-post HRSD change as a function of ethnicity and levels of social undermining (groups determined by tertile split). ** = p

Figure 2

Adjusted mean pre-post HRSD change as a function of levels of social undermining and social support (groups determined by tertile split). ** = p

Figure 3

Percent remitting as a function of social undermining and social support (groups determined by tertile split). ** = p