Maria Panagioti1, Peter Bower1, Evangelos Kontopantelis1, Karina Lovell2, Simon Gilbody3, Waquas Waheed1, Chris Dickens4, Janine Archer2, Gregory Simon5, Kathleen Ell6, Jeff C Huffman7, David A Richards8, Christina van der Feltz-Cornelis9, David A Adler10, Martha Bruce11, Marta Buszewicz12, Martin G Cole13, Karina W Davidson14, Peter de Jonge15, Jochen Gensichen16, Klaas Huijbregts17, Marco Menchetti18, Vikram Patel19, Bruce Rollman20, Jonathan Shaffer21, Moniek C Zijlstra-Vlasveld17, Peter A Coventry22. 1. National Institute of Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, England. 2. School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, England. 3. Mental Health and Addiction Research Group, Department of Health Sciences, Hull York Medical School, University of York, York, England. 4. Institute of Health Research, University of Exeter Medical School, Exeter, England 5National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, University of Exeter, Exeter, England. 5. Group Health Research Institute, Seattle, Washington. 6. Ethnicity and Poverty, School of Social Work, University of Southern California, Los Angeles. 7. Harvard Medical School, General Hospital/Blake 11, Boston, Massachusetts. 8. Institute of Health Research, University of Exeter Medical School, Exeter, England. 9. Department of Psychiatry and Behavioral Sciences, Faculty of Social and Behavioral Sciences, Tilburg University, the Netherlands. 10. Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts. 11. Department of Psychiatry, Weill Cornell Medical College, White Plains, New York. 12. Institute of Epidemiology and Health, Faculty of Population and Health Sciences, University College London, London, England. 13. Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada. 14. Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University, New York, New York. 15. Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, the Netherlands. 16. Institute of General Practice, Friedrich-Schiller-University, School of Medicine, University Hospital, Jena, Germany. 17. Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, the Netherlands. 18. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 19. Public Health Foundation of India, Gurgaon, India. 20. Psychiatry, Biomedical Informatics, and Clinical and Translational Science, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania. 21. Department of Psychology, University of Colorado, Denver. 22. Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, England23Centre for Reviews and Dissemination, University of York, York, England.
Abstract
IMPORTANCE: Collaborative care is an intensive care model involving several health care professionals working together, typically a physician, a case manager, and a mental health professional. Meta-analyses of aggregate data have shown that collaborative care is particularly effective in people with depression and comorbid chronic physical conditions. However, only participant-level analyses can rigorously test whether the treatment effect is influenced by participant characteristics, such as chronic physical conditions. OBJECTIVE: To assess whether the effectiveness of collaborative care for depression is moderated by the presence, type, and number of chronic physical conditions. DATA SOURCES: Data were obtained from MEDLINE, EMBASE, PubMed, PsycINFO, CINAHL Complete, and Cochrane Central Register of Controlled Trials, and references from relevant systematic reviews. The search and collection of eligible studies was ongoing until May 22, 2015. STUDY SELECTION: This was an update to a previous meta-analysis. Two independent reviewers were involved in the study selection process. Randomized clinical trials that compared the effectiveness of collaborative care with usual care in adults with depression and reported measured changes in depression severity symptoms at 4 to 6 months after randomization were included in the analysis. Key search terms included depression, dysthymia, anxiety, panic, phobia, obsession, compulsion, posttraumatic, care management, case management, collaborative care, enhanced care, and managed care. DATA EXTRACTION AND SYNTHESIS: Individual participant data on baseline demographics and chronic physical conditions as well as baseline and follow-up depression severity symptoms were requested from authors of the eligible studies. One-step meta-analysis of individual participant data using appropriate mixed-effects models was performed. MAIN OUTCOMES AND MEASURES: Continuous outcomes of depression severity symptoms measured using self-reported or observer-rated measures. RESULTS: Data sets from 31 randomized clinical trials including 36 independent comparisons (N = 10 962 participants) were analyzed. Individual participant data analyses found no significant interaction effects, indicating that the presence (interaction coefficient, 0.02 [95% CI, -0.10 to 0.13]), numbers (interaction coefficient, 0.01 [95% CI, -0.01 to 0.02]), and types of chronic physical conditions do not influence the treatment effect. CONCLUSIONS AND RELEVANCE: There is evidence that collaborative care is effective for people with depression alone and also for people with depression and chronic physical conditions. Existing guidance that recommends limiting collaborative care to people with depression and physical comorbidities is not supported by this individual participant data meta-analysis.
IMPORTANCE: Collaborative care is an intensive care model involving several health care professionals working together, typically a physician, a case manager, and a mental health professional. Meta-analyses of aggregate data have shown that collaborative care is particularly effective in people with depression and comorbid chronic physical conditions. However, only participant-level analyses can rigorously test whether the treatment effect is influenced by participant characteristics, such as chronic physical conditions. OBJECTIVE: To assess whether the effectiveness of collaborative care for depression is moderated by the presence, type, and number of chronic physical conditions. DATA SOURCES: Data were obtained from MEDLINE, EMBASE, PubMed, PsycINFO, CINAHL Complete, and Cochrane Central Register of Controlled Trials, and references from relevant systematic reviews. The search and collection of eligible studies was ongoing until May 22, 2015. STUDY SELECTION: This was an update to a previous meta-analysis. Two independent reviewers were involved in the study selection process. Randomized clinical trials that compared the effectiveness of collaborative care with usual care in adults with depression and reported measured changes in depression severity symptoms at 4 to 6 months after randomization were included in the analysis. Key search terms included depression, dysthymia, anxiety, panic, phobia, obsession, compulsion, posttraumatic, care management, case management, collaborative care, enhanced care, and managed care. DATA EXTRACTION AND SYNTHESIS: Individual participant data on baseline demographics and chronic physical conditions as well as baseline and follow-up depression severity symptoms were requested from authors of the eligible studies. One-step meta-analysis of individual participant data using appropriate mixed-effects models was performed. MAIN OUTCOMES AND MEASURES: Continuous outcomes of depression severity symptoms measured using self-reported or observer-rated measures. RESULTS: Data sets from 31 randomized clinical trials including 36 independent comparisons (N = 10 962 participants) were analyzed. Individual participant data analyses found no significant interaction effects, indicating that the presence (interaction coefficient, 0.02 [95% CI, -0.10 to 0.13]), numbers (interaction coefficient, 0.01 [95% CI, -0.01 to 0.02]), and types of chronic physical conditions do not influence the treatment effect. CONCLUSIONS AND RELEVANCE: There is evidence that collaborative care is effective for people with depression alone and also for people with depression and chronic physical conditions. Existing guidance that recommends limiting collaborative care to people with depression and physical comorbidities is not supported by this individual participant data meta-analysis.
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