Advertisement

Collaborative Care to Improve the Management of Depressive Disorders

A Community Guide Systematic Review and Meta-Analysis

      Context

      To improve the quality of depression management, collaborative care models have been developed from the Chronic Care Model over the past 20 years. Collaborative care is a multicomponent, healthcare system–level intervention that uses case managers to link primary care providers, patients, and mental health specialists. In addition to case management support, primary care providers receive consultation and decision support from mental health specialists (i.e., psychiatrists and psychologists). This collaboration is designed to (1) improve routine screening and diagnosis of depressive disorders; (2) increase provider use of evidence-based protocols for the proactive management of diagnosed depressive disorders; and (3) improve clinical and community support for active client/patient engagement in treatment goal-setting and self-management.

      Evidence acquisition

      A team of subject matter experts in mental health, representing various agencies and institutions, conceptualized and conducted a systematic review and meta-analysis on collaborative care for improving the management of depressive disorders. This team worked under the guidance of the Community Preventive Services Task Force, a nonfederal, independent, volunteer body of public health and prevention experts. Community Guide systematic review methods were used to identify, evaluate, and analyze available evidence.

      Evidence synthesis

      An earlier systematic review with 37 RCTs of collaborative care studies published through 2004 found evidence of effectiveness of these models in improving depression outcomes. An additional 32 studies of collaborative care models conducted between 2004 and 2009 were found for this current review and analyzed. The results from the meta-analyses suggest robust evidence of effectiveness of collaborative care in improving depression symptoms (standardized mean difference [SMD]=0.34); adherence to treatment (OR=2.22); response to treatment (OR=1.78); remission of symptoms (OR=1.74); recovery from symptoms (OR=1.75); quality of life/functional status (SMD=0.12); and satisfaction with care (SMD=0.39) for patients diagnosed with depression (all effect estimates were significant).

      Conclusions

      Collaborative care models are effective in achieving clinically meaningful improvements in depression outcomes and public health benefits in a wide range of populations, settings, and organizations. Collaborative care interventions provide a supportive network of professionals and peers for patients with depression, especially at the primary care level.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Lopez A.D.
        • Mathers C.D.
        • Ezzati M.
        • Jamison D.T.
        • Murray C.J.
        Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data.
        Lancet. 2006; 367: 1747-1757
        • Kessler R.C.
        • Chiu W.T.
        • Demler O.
        • Merikangas K.R.
        • Walters E.E.
        Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R).
        Arch Gen Psychiatry. 2005; 62: 617-627
        • Strine T.W.
        • Mokdad A.H.
        • Balluz L.S.
        • et al.
        Depression and anxiety in the U.S: findings from the 2006 Behavioral Risk Factor Surveillance System.
        Psychiatr Serv. 2008; 59: 1383-1390
        • Substance Abuse and Mental Health Services Administration
        Results from the 2008 National Survey on Drug Use and Health: national findings.
        Office of Applied Studies, Rockville MD2009 (NSDUH Series H-36, HHS Publication No. SMA 09-4434)
        • Greenberg P.
        • Kessler R.
        • Birnbaum H.
        • et al.
        The economic burden of depression in the U.S.: how did it change between 1990 and 2000?.
        J Clin Psychiatry. 2003; 64: 1465-1475
        • Young A.S.
        • Klap R.
        • Sherbourne C.D.
        • Wells K.B.
        The quality of care for depressive and anxiety disorders in the U.S..
        Arch Gen Psychiatry. 2001; 58: 55-61
        • Wagner E.H.
        Chronic disease management: what will it take to improve care for chronic illness?.
        Eff Clin Pract. 1998; 1: 2-4
        • Wagner E.H.
        • Austin B.T.
        • Von Korff M.
        Organizing care for patients with chronic illness.
        Milbank Q. 1996; 74: 511-544
        • Coleman K.
        • Austin B.T.
        • Brach C.
        • Wagner E.H.
        Evidence on the chronic care model in the new millennium.
        Health Aff. 2009; 28: 75-85
        • Wagner E.H.
        • Grothaus L.C.
        • Sandhu N.
        • et al.
        Chronic care clinics for diabetes in primary care.
        Diabetes Care. 2001; 24: 695-700
        • Katon W.
        • Von Korff M.
        • Lin E.
        • Simon G.
        Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse.
        Gen Hosp Psychiatry. 2001; 23: 138-144
        • Bower P.
        • Gilbody S.
        • Richards D.
        • Fletcher J.
        • Sutton A.
        Collaborative care for depression in primary care: making sense of a complex intervention: systematic review and meta-regression.
        Br J Psychiatry. 2006; 189: 484-493
        • Gilbody S.
        • Bower P.
        • Fletcher J.
        • Richards D.
        • Sutton A.J.
        Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes.
        Arch Intern Med. 2006; 166: 2314-2321
        • Briss P.A.
        • Zaza S.
        • Pappaioanou M.
        • et al.
        Developing an evidence-based Guide to Community Preventive Services—methods.
        Am J Prev Med. 2000; 18: 35-43
        • Zaza S.
        • Wright-deAguero L.K.
        • Briss P.A.
        • et al.
        Data collection instrument and procedure for systematic reviews in the Guide to Community Preventive Services.
        Am J Prev Med. 2000; 18: 44-74
      1. Healthy People 2020.
        • U.S. Preventive Services Task Force
        Screening for depression in adults: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2009; 151: 784-792
        • U.S. Preventive Services Task Force
        Screening and treatment for major depressive disorder in children and adolescents: U.S. Preventive Services Task Force recommendation statement.
        Pediatrics. 2009; 123: 1223-1228
        • American Psychiatric Association
        Practice guideline for the treatment of patients with major depressive disorder, third edition.
        Am J Psychiatry. 2010; 167
        • Task Force on Community Preventive Services
        The Guide to Community Preventive Services: what works to promote health?.
        Oxford University Press, New York NY2005
        • Kupfer D.J.
        Long-term treatment of depression.
        J Clin Psychiatry. 1991; 52: 28-34
        • Dobscha S.K.
        • Corson K.
        • Hickam D.H.
        • Perrin N.A.
        • Kraemer D.F.
        • Gerrity M.S.
        Depression decision support in primary care: a cluster randomized trial [see comment; summary for patients in Ann Intern Med 2006;145(7):I10; PMID: 17015861].
        Ann Intern Med. 2006; 145: 477-487
        • McMahon L.
        • Foran K.M.
        • Forrest S.D.
        • et al.
        Graduate mental health worker case management of depression in UK primary care: a pilot study.
        Br J Gen Pract. 2007; 57: 880-885
        • Sharpe M.
        • Strong V.
        • Allen K.
        • et al.
        Management of major depression in outpatients attending a cancer centre: a preliminary evaluation of a multicomponent cancer nurse-delivered intervention.
        Br J Cancer. 2004; 90: 310-313
        • Williams L.S.
        • Kroenke K.
        • Bakas T.
        • et al.
        Care management of poststroke depression: a randomized, controlled trial.
        Stroke. 2007; 38: 998-1003
        • Spitzer R.L.
        • Williams J.B.
        • Gibbon M.
        • First M.B.
        The Structured Clinical Interview for DSM-III-R (SCID): history, validation, and description.
        Arch Gen Psychiatry. 1992; 49: 624-629
        • Rush A.
        • Pincus A.
        • First M.
        • et al.
        Handbook of psychiatric measures.
        American Psychiatric Association, Washington DC2000
        • Lee P.W.
        Concordance between the PHQ-9 and the HSCL-20 in depressed primary care patients.
        J Affect Disord. 2007; 99: 139-145
        • Lowe B.
        • Unutzer J.
        • Callahan C.M.
        • Perkins A.J.
        • Kroenke K.
        Monitoring depression treatment outcomes with the Patient Health Questionnaire-9.
        Med Care. 2004; 42: 1194-1201
        • Rush A.J.
        Report by the ACNP Task Force on response and remission in major depressive disorder.
        Neuropsychopharmacology. 2006; 31: 1841-1853
        • National Center for Chronic Disease Prevention and Health Promotion
        Health-related quality of life.
        • Leidy N.
        Functional status and the forward progress of merry-go-rounds: toward a coherent analytical framework.
        Nurs Res. 1994; 43: 196-202
        • Wilson I.B.
        • Cleary P.D.
        Linking clinical variables with health-related quality of life: a conceptual model of patient outcomes.
        JAMA. 1995; 273: 59-65
        • Rapkin B.
        • Weiss E.
        • Chhabra R.
        • et al.
        Beyond satisfaction: using the Dynamics of Care assessment to better understand patients' experiences in care.
        Health Qual Life Outcomes. 2008; 6: 20
        • Cherin D.A.
        • Huba G.J.
        • Steinberg J.
        • et al.
        Satisfaction with services in innovative managed care programs for groups of traditionally underserved individuals with HIV/AIDS: empirical models.
        Home Health Care Serv Q. 2001; 19: 103-125
        • Jacob V.
        • Chattopadhyay S.K.
        • Sipe T.A.
        • et al.
        Economics of collaborative care for management of depressive disorders: a Community Guide systematic review.
        Am J Prev Med. 2012; 42: 539-549
        • Hedges L.V.
        Distribution theory for Glass's estimator of effect size and related estimators.
        J Educ Behav Stat. 1981; 6: 107-128
        • Cooper H.M.
        • Hedges L.V.
        The handbook of research synthesis.
        Russell Sage Foundation Publications, New York1994
        • Higgins J.
        • Thompson S.
        Quantifying heterogeneity in a meta-analysis.
        Stat Med. 2002; 21: 1539-1558
        • Sutton A.
        • Duval S.
        • Tweedie R.
        • Abrams K.
        • Jones D.
        Empirical assessment of effect of publication on meta-analyses.
        BMJ. 2000; 320: 1574-1577
        • Borenstein M.
        Software for publication bias.
        in: Rothstein H. Sutton A. Borenstein M. Publication bias in meta-analysis—prevention, assessment and adjustments. John Wiley and Sons, Ltd., New York2005
        • Orwin R.G.
        A fail-safe N for effect size in meta-analysis.
        J Educ Behav Stat. 1983; 8: 157-159
        • Lipsey M.
        • Wilson D.
        Practical meta-analysis.
        Sage Publications, Thousand Oaks CA2001
        • Becker B.
        Combining significance levels.
        in: Cooper H.M. Hedges L.V. The handbook of research synthesis. Russell Sage Foundation Publications, New York1994: 215-230
        • Greenhouse J.
        • Iyengar S.
        Sensitivity analysis and diagnostics.
        in: Cooper H.M. Hedges L.V. The handbook of research synthesis. Russell Sage Foundation Publications, New York1994: 383-398
        • Asarnow J.R.
        • Jaycox L.H.
        • Duan N.
        • et al.
        Effectiveness of a quality improvement intervention for adolescent depression in primary care clinics: a randomized controlled trial [see comment].
        JAMA. 2005; 293: 311-319
        • Baldwin R.
        • Pratt H.
        • Goring H.
        • Marriott A.
        • Roberts C.
        Does a nurse-led mental health liaison service for older people reduce psychiatric morbidity in acute general medical wards?.
        Age Ageing. 2004; 33: 472-478
        • Bogner H.R.
        • de Vries H.F.
        Integration of depression and hypertension treatment: a pilot, randomized controlled trial.
        Ann Fam Med. 2008; 6: 295-301
        • Ciechanowski P.
        • Wagner E.
        • Schmaling K.
        • et al.
        Community-integrated home-based depression treatment in older adults: a randomized controlled trial.
        JAMA. 2004; : 1569-1577
        • Chew-Graham C.A.
        • Lovell K.
        • Roberts C.
        • et al.
        A randomised controlled trial to test the feasibility of a collaborative care model for the management of depression in older people.
        Br J Gen Pract. 2007; 57: 364-370
        • Cole M.G.
        • McCusker J.
        • Elie M.
        • Dendukuri N.
        • Latimer E.
        • Belzile E.
        Systematic detection and multidisciplinary care of depression in older medical inpatients: a randomized trial.
        CMAJ. 2006; 174: 38-44
        • Cullum S.
        • Tucker S.
        • Todd C.
        • Brayne C.
        Effectiveness of liaison psychiatric nursing in older medical inpatients with depression: a randomised controlled trial.
        Age Ageing. 2007; 36: 436-442
        • Dietrich A.J.
        • Oxman T.E.
        • Williams Jr, J.W.
        • et al.
        Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial [references].
        BMJ. 2004; 329: 602
        • Dwight-Johnson M.
        • Ell K.
        • Lee P.-J.
        Can collaborative care address the needs of low-income Latinas with comorbid depression and cancer?.
        Psychosomatics. 2005; 46: 224-232
        • Ell K.
        • Unutzer J.
        • Aranda M.
        • Gibbs N.E.
        • Lee P.
        • Xie B.
        Managing depression in home health care: a randomized clinical trial.
        Home Health Care Serv Q. 2007; 26: 81-104
        • Ell K.
        • Xie B.
        • Quon B.
        • Quinn D.I.
        • Dwight-Johnson M.
        • Lee P.J.
        Randomized controlled trial of collaborative care management of depression among low-income patients with cancer.
        J Clin Oncol. 2008; 26: 4488-4496
        • Fortney J.C.
        • Pyne J.M.
        • Edlund M.J.
        • et al.
        A randomized trial of telemedicine-based collaborative care for depression.
        J Gen Intern Med. 2007; 22: 1086-1093
        • Gallo J.J.
        • Bogner H.R.
        • Morales K.H.
        • Post E.P.
        • Lin J.Y.
        • Bruce M.L.
        The effect of a primary care practice-based depression intervention on mortality in older adults: a randomized trial.
        Ann Intern Med. 2007; 146: 689-698
        • Gensichen J.
        • von Korff M.
        • Peitz M.
        • et al.
        • PRoMPT (PRimary care Monitoring for depressive Patients Trial)
        Case management for depression by health care assistants in small primary care practices.
        Ann Intern Med. 2009; 151: 369-378
        • Joubert J.
        • Joubert L.
        • Reid C.
        • et al.
        The positive effect of integrated care on depressive symptoms in stroke survivors.
        Cerebrovasc Dis. 2008; 26: 199-205
        • Knight M.M.
        • Houseman E.A.
        A collaborative model for the treatment of depression in homebound elders.
        Issues Ment Health Nurs. 2008; 29: 974-991
        • Ludman E.J.
        • Simon G.E.
        • Grothaus L.C.
        • Luce C.
        • Markley D.K.
        • Schaefer J.
        A pilot study of telephone care management and structured disease self-management groups for chronic depression.
        Psychiatr Serv. 2007; 58: 1065-1072
        • Oslin D.W.
        • Thompson R.
        • Kallan M.J.
        • et al.
        Treatment effects from UPBEAT: a randomized trial of care management for behavioral health problems in hospitalized elderly patients.
        J Geriatr Psychiatry Neurol. 2004; 17: 99-106
        • Reiss-Brennan B.
        • Briot P.
        • Daumit G.
        • Ford D.
        Evaluation of “depression in primary care” innovations [references].
        Adm Policy Ment Health. 2006; 33: 86-91
        • Richards D.A.
        • Lovell K.
        • Gilbody S.
        • et al.
        Collaborative care for depression in UK primary care: a randomized controlled trial.
        Psychol Med. 2008; 38: 279-287
        • Rollman B.L.
        • Belnap B.H.
        • LeMenager M.S.
        • et al.
        Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial.
        JAMA. 2009; 302: 2095-2103
        • Schrader G.
        • Cheok F.
        • Hordacre A.L.
        • Marker J.
        • Wade V.
        Effect of psychiatry liaison with general practitioners on depression severity in recently hospitalised cardiac patients: a randomised controlled trial.
        Med J Aust. 2005; 182: 272-276
        • Simon G.E.
        • Katon W.J.
        • Lin E.H.
        • et al.
        Cost-effectiveness of systematic depression treatment among people with diabetes mellitus [see comment].
        Arch Gen Psychiatry. 2007; 64: 65-72
        • Simon G.E.
        • Ludman E.J.
        • Operskalski B.H.
        Randomized trial of a telephone care management program for outpatients starting antidepressant treatment.
        Psychiatr Serv. 2006; 57: 1441-1445
        • Smit A.
        • Kluiter H.
        • Conradi H.J.
        • et al.
        Short-term effects of enhanced treatment for depression in primary care: results from a randomized controlled trial.
        Psychol Med. 2006; 36: 15-26
        • Stiefel F.
        • Zdrojewski C.
        • Bel Hadj F.
        • et al.
        Effects of a multifaceted psychiatric intervention targeted for the complex medically ill: a randomized controlled trial.
        Psychother Psychosom. 2008; 77: 247-256
        • Strong V.
        • Waters R.
        • Hibberd C.
        • et al.
        Management of depression for people with cancer (SMaRT oncology 1): a randomised trial.
        Lancet. 2008; 372: 40-48
        • Wang P.S.
        • Simon G.E.
        • Avorn J.
        • et al.
        Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial.
        JAMA. 2007; 298: 1401-1411
        • Wells K.B.
        • Tang L.
        • Miranda J.
        • Benjamin B.
        • Duan N.
        • Sherbourne C.D.
        The effects of quality improvement for depression in primary care at nine years: results from a randomized, controlled group-level trial.
        Health Serv Res. 2008; 43: 1952-1974
        • Hedrick S.C.
        • Chaney E.F.
        • Felker B.
        • et al.
        Effectiveness of collaborative care depression treatment in Veterans' Affairs primary care.
        J Gen Intern Med. 2003; 18: 9-16
        • Juni P.
        • Holenstein F.
        • Sterne J.
        • Bartlett C.
        • Egger M.
        Direction and impact of language bias in meta-analyses of controlled trials: empirical study.
        Int J Epidemiol. 2002; 31: 115-123