Social Needs Analysis in a Transcranial Magnetic Stimulation Patient Cohort with Major Depressive Disorder

Social determinants of health play a critical role in mental health outcomes, yet their influence on access to and response to transcranial magnetic stimulation (TMS) for major depressive disorder (MDD) remains poorly understood. As TMS is an effective intervention for treatment-resistant depression and may serve a clinically vulnerable population, characterizing the social context of patients receiving TMS is essential. We examined social needs and assets in a TMS-treated cohort and evaluated their relationship to treatment response, hypothesizing greater social need burden among non-responders.

We conducted a retrospective analysis of adults who received an acute course of TMS for MDD at Butler Hospital between 2019 and 2021. Depressive symptom severity, response, and remission were assessed using the Inventory of Depressive Symptomatology-Self Report (IDS-SR). Social needs and assets were measured using a modified Accountable Health Communities Health-Related Social Needs (AHC-HRSN) Screening Tool, including items assessing community engagement.

Seventy-four patients were included in the analysis. Baseline social needs were not significantly associated with TMS response or remission. Patients accessing TMS generally demonstrated high levels of social assets and minimal deficits in basic needs and substance use; however, most reported social isolation and substantial functional impairment. Several domains of self-reported social needs improved following TMS treatment, independent of clinical response.

Patients receiving TMS exhibited relatively high social assets despite pronounced psychosocial burden associated with depression. Several self-reported psychosocial domains improved following treatment, including isolation/loneliness, difficulty with concentration, and ability to complete errands independently. These findings suggest that TMS may coincide with functional improvements beyond depressive symptom reduction and highlights opportunities to integrate supportive psychosocial services alongside treatment that may further optimize clinical outcomes and reduce social unmet needs. Further investigation is needed to understand how social context influences access to and outcomes of TMS care.