NEW YORK (Reuters Health) - Elderly women, people with serious physical illness and less-educated individuals may be less likely than others to see their depression symptoms get better with treatment, new research shows.

The study of nearly 300 men and women with depression showed that these individuals--plus those with highly neurotic personalities--were less likely to respond to treatment with behavioral therapy or the antidepressant drug paroxetine (Paxil).

People with "neuroticism" tend to have more anxiety, lower self esteem and lower tolerance for stress than other individuals, and they may feel alienated, victimized and resentful.

Researchers led by Dr. Wayne Katon of the University of Washington School of Medicine in Seattle report the findings in the current issue of the journal General Hospital Psychiatry.

Patients in the 11-week study all had mild depression and were assigned to treatment with either medication, problem-solving therapy or an inactive placebo. At the end of the study, 52% had recovered based on standard tests of depression, according to the report.

But certain patients--women ages 60 and older, people in poorer physical health, those who scored high on neuroticism tests and those with no higher education--had lower rates of recovery.

For example, the researchers report, while 71% of women ages 18 to 59 recovered, only 37% of older women did.

Among participants with 12 years of education or less, the recovery rate was 41%, compared with 61% for those with some higher education. The researchers point out that education level may serve as a proxy for social and economic disadvantage, which often comes with chronic "stressors" like housing and money problems and poorer health habits like smoking and little exercise.

As for their findings on neurotic personalities, the researchers note that anxiety, low self-esteem, low tolerance for stress and other problems could hinder recovery from depression.

According to the researchers, these findings call attention to certain patients who may need specialized care for depression. For example, they write, those with significant physical illness may need both depression treatment and care aimed at improving physical functioning and reducing any pain they have.

And, Katon's team notes, "it is essential to develop and test active treatments for [depression] that will be more effective in less educated, medically ill populations since these patients represent a sizable minority of elderly primary care populations."

SOURCE: General Hospital Psychiatry 2002;24.

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