Collaborative care for patients with depression and chronic illnesses
Open accessAbstract
BACKGROUND: Patients with depression and poorly controlled diabetes, coronary heart disease, or both have an increased risk of adverse outcomes and high health care costs. We conducted a study to determine whether coordinated care management of multiple conditions improves disease control in these patients. METHODS: We conducted a single-blind, randomized, controlled trial in 14 primary care clinics in an integrated health care system in Washington State, involving 214 participants with poorly controlled diabetes, coronary heart disease, or both and coexisting depression. Patients were randomly assigned to the usual-care group or to the intervention group, in which a medically supervised nurse, working with each patient's primary care physician, provided guideline-based, collaborative care management, with the goal of controlling risk factors associated with multiple diseases. The primary outcome was based on simultaneous modeling of glycated hemoglobin, low-density lipoprotein (LDL) cholesterol, and systolic blood-pressure levels and Symptom Checklist-20 (SCL-20) depression outcomes at 12 months; this modeling allowed estimation of a single overall treatment effect. RESULTS: As compared with controls, patients in the intervention group had greater overall 12-month improvement across glycated hemoglobin levels (difference, 0.58%), LDL cholesterol levels (difference, 6.9 mg per deciliter [0.2 mmol per liter]), systolic blood pressure (difference, 5.1 mm Hg), and SCL-20 depression scores (difference, 0.40 points) (P<0.001). Patients in the intervention group also were more likely to have one or more adjustments of insulin (P=0.006), antihypertensive medications (P<0.001), and antidepressant medications (P<0.001), and they had better quality of life (P<0.001) and greater satisfaction with care for diabetes, coronary heart disease, or both (P<0.001) and with care for depression (P<0.001). CONCLUSIONS: As compared with usual care, an intervention involving nurses who provided guideline-based, patient-centered management of depression and chronic disease significantly improved control of medical disease and depression. (Funded by the National Institute of Mental Health; ClinicalTrials.gov number, NCT00468676.).
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A 2021 meta-analysis found that continuous positive airway pressure treatment in adults with type 2 diabetes and obstructive sleep apnea significantly improved A1C.
“However, a 2021 meta-analysis found that in adults with T2D and OSA, treatment with CPAP resulted in significant improvement in A1C.1638”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1638]
The Results and Discussion (pages unavailable) report improved glycated hemoglobin with collaborative care for patients with depression and chronic illness, not CPAP treatment. Searches for CPAP, obstructive sleep apnea, and the claimed 2021 meta-analysis found no passage addressing that claim. (LLM, conf=0.78)
Experimental — accuracy not yet measuredPsychological interventions have additional impact on prevention of clinical CHD, especially in patients who achieved behavioural goals.
“Two recent meta-analyses and two recent RCTs 86,199,343,348 have also shown their additional impact on the prevention of clinical CHD, especially in patients who achieved their behavioural goals.349”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [86]
Multimodal behavioural interventions can reduce mood symptoms and enhance health-related quality of life, although evidence for a definite beneficial effect on cardiac endpoints is inconclusive.
“This approach can reduce mood symptoms and enhance health-related quality of life, although evidence for a definite beneficial effect on cardiac endpoints is inconclusive.”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [86]
Drugs targeting glutamatergic, GABAergic, opioidergic, and inflammatory systems have been developed and trialled, with promising results for some; however, initial results for many novel treatments have not been replicated.
“Drugs that focus on the glutamatergic system (ketamine, esketamine, rapastinel), the GABAergic system (brexanolone, SAGE-217), the opioidergic system (buprenorphine, samidorphan), and the inflammatory system (minocycline) have been developed and trialled, with promising results for some. 543-545 However, the initial results for many novel treatments have not been replicated.”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [543]
The TeamCare trial evaluated a collaborative integrated care model for patients with diabetes and/or heart disease and depression in community-based primary care clinics in Washington State and demonstrated improved physical and mental health outcomes compared to care as usual.
“such as the TeamCare trial which evaluated a collaborative integrated care model for patients with diabetes and/or heart disease and depression in community-based primary care clinics in Washington State and demonstrated improved physical and mental health outcomes when compared to care as usual 30-32 33”
From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [31]
The majority of studies concerned with mental-physical comorbidity have addressed people with common mental disorders rather than severe mental illnesses.
“The majority of the studies concerned with mental-physical comorbidity have addressed people with common mental disorders (rather than severe mental illnesses)”
From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [31]
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“Whereas there is ample evidence that multifaceted and collaborative care packages are effective for managing depression and chronic disease in primary care [159, 160], there is only limited evidence that such patient-centred care approaches are similarly effective for people with PTSD and mental health comorbidities […”
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1. Improving Care and Promoting Health in Populations: Standards of Medical Care in Diabetes—2020
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Mental health collaborative care and its role in primary care settings
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Nurse Navigators in Early Cancer Care: A Randomized, Controlled Trial
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Self-citation1. Improving Care and Promoting Health in Populations: Standards of Care in Diabetes-2023.
ElSayed, N. A., Aleppo, G., Aroda, V., Bannuru, R., Brown, F. M., Bruemmer, D., Collins, B., Hilliard, M., Isaacs, D. M., Johnson, E. L., et al. (2022) · Diabetes Care · doi:10.2337/dc23-s001 · Cited by 157 · see citing works
- Authors
- Katon, W. J., Lin, E. H. B., Von Korff, M., Ciechanowski, P., Ludman, E. J., Young, B., Peterson, D., Rutter, C. M., McGregor, M., & McCulloch, D.
- Affiliations
- University of Washington (US)
- Kaiser Permanente Washington Health Research Institute (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2010-12-30
- Volume
- 363
- Issue
- 27
- Pages
- 2611-2620
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC3312811
- OpenAlex
- W2153327521
- Cited by
- 1,697
- References
- 35
- Citations by year
- 2026: 52 · 2025: 62 · 2024: 75 · 2023: 79 · 2022: 93 · 2021: 93 · 2020: 124 · 2019: 104 · 2018: 123 · 2017: 124 · 2016: 131 · 2015: 147 · 2014: 152 · 2013: 140 · 2012: 134
- FWCI
- 80.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01MH041739, K08MH069741, MH069741, MH041739)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- collaborative care, depression, chronic disease, diabetes mellitus, coronary artery disease, HbA1c, LDL cholesterol, blood pressure control, antidepressants, insulin dose adjustment, quality of life, patient satisfaction, integrated care, primary care
- MeSH terms
- Antidepressive Agents, Antihypertensive Agents, Blood Pressure, Chronic Disease, Cooperative Behavior, Coronary Disease, Depressive Disorder, Major, Major Depressive Disorder, Diabetes Mellitus, Glycated Hemoglobin, Humans, Cholesterol, LDL, Patient Care Team, Primary Health Care, Risk Factors, Single-Blind Method, Patient-Centered Care
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