Collaborative Care for Depression: A Cumulative Meta-analysis and Review of Longer-term Outcomes
Abstract
BACKGROUND: Depression is common in primary care but is suboptimally managed. Collaborative care, that is, structured care involving a greater role of nonmedical specialists to augment primary care, has emerged as a potentially effective candidate intervention to improve quality of primary care and patient outcomes. METHODS: To quantify the short-term and longer-term effectiveness of collaborative care compared with standard care and to understand mechanisms of action by exploring between-study heterogeneity, we conducted a systematic review of randomized controlled trials that compared collaborative care with usual primary care in patients with depression. We searched MEDLINE (from the beginning of 1966), EMBASE (from the beginning of 1980), CINAHL (from the beginning of 1980), PsycINFO (from the beginning of 1980), the Cochrane Library (from the beginning of 1966), and DARE (Database of Abstracts of Reviews of Effectiveness) (from the beginning of 1985) databases from study inception to February 6, 2006. RESULTS: We found 37 randomized studies including 12 355 patients with depression receiving primary care. Random effects meta-analysis showed that depression outcomes were improved at 6 months (standardized mean difference, 0.25; 95% confidence interval, 0.18-0.32), and evidence of longer-term benefit was found for up to 5 years (standardized mean difference, 0.15; 95% confidence interval, 0.001-0.31). When exploring determinants of effectiveness, effect size was directly related to medication compliance and to the professional background and method of supervision of case managers. The addition of brief psychotherapy did not substantially improve outcome, nor did increased numbers of sessions. Cumulative meta-analysis showed that sufficient evidence had emerged by 2000 to demonstrate the statistically significant benefit of collaborative care. CONCLUSIONS: Collaborative care is more effective than standard care in improving depression outcomes in the short and longer terms. Future research needs to address the implementation of collaborative care, particularly in settings other than the United States.
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In a systematic review of 37 randomized trials of collaborative care vs usual primary care, collaborative care was associated with a twofold increase in adherence to antidepressant medication over a 6-month period and significant improvement in depressive symptoms for 2 to 5 years.
“Gilbody et al85 reported in a systematic review of 37 randomized trials of collaborative care vs usual primary care that a collaborative-care model was associated with a twofold increase in adherence to antidepressant medication over a 6-month period as well as significant improvement in depressive symptoms for 2 to 5 years.”
From Anxiety and Depression in COPD (2008) · cites this paper as [85]
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- Authors
- Gilbody, S.
- Affiliations
- University of York (GB)
- Corresponding author
- Gilbody, Simon
- ORCID
- Gilbody, Simon
- Venue
- Archives of Internal Medicine
- Publisher
- American Medical Association (AMA)
- Published
- 2006-11-27
- Volume
- 166
- Issue
- 21
- Pages
- 2314
- ISSN
- 0003-9926 (ISSN-L)
- OpenAlex
- W2069790930
- Cited by
- 1,340
- References
- 70
- Citations by year
- 2026: 21 · 2025: 27 · 2024: 51 · 2023: 28 · 2022: 32 · 2021: 63 · 2020: 41 · 2019: 50 · 2018: 70 · 2017: 120 · 2016: 62 · 2015: 69 · 2014: 97 · 2013: 114 · 2012: 110
- FWCI
- 76.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (submittedVersion)
- Leicester Research Archive (University of Leicester) (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- collaborative care, depression, primary care, case managers, medication adherence, brief psychotherapy, long-term outcomes, usual care comparison, mechanism of action
- MeSH terms
- Cooperative Behavior, Depression, Depressive Disorder, Humans, Patient Care Team, Primary Health Care, Psychotherapy, Confidence Intervals, Randomized Controlled Trials as Topic, Databases, Bibliographic, Treatment Outcome, Evidence-Based Medicine
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