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PLoS One. 2014 Sep 29;9(9):e108114. doi: 10.1371/journal.pone.0108114. eCollection 2014.

Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials.

Author information

1
Collaboration for Leadership in Applied Health Research and Care, Centre for Primary Care and Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
2
Health Psychology Section, Psychology Department, Institute of Psychiatry, King's College London, London, United Kingdom.
3
NIHR School for Primary Care Research, Centre for Primary Care and Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
4
School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom.
5
Institute of Health Service Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom.
6
Mental Health Research Group, Department of Health Sciences and Hull York Medical School, University of York, York, United Kingdom.
7
Lancashire Care NHS Foundation Trust, Preston, United Kingdom.

Abstract

BACKGROUND:

Collaborative care is a complex intervention based on chronic disease management models and is effective in the management of depression. However, there is still uncertainty about which components of collaborative care are effective. We used meta-regression to identify factors in collaborative care associated with improvement in patient outcomes (depressive symptoms) and the process of care (use of anti-depressant medication).

METHODS AND FINDINGS:

Systematic review with meta-regression. The Cochrane Collaboration Depression, Anxiety and Neurosis Group trials registers were searched from inception to 9th February 2012. An update was run in the CENTRAL trials database on 29th December 2013. Inclusion criteria were: randomised controlled trials of collaborative care for adults ≥18 years with a primary diagnosis of depression or mixed anxiety and depressive disorder. Random effects meta-regression was used to estimate regression coefficients with 95% confidence intervals (CIs) between study level covariates and depressive symptoms and relative risk (95% CI) and anti-depressant use. The association between anti-depressant use and improvement in depression was also explored. Seventy four trials were identified (85 comparisons, across 21,345 participants). Collaborative care that included psychological interventions predicted improvement in depression (β coefficient -0.11, 95% CI -0.20 to -0.01, p = 0.03). Systematic identification of patients (relative risk 1.43, 95% CI 1.12 to 1.81, p = 0.004) and the presence of a chronic physical condition (relative risk 1.32, 95% CI 1.05 to 1.65, p = 0.02) predicted use of anti-depressant medication.

CONCLUSION:

Trials of collaborative care that included psychological treatment, with or without anti-depressant medication, appeared to improve depression more than those without psychological treatment. Trials that used systematic methods to identify patients with depression and also trials that included patients with a chronic physical condition reported improved use of anti-depressant medication. However, these findings are limited by the observational nature of meta-regression, incomplete data reporting, and the use of study aggregates.

PMID:
25264616
PMCID:
PMC4180075
DOI:
10.1371/journal.pone.0108114
[Indexed for MEDLINE]
Free PMC Article

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