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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 [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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ResultThe State of the Evidence for Integrated Behavioral Health in Primary Care
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“It is a phase III trial following the purportedly successful implementation of phase I and II demonstrations (Richards et al., 2008 ).”
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Self-citationThe BestFIT trial: A SMART approach to developing individualized weight loss treatments
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“This work was tested in a pilot RCT (Richards et al., 2008) which included a process evaluation to refine the intervention, attracting subsequent funding to test the intervention in a large scale multi-centre ‘definitive’ RCT by the MRC.”
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“Participants were drawn from a randomised controlled trial, to evaluate the impact of a collaborative care intervention compared to usual care in 19 UK, primary care practices based in urban and rural communities in the North of England [ 26 ].”
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“Characteristics of the patients in the collaborative care condition Patients in collaborative care condition n=62 Age (mean, SD) 47.1 (13.9) Percentage female 72.6 PHQ-9 score at baseline (mean, SD) 16.9 (4.8) This article is published in a peer reviewed section of the International Journal of Integrated Care”
BackgroundMethodInfluentialThe role of relapse prevention for depression in collaborative care: a systematic review
Moriarty, A. S., Coventry, P. A., Hudson, J. L., Cook, N., Fenton, O. J., Bower, P., Lovell, K., Archer, J., Clarke, R., Richards, D. A., et al. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.11.105 · Cited by 35
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Self-citationPrimary care management of major depression in patients aged ≥55 years:
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Collaborative care approaches for people with severe mental illness
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“In Europe, the model has been studied extensively in the Netherlands and the United Kingdom [25-30].”
Collaborative care approaches for people with severe mental illness
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Mental Health Clinics in the 21st Century
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“But cluster trials also have their limitations [16-21].”
BackgroundBehavioural health consultants in integrated primary care teams: a model for future care
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“Around the UK, attempts have been increasingly made to embed psychological/mental health expertise into primary care and other settings, bringing a greater level of integration [73–79].”
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“For example, previous studies in primary care depression have shown that men are generally less likely to take part than women [9,15,16].”
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“Brief training for this role and supervision are necessary and, although much of the evidence for this approach derives from US primary care,(19) encouraging results have been obtained from a recent UK study, in which case managers, as part of their role, employed a brief CBT-based psychological approach, behavioural…”
Does shared care help in the treatment of depression?
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“3) [104].”
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Self-citationCase Management for Depression by Health Care Assistants in Small Primary Care Practices
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Primary Care Psychiatry in Italy
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“Various randomized studies from other counties have demonstrated the effectiveness of collaborative care model in the management of late-life depression in primary care settings (Richards et al., 2008).”
BackgroundResultPostdischarge Care for Depression in Ontario
Lin, E. H. B., Diaz-Granados, N., Stewart, D. E., & Bierman, A. S. (2011) · The Canadian Journal of Psychiatry · doi:10.1177/070674371105600806 · Cited by 13
Metadata
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › 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
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