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Cited by 1,126Mental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and Applications

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Collaborative care for depression and anxiety problems

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Archer, Janine, Bower, Peter, Gilbody, Simon, Lovell, Karina, Richards, David, Gask, Linda, Dickens, Chris, Coventry, Peter·2012·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd006525.pub2PMC PMC11627142
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Abstract

BACKGROUND: Common mental health problems, such as depression and anxiety, are estimated to affect up to 15% of the UK population at any one time, and health care systems worldwide need to implement interventions to reduce the impact and burden of these conditions. Collaborative care is a complex intervention based on chronic disease management models that may be effective in the management of these common mental health problems. OBJECTIVES: To assess the effectiveness of collaborative care for patients with depression or anxiety. SEARCH METHODS: We searched the following databases to February 2012: The Cochrane Collaboration Depression, Anxiety and Neurosis Group (CCDAN) trials registers (CCDANCTR-References and CCDANCTR-Studies) which include relevant randomised controlled trials (RCTs) from MEDLINE (1950 to present), EMBASE (1974 to present), PsycINFO (1967 to present) and the Cochrane Central Register of Controlled Trials (CENTRAL, all years); the World Health Organization (WHO) trials portal (ICTRP); ClinicalTrials.gov; and CINAHL (to November 2010 only). We screened the reference lists of reports of all included studies and published systematic reviews for reports of additional studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) of collaborative care for participants of all ages with depression or anxiety. DATA COLLECTION AND ANALYSIS: Two independent researchers extracted data using a standardised data extraction sheet. Two independent researchers made 'Risk of bias' assessments using criteria from The Cochrane Collaboration. We combined continuous measures of outcome using standardised mean differences (SMDs) with 95% confidence intervals (CIs). We combined dichotomous measures using risk ratios (RRs) with 95% CIs. Sensitivity analyses tested the robustness of the results. MAIN RESULTS: We included seventy-nine RCTs (including 90 relevant comparisons) involving 24,308 participants in the review. Studies varied in terms of risk of bias.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; RR 1.32, 95% CI 1.22 to 1.43), medium-term (SMD -0.28, 95% CI -0.41 to -0.15; RR 1.31, 95% CI 1.17 to 1.48), and long-term (SMD -0.35, 95% CI -0.46 to -0.24; RR 1.29, 95% CI 1.18 to 1.41). However, these significant benefits were not demonstrated into the very long-term (RR 1.12, 95% CI 0.98 to 1.27).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; RR 1.50, 95% CI 1.21 to 1.87), medium-term (SMD -0.33, 95% CI -0.47 to -0.19; RR 1.41, 95% CI 1.18 to 1.69), and long-term (SMD -0.20, 95% CI -0.34 to -0.06; RR 1.26, 95% CI 1.11 to 1.42). 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. AUTHORS' CONCLUSIONS: Collaborative care is associated with significant improvement in depression and anxiety outcomes compared with usual care, and represents a useful addition to clinical pathways for adult patients with depression and anxiety.

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Metadata

Authors
Archer, J., Bower, P., Gilbody, S., Lovell, K., Richards, D., Gask, L., Dickens, C., & Coventry, P.
Affiliations
  • University of Manchester (GB)
  • Manchester Academic Health Science Centre (GB)
  • University of York (GB)
  • University of Exeter (GB)
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2012-10-17
Volume
2012
Issue
10
Pages
CD006525-CD006525
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd006525.pub2
PMC
PMC11627142
OpenAlex
W1603154299
Cited by
1,126
References
468
Citations by year
2026: 46 · 2025: 57 · 2024: 84 · 2023: 89 · 2022: 93 · 2021: 90 · 2020: 98 · 2019: 88 · 2018: 91 · 2017: 129 · 2016: 83 · 2015: 71 · 2014: 74 · 2013: 29 · 2012: 1
FWCI
8.00
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Research Explorer (The University of Manchester) (publishedVersion)
  • Open Research Exeter (University of Exeter) (submittedVersion)
  • Figshare (submittedVersion)
Funders
  • National Institute for Health and Care Research (NF-SI-0611-10203, 08/19/04, 10/57/43)
  • NIHR School for Primary Care Research
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
collaborative care, depression, anxiety, common mental disorders, primary care, mental health integration, complex interventions, treatment effectiveness, risk of bias, depression severity, anxiety levels, depression remission, anxiety remission
MeSH terms
Adult, Anxiety, Depression, Female, Humans, Interprofessional Relations, Male, Patient Care Team, Primary Health Care, Psychiatric Nursing, Psychiatry, Psychology, Randomized Controlled Trials as Topic, Case Management, Standard of Care

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