Ever seen this commercial?
Dr. Lydia Falconnier took a look at data collected by the National Institute of Mental Health that tracked 239 patients suffering from depression over four years. She wanted to see if a patient’s social class had any effect on the outcome of their treatment.
What she found was pretty surprising. Not only does social class affect how well you respond to treatment, but it actually does more to explain why that is than how depressed you were when you started or how well you functioned before depression.
Why? Falconnier has a few ideas.
First, there are three major kinds of treatment for depression that have been proven to work through clinical trials: medication, cognitive behavioral therapy and interpersonal relationship therapy.
Falconnier doesn’t know why medication doesn’t work as well on working-class people. But cognitive behavioral therapy, a kind of therapy where a counselor works with a patient to identify distorted thoughts about themselves or the world and helps them correct it, has a pretty serious flaw.
“If you’re extremely poor, or if you’re part of a group that is routinely discriminated against, some of your thoughts may be negative, but they may also be real,” says Falconnier.
In addition, because most therapists tend to be middle-class and white, the counselor themselves may not understand the unique worldview that a person from a lower social class has.
Interpersonal therapy seeks to help people deal with difficult relationships in their life–like a bad marriage or grieving the loss of a loved one. But for people of lower social classes, talking through a difficult circumstance might help, but it doesn’t actually relieve the difficult circumstances that often bring stress and tension to their relationships.
“Among people who have less resources, there are stressors and things going on related to work that therapy can’t touch,” says Falconnier. “We have to be more thoughtful about that.”
But all these conventional treatments are proven to work, right? They’ve got studies and evidence to back them up. Well, yes. Kind of.
Just like most therapists are white and middle-class, most of the patients in clinical trials are too. That’s a problem most research institutions have yet to address, says Falconnier.
Meanwhile, thousands of low-income people are suffering from depression. Moms and children are particularly at risk. Falconnier says there’s volumes of research that shows that children raised by depressed moms have more behavior problems, more injuries, higher rates of depression themselves and lower academic achievement. And it’s not a rare problem.
“The rates of depression among low-income mothers are astronmically high,” says Falconnier. “It makes it even scarier that we don’t have treatments that work.”
And depression can have a cyclical affect on a person’s social class. Depression might hindertheir ability to get to work on time, concentrate while they’re there, take care
of their children or think about their future. Those risk factors make them
more likely to sink further in the marketplace, making them vulnerable
to more of the stressors of living on the margins.
“Work functioning is so important for people who are working class,” said Falconnier. “You get depressed. You lose your job. You don’t have anything to fall back on.”