Andrew S Moriarty1, Peter A Coventry2, Joanna L Hudson3, Natalie Cook4, Oliver J Fenton5, Peter Bower6, Karina Lovell7, Janine Archer8, Rose Clarke9, David A Richards10, Chris Dickens11, Linda Gask12, Waquas Waheed13, Klaas M Huijbregts14, Christina van der Feltz-Cornelis15, Shehzad Ali16, Simon Gilbody17, Dean McMillan18. 1. Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK. Electronic address: andrew.moriarty@york.ac.uk. 2. Department of Health Sciences and Centre for Reviews and Dissemination, University of York, Heslington, York, YO10 5DD, UK. Electronic address: peter.coventry@york.ac.uk. 3. King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, UK. Electronic address: joanna.hudson@kcl.ac.uk. 4. Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK. Electronic address: natalie.cook@york.ac.uk. 5. Tees, Esk and Wear Valleys NHS Foundation Trust, South and West Community Mental Health Team, Acomb Garth, 2 Oak Rise, York, YO24 4LJ, UK. Electronic address: ojfenton@gmail.com. 6. NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK. Electronic address: peter.bower@manchester.ac.uk. 7. Division of Nursing, Midwifery & Social Work, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK. Electronic address: karina.lovell@manchester.ac.uk. 8. School of Health and Society, University of Salford, Mary Seacole Building, Broad St, Frederick Road Campus, Salford, M6 6PU, UK. Electronic address: j.e.archer@salford.ac.uk. 9. Sheffield IAPT, St George's Community Health Centre, Winter Street, Sheffield, South Yorkshire, S3 7ND, UK. Electronic address: rosecclarke@gmail.com. 10. Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. Electronic address: d.a.richards@exeter.ac.uk. 11. Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK. Electronic address: c.m.dickens@exeter.ac.uk. 12. NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK. Electronic address: linda.gask@manchester.ac.uk. 13. NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Oxford Rd, Manchester, M13 9PL, UK. Electronic address: waquas.waheed@manchester.ac.uk. 14. GGNet, Mental Health, RGC SKB Winterswijk, Beatrixpark 1, 7101 BN Winterswijk, The Netherlands. Electronic address: k.huijbregts@ggnet.nl. 15. Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK. Electronic address: christina.vanderfeltz-cornelis@york.ac.uk. 16. Epidemiology and Biostatistics Department, Schulich School of Medicine & Dentistry, Western University, Kresge Building, Room K201, London, Ontario, N6A 5C1, Canada; Department of Health Sciences, University of York, Heslington, York, YO10 5DD, UK. Electronic address: shehzad.ali@uwo.ca. 17. Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK. Electronic address: simon.gilbody@york.ac.uk. 18. Department of Health Sciences and the Hull York Medical School, University of York, Heslington, York, YO10 5DD, UK. Electronic address: dean.mcmillan@york.ac.uk.
Abstract
BACKGROUND: Relapse (the re-emergence of depression symptoms before full recovery) is common in depression and relapse prevention strategies are not well researched in primary care settings. Collaborative care is effective for treating acute phase depression but little is known about the use of relapse prevention strategies in collaborative care. We undertook a systematic review to identify and characterise relapse prevention strategies in the context of collaborative care. METHODS: We searched for Randomised Controlled Trials (RCTs) of collaborative care for depression. In addition to published material, we obtained provider and patient manuals from authors to provide more detail on intervention content. We reported the extent to which collaborative care interventions addressed four relapse prevention components. RESULTS: 93 RCTs were identified. 31 included a formal relapse prevention plan; 42 had proactive monitoring and follow-up after the acute phase; 39 reported strategies for optimising sustained medication adherence; and 20 of the trials reported psychological or psycho-educational treatments persisting beyond the acute phase or focussing on long-term health/relapse prevention. 30 (32.3%) did not report relapse prevention approaches. LIMITATIONS: We did not receive trial materials for approximately half of the trials, which limited our ability to identify relevant features of intervention content. CONCLUSION: Relapse is a significant risk amongst people treated for depression and interventions are needed that specifically address and minimise this risk. Given the advantages of collaborative care as a delivery system for depression care, there is scope for more consistency and increased effort to implement and evaluate relapse prevention strategies.
BACKGROUND: Relapse (the re-emergence of depression symptoms before full recovery) is common in depression and relapse prevention strategies are not well researched in primary care settings. Collaborative care is effective for treating acute phase depression but little is known about the use of relapse prevention strategies in collaborative care. We undertook a systematic review to identify and characterise relapse prevention strategies in the context of collaborative care. METHODS: We searched for Randomised Controlled Trials (RCTs) of collaborative care for depression. In addition to published material, we obtained provider and patient manuals from authors to provide more detail on intervention content. We reported the extent to which collaborative care interventions addressed four relapse prevention components. RESULTS: 93 RCTs were identified. 31 included a formal relapse prevention plan; 42 had proactive monitoring and follow-up after the acute phase; 39 reported strategies for optimising sustained medication adherence; and 20 of the trials reported psychological or psycho-educational treatments persisting beyond the acute phase or focussing on long-term health/relapse prevention. 30 (32.3%) did not report relapse prevention approaches. LIMITATIONS: We did not receive trial materials for approximately half of the trials, which limited our ability to identify relevant features of intervention content. CONCLUSION: Relapse is a significant risk amongst people treated for depression and interventions are needed that specifically address and minimise this risk. Given the advantages of collaborative care as a delivery system for depression care, there is scope for more consistency and increased effort to implement and evaluate relapse prevention strategies.
Authors: Emily Fu; Allison J Carroll; Lisa J Rosenthal; Jeffrey Rado; Inger Burnett-Zeigler; Neil Jordan; Andrew D Carlo; Adaora Ekwonu; Ariella Kust; C Hendricks Brown; John G Csernansky; Justin D Smith Journal: J Gen Intern Med Date: 2022-08-05 Impact factor: 6.473