Association Between Chronic Physical Conditions and the Effectiveness of Collaborative Care for Depression: An Individual Participant Data Meta-analysis
Open accessAbstract
IMPORTANCE: Collaborative care is an intensive care model involving several health care professionals working together, typically a physician, a case manager, and a mental health professional. Meta-analyses of aggregate data have shown that collaborative care is particularly effective in people with depression and comorbid chronic physical conditions. However, only participant-level analyses can rigorously test whether the treatment effect is influenced by participant characteristics, such as chronic physical conditions. OBJECTIVE: To assess whether the effectiveness of collaborative care for depression is moderated by the presence, type, and number of chronic physical conditions. DATA SOURCES: Data were obtained from MEDLINE, EMBASE, PubMed, PsycINFO, CINAHL Complete, and Cochrane Central Register of Controlled Trials, and references from relevant systematic reviews. The search and collection of eligible studies was ongoing until May 22, 2015. STUDY SELECTION: This was an update to a previous meta-analysis. Two independent reviewers were involved in the study selection process. Randomized clinical trials that compared the effectiveness of collaborative care with usual care in adults with depression and reported measured changes in depression severity symptoms at 4 to 6 months after randomization were included in the analysis. Key search terms included depression, dysthymia, anxiety, panic, phobia, obsession, compulsion, posttraumatic, care management, case management, collaborative care, enhanced care, and managed care. DATA EXTRACTION AND SYNTHESIS: Individual participant data on baseline demographics and chronic physical conditions as well as baseline and follow-up depression severity symptoms were requested from authors of the eligible studies. One-step meta-analysis of individual participant data using appropriate mixed-effects models was performed. MAIN OUTCOMES AND MEASURES: Continuous outcomes of depression severity symptoms measured using self-reported or observer-rated measures. RESULTS: Data sets from 31 randomized clinical trials including 36 independent comparisons (N = 10 962 participants) were analyzed. Individual participant data analyses found no significant interaction effects, indicating that the presence (interaction coefficient, 0.02 [95% CI, -0.10 to 0.13]), numbers (interaction coefficient, 0.01 [95% CI, -0.01 to 0.02]), and types of chronic physical conditions do not influence the treatment effect. CONCLUSIONS AND RELEVANCE: There is evidence that collaborative care is effective for people with depression alone and also for people with depression and chronic physical conditions. Existing guidance that recommends limiting collaborative care to people with depression and physical comorbidities is not supported by this individual participant data meta-analysis.
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Such interventions appear to be equally effective in delivering MDD care for people with and without physical diseases.
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- Authors
- Panagioti, M., Bower, P., Kontopantelis, E., Lovell, K., Gilbody, S., Waheed, W., Dickens, C., Archer, J., Simon, G., Ell, K., Huffman, J. C., Richards, D. A., van der Feltz-Cornelis, C., Adler, D. A., Bruce, M., Buszewicz, M., Cole, M. G., Davidson, K. W., de Jonge, P., Gensichen, J., Huijbregts, K., Menchetti, M., Patel, V., Rollman, B., Shaffer, J., Zijlstra-Vlasveld, M. C., & Coventry, P. A.
- Affiliations
- University of Manchester (GB)
- University of York (GB)
- University of Exeter (GB)
- Kaiser Permanente Washington Health Research Institute (US)
- University of Southern California (US)
- Harvard University (US)
- Department of Psychiatry and Behavioral Sciences, Faculty of Social and Behavioral Sciences, Tilburg University, the Netherlands
- Tufts Medical Center (US)
- Weill Cornell Medicine (US)
- University College London (GB)
- Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada
- Columbia University (US)
- Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, the Netherlands
- Jena University Hospital (DE)
- Trimbos Institute (NL)
- University of Bologna (IT)
- Public Health Foundation of India (IN)
- University of Pittsburgh (US)
- University of Colorado Denver (US)
- Corresponding author
- Coventry, Peter A.
- ORCID
- Panagioti, Maria
- Bower, Peter
- Kontopantelis, Evangelos
- Lovell, Karina
- Gilbody, Simon
- Waheed, Waquas
- Dickens, Chris
- Archer, Janine
- Simon, Gregory
- Ell, Kathleen
- Huffman, Jeff C.
- Richards, David A.
- Bruce, Martha
- Buszewicz, Marta
- Davidson, Karina W.
- Gensichen, Jochen
- Menchetti, Marco
- Patel, Vikram
- Rollman, Bruce
- Shaffer, Jonathan
- Coventry, Peter A.
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2016-09-01
- Volume
- 73
- Issue
- 9
- Pages
- 978
- ISSN
- 2168-622X (ISSN-L)
- OpenAlex
- W2518391928
- Cited by
- 94
- References
- 98
- Citations by year
- 2026: 8 · 2025: 3 · 2024: 6 · 2023: 8 · 2022: 6 · 2021: 15 · 2020: 12 · 2019: 12 · 2018: 11 · 2017: 13
- FWCI
- 1.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- Research portal (Tilburg University) (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Open Research Exeter (University of Exeter) (acceptedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- National Institute for Health and Care Research (NF-SI-0514-10037, NF-SI-0611-10203)
- Medical Research Council (MC_PC_13042)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- collaborative care, depression, chronic physical illness, comorbidities, depression severity, treatment moderators, case management, mental health integration, somatic comorbidity, treatment effect generalizability, comorbid depression and anxiety, post-traumatic depression, dysthymia, panic disorder, phobia, obsessive-compulsive disorder, managed care, care management
- MeSH terms
- Intersectoral Collaboration, Adolescent, Adult, Aged, Aged, 80 and over, Anxiety Disorders, Chronic Disease, Depressive Disorder, Female, Humans, Male, Middle Aged, Patient Care Team, Primary Health Care, Comorbidity, Randomized Controlled Trials as Topic, Treatment Outcome, Interdisciplinary Communication, Young Adult
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