Individual and neighborhood characteristics as predictors of depression symptom response

OBJECTIVE: Assess whether neighborhood characteristics predict patient-reported outcomes for depression. DATA SOURCES: VA electronic medical record data and U.S. census data. STUDY DESIGN: Retrospective longitudinal cohort. DATA EXTRACTION METHODS: Neighborhood and individual characteristics of patients (N = 4,269) with a unipolar depressive disorder diagnosis and an initial Patient Health Questionnaire (PHQ-9) score ≥10 were used to predict 50 percent improvement in 4-8-month PHQ-9 scores. PRINCIPAL FINDINGS: The proportion of a patient's neighborhood living in poverty (OR = 0.98; 95% CI: 0.97-.1.00; P = 0.03) was associated with lower likelihood of depression symptom improvement in addition to whether the patient was black (OR = 0.76; 95% CI:0.61-0.96; P = 0.02) had PTSD (OR = 0.59; 95% CI:0.50-0.69; P < 0.001) or had any service-connected disability (OR = 0.73; 95% CI:0.61-0.87; P < 0.001). CONCLUSIONS: Neighborhood poverty should be considered along with patient characteristics when determining likelihood of depression improvement.