Collaborative Care for Depression and Anxiety Problems

Summary

A Cochrane review [Abstract] 1 included 79 studies with a total of 24308 subjects. The trials included 90 relevant comparisons. Collaborative care included in all trials a multi-professional approach to patient care, a structured management plan, scheduled patient follow-ups and enhanced inter-professional communication. Thirty-four (38%) comparisons provided no additional intervention in the usual care group whereas 52 (58%) comparisons did provide additional interventions in the usual care group.

•Depression: the results of primary analyses demonstrated significantly greater improvement in depression outcomes for adults with depression treated with the collaborative care model in the short-term (SMD -0.34, 95% CI -0.41 to -0.27; 30 comparisons, n=5984; RR 1.32, 95% CI 1.22 to 1.43; 48 comparisons, n=11250), medium-term (SMD -0.28, 95% CI -0.41 to -0.15; 13 comparisons, n=4092; RR 1.31, 95% CI 1.17 to 1.48; 29 comparisons, n=8001), and long-term (SMD -0.35, 95% CI -0.46 to -0.24; one comparison, n=1379; RR 1.29, 95% CI 1.18 to 1.41; 6 comparisons, n=2983). However, these significant benefits were not demonstrated into the very long-term (RR 1.12, 95% CI 0.98 to 1.27; 5 comparisons, n=943).

•Anxiety: the results also demonstrated significantly greater improvement in anxiety outcomes for adults with anxiety treated with the collaborative care model in the short-term (SMD -0.30, 95% CI -0.44 to -0.17; one comparison, n=876; RR 1.50, 95% CI 1.21 to 1.87; 4 comparisons, n=1248), medium-term (SMD -0.33, 95% CI -0.47 to -0.19; one comparison, n=813; RR 1.41, 95% CI 1.18 to 1.69; 5 comparisons, n=1374), and long-term (SMD -0.20, 95% CI -0.34 to -0.06; one comparison, n=804; RR 1.26, 95% CI 1.11 to 1.42; one comparison, n=804). No comparisons examined the effects of the intervention on anxiety outcomes in the very long-term.There was evidence of benefit in secondary outcomes including medication use, mental health quality of life, and patient satisfaction, although there was less evidence of benefit in physical quality of life.

Comment: The quality of the evidence is downgraded by inconsistency (heterogeneity in participants, interventions, comparisons and outcome measures).