Collaborative care for depression in UK primary care: a randomized controlled trial
Abstract
Background: Collaborative care is an effective intervention for depression which includes both organizational and patient-level intervention components. The effect in the UK is unknown, as is whether cluster- or patient-randomization would be the most appropriate design for a Phase III clinical trial. Method: We undertook a Phase II patient-level randomized controlled trial in primary care, nested within a cluster-randomized trial. Depressed participants were randomized to ‘collaborative care’ – case manager-coordinated medication support and brief psychological treatment, enhanced specialist and GP communication – or a usual care control. The primary outcome was symptoms of depression (PHQ-9). Results: We recruited 114 participants, 41 to the intervention group, 38 to the patient randomized control group and 35 to the cluster-randomized control group. For the intervention compared to the cluster control the PHQ-9 effect size was 0.63 (95% CI 0.18–1.07). There was evidence of substantial contamination between intervention and patient-randomized control participants with less difference between the intervention group and patient-randomized control group (−2.99, 95% CI −7.56 to 1.58, p=0.186) than between the intervention and cluster-randomized control group (−4.64, 95% CI −7.93 to −1.35, p=0.008). The intra-class correlation coefficient for our primary outcome was 0.06 (95% CI 0.00–0.32). Conclusions: Collaborative care is a potentially powerful organizational intervention for improving depression treatment in UK primary care, the effect of which is probably partly mediated through the organizational aspects of the intervention. A large Phase III cluster-randomized trial is required to provide the most methodologically accurate test of these initial encouraging findings.
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The CORE-OM has published evidence of reliability and validity and has been used in previous UK mental health trials.
“The CORE-OM has published evidence of reliability and validity [29,30] and has been used in previous UK mental health trials [31].”
From Development and evaluation of culturally sensitive psychosocial interventions for under-served people in primary care (2014) · cites this paper as [31]
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- Authors
- Richards, D. A., Lovell, K., Gilbody, S., Gask, L., Torgerson, D., Barkham, M., Bland, M., Bower, P., Lankshear, A. J., Simpson, A., Fletcher, J., Escott, D., Hennessy, S., & Richardson, R.
- Affiliations
- University of York (GB)
- University of Manchester (GB)
- University of Sheffield (GB)
- Cardiff University (GB)
- Corresponding author
- Richards, D. A.
- ORCID
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2007-09-06
- Volume
- 38
- Issue
- 2
- Pages
- 279-287
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2097467803
- Cited by
- 165
- References
- 33
- Citations by year
- 2025: 4 · 2024: 6 · 2023: 5 · 2022: 2 · 2021: 4 · 2020: 4 · 2019: 4 · 2018: 4 · 2017: 10 · 2016: 6 · 2015: 7 · 2014: 11 · 2013: 12 · 2012: 23
- FWCI
- 22.51
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Figshare (submittedVersion)
- Open Research Exeter (University of Exeter) (submittedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- collaborative care, depression, primary care, case managers, medication support, PHQ-9, contamination, organizational interventions
- MeSH terms
- Workforce, Adult, Mental Disorders, Cooperative Behavior, Demography, Female, United Kingdom, Humans, Male, Mental Health Services, Patient Care Team, Primary Health Care, Treatment Outcome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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