Psychotherapy Less Effective for People in Poverty and Those on Antidepressants

A new study finds poorer depression and anxiety outcomes in psychotherapy for people in economically deprived neighborhoods. and those on antidepressants.


A new study, published in Psychotherapy Research, investigates specific factors of neighborhood socioeconomic deprivation that influence psychotherapy treatment outcomes. The authors found poorer treatment outcomes were associated with higher rates of poverty and crime, younger age, unemployment, minority ethnic status, use of antidepressant medications, and higher baseline symptom severity. Additionally, providing lengthier treatment sessions was found to be associated with lower symptom severity. They describe how economic deprivation adversely affects mental health care access and outcomes, writing:

“This highlights the need to consider deprivation as an important public health problem and a major hindrance to the successful implementation of psychological care. From this perspective, reducing socioeconomic deprivation, promoting equality and social justice are important social policy goals that extend far beyond the confines of psychology and mental healthcare.”

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The existing literature has identified the harmful effects of socioeconomic distress on mental health and treatment outcomes (see previous MIA reports). Finegan, Firth, and Delgadillo are the first to explore the mechanisms underlying the association between neighborhood influences and individual treatment response.

The researchers analyzed regularly collected demographic and clinical data that spanned across five types of psychological therapy services from January 2013-2015 throughout urban, suburban, rural, and socioeconomically diverse areas in the UK. Both low-intensity therapies and high-intensity therapies were accessed and measured using the PHQ-9 for depression, the GAD-7 for anxiety, the Work and Social Adjustment Scale for functional impairment, and the English Index of Multiple Deprivation to assess neighborhood socioeconomic data. The final sample included 44,805 cases of individuals who accessed treatment at least one time after an initial assessment.

The team found results consistent with the existing literature, namely, that people living in less deprived neighborhoods experience less post-treatment symptom severity. Their study goes on to explore the nuances existing in the environment that are associated with anxiety and depressive symptomology. For example, the authors found that unemployment tends to have poorer treatment outcomes. Yet, neighborhood income and crime rates were shown to influence psychological improvement despite employment status, treatment duration, and other demographic and clinical features.

The authors explain, “These findings highlight the impact of specific area-level factors on psychological wellbeing and indicate that these neighborhood statistics are not merely proxy measures of individual-level factors such as employment or income.”

They go on,

“This suggests that the environment plays a substantial role in the recovery of patients with common mental health problems, broadly in line with social causation theory.”

Ultimately, neighborhood deprivation affects psychological treatment outcomes through both material (e.g., access and financial means) and psychological pathways (sense of control, self-worth, and opportunity).

Finegan, Firth, and Delgadillo acknowledge their interpretations as “speculative and based on indirect evidence from other studies.” Other limitations may include a lack of quality control of delivered psychotherapy treatments, regarding both therapy and therapist fit. The authors note limitations to assessing the seven domains linked to the index of multiple deprivations, encouraging future research to include other area-level features, such as participation in community activities and feelings of purpose or belonging versus loneliness.

They outline the implications of their findings for policy and practice. They advocate for offering more treatment sessions for people living in low-income neighborhoods, as well as enhancing accessibility to resources such as programs that address financial and employment difficulty.

This study is the first to investigate associations between specific neighborhood deprivation factors and poorer psychological treatment outcomes, underscoring the need to promote the reduction of neighborhood poverty and inequality alongside supporting people with appropriate psychological treatment.



Finegan, M., Firth, N., & Delgadillo, J. (2019). Adverse impact of socioeconomic deprivation on psychological treatment outcomes: the role of area-level income and crime. Psychotherapy Research. (Link)


  1. Psychiatric research talks about ” psychological pathways (sense of control, self-worth, and opportunity).”……..when psychiatry is busy taking away control and opportunity from an already vulnerable population by labeling. The labels are toxic, hurting people applying for jobs, housing, in fact in all areas of society.

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  2. Has anyone ever considered that it IS a therapist’s job to fight for the underprivileged in the courts? To pursue changes in the laws?

    Specifically, socialworkers? It’s part of their job definition. Whatever happen to their mission? Academia has misdirected them.

    Even more, there are all types of therapists these days from all kinds of backgrounds wanting to just “talk about problems,” but none to help with wider pressing issues. Why is that?

    No one WANTS to do that job. Fight for justice. There’s no money involved. And it’s not considered fun.

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  3. It makes sense to me that people who are at risk of going without their basic needs, are not going to gain much from psychotherapy. Unless the psychotherapy can show them how to survive better.
    But in Western Europe according to my (historical) experience a person can only be so poor!

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  4. I notice a lot of good counselors–ignorant of how psych “treatments” work–get frustrated at how apathetic and helpless their “SMI” people remain. Not knowing the drugs aren’t supposed to make you independent and productive but childish and docile. Like a house pet rather than a grown up. Or a “mentally handicapped” person who wasn’t that way till Psychiatry had its way with them.

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  5. The psychologists, psychiatrists, and their many “mental health” and social worker minion have been, and still are, knowingly or unknowingly, functioning as the hidden enemies/”helping professionals” within America. For the never ending war mongering and profiteering, bailout needing, fiscally irresponsible, “trillions in homes” stealing .01% globalist banksters.

    I have medical proof of their political abuse of psychiatry, since I was drugged for knowing there was something wrong with the 9/11 narrative in 2001. And because I knew the wrong people were in charge of America back then, based upon a now seemingly prophetic dream. Thankfully many now see these societal problems.

    Murdering and/or stealing from all people of America is the globalist banksters’, and their “mental health” minions’ goal, knowingly or unknowingly. A psychologist recently confessed to me that a school social workers’ attempt to drug the best and brightest American children isn’t surprising, because the goal of the “mental health” and school social workers is to maintain the status quo.

    I also have written proof that that psychologist recently attempted to steal all profits from my work, all my work, take control of my story, lawyers and accountants, and eventually steal all my family’s money, in the form of a BS “art manager” contract. The “mental health” workers are often scientific fraud believing criminals, and traitors to America, due to their worship of our fraud based, and now worthless paper, money.

    Perhaps the psychologists should end their attempted thievery from the people who actually create truth telling goods. And we should arrest both the, primarily child abuse covering up, fraud based “mental health” workers, as well as their thieving, fraud based bankster masters. At least if reducing poverty and economic injustice is actually the goal of the “mental health” workers. But I already have physical proof and a confession, that it is not.

    Wake up “mental health” workers, you’re on the wrong side. Just like psychiatrists were on the wrong side during the Nazi holocaust. You are aiding, abetting, and complicit in repeating the worst of history, with your modern day psychiatric holocaust.

    Confess, repent, and walk away from the scientific fraud based, money only worshipping, psychiatrists. Their “bible” was debunked long ago.

    Flush the psychiatric DSM “bible,” and actually start to try to help people instead.

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  6. One thing I always knew even when I was a child is that therapy is a dangerous practice that focuses on the child, on the adult without changing their environment. Even therapy for the whole family is useless unless you change the environment and stop viewing every friggin behaviour, action as the problem.

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    • A good counselor should look out for abuse and help victims to escape instead of labeling them “SMI” and having the shrink put them on drugs.

      All my counselors worked for “mental health” community centers. Hence their advice was nearly all worthless, based on the assumptions that 1. I needed my crippling, mind altering drugs to survive. 2. My accumulating list of pessimistic, defeatist labels proved how hopeless I was.

      These are the only kind Medicaid covers. In theory I’m positive about ethical counselors or coaches who know what they’re doing and how people think. But that kind seldom works for your local mental center. Those who do burn out easily due to frustration at how “clients” never improve.

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  7. Nothing helps people more than diversion from the pathetic states they are in which are caused by their surroundings and societal, family constructs. Give that child friends that won’t make fun of their clothes or looks or behaviour, WITHOUT making the child aware. Give that child an alternative way of learning, geared to his own brain, WITHOUT making him feel different. Give that adult a job, and fair pay. Give the people a society that does not marginalize, isolate, pathologize. Don’t send them to an hour a week therapy or program that does nothing more than talk about their plight, but does nothing to divert and change their plight.

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