Associations between socioeconomic status and psychological therapy outcomes: A systematic review and meta-analysis

Background: Socioeconomic deprivation is associated with higher prevalence of mental health problems; however, the influence of socioeconomic status (SES) on psychological therapy outcomes is as yet unclear. Aim: To review published evidence on the association between indicators of SES (income, education, employment, neighbourhood deprivation, social position) and the outcomes of psychological interventions for depression and anxiety. Methods: Systematic review and meta-analysis of outcomes research studies published in the last 10 years. Results: Seventeen studies including 165,574 patients measured at least one indicator of SES and its relationship with psychological therapy outcomes. Twelve of these studies found significant relationships between SES measures and mental health outcomes. Six studies focusing on employment status offered sufficient quantitative information to conduct meta-analysis. The overall effect of employment was not significant (-0.66, C.I. -1.33, 0.02). A sensitivity analysis (k=5) showed a small effect (-0.22, C.I. -0.36, -0.09) of employment on treatment outcomes. Conclusions: There is some evidence to indicate that socioeconomic deprivation is associated with poorer treatment outcomes, although limitations of the available data warrant treating this as a preliminary conclusion.