This article is more than 5 years old. Information may no longer be current.

Analysis confirms efficacy of collaborative care for depression, chronic physical conditions

Chronic physical conditions did not moderate the efficacy of collaborative care for depression in adults, according to recent findings.

“The combination of depression with a chronic physical condition, such as cardiovascular diseases, respiratory diseases and diabetes, is associated with the greatest decrements in quality of life, years lost owing to disability, patient safety failures and unscheduled care,” Janine Archer, PhD, of the University of Manchester, England, and colleagues wrote. “A promising intervention for depression in primary care is collaborative care, which involves the use of a case manager (usually nonmedical but also medical; eg, clinical social workers) working with primary care professionals, often supervised by a mental health specialist and supported by care management systems.”

To determine if collaborative care efficacy for depression is moderated by presence, type and number of chronic physical conditions, researchers conducted a meta-analysis of individual participant data from randomized clinical trials that compared collaborative care with usual care for depression in adults. Analysis included 31 randomized clinical trials and 36 independent comparisons (n = 10, 962).

There were no significant interaction effects, according to individual participant data analyses, which indicated interaction coefficients of 0.02 (95% CI, –0.1 to 0.13) for presence and 0.01 (95% CI, –0.01 to 0.02) for number of chronic physical conditions.

Interaction coefficients ranged from –0.02 for cardiac disease and diabetes to –0.11 for cancer.

“Our findings do not support the recommendation by the National Institute for Health and Care Excellence that collaborative care should be considered only for people with depression and comorbid physical conditions with functional impairment,” the researchers wrote. “Limiting collaborative care to people with depression and comorbid physical conditions does not appear to be a reasonable policy recommendation with important implications for patient benefit. Individual participant data meta-analyses are underused in the development of clinical guidelines, and the next iteration of guidelines for depression could be improved by using the most-reliable evidence available.” – by Amanda Oldt

Disclosure: Archer reports no relevant financial disclosures. Please see the full study for a list of all authors’ relevant financial disclosures.