Characteristics of Effective Collaborative Care for Treatment of Depression: A Systematic Review and Meta-Regression of 74 Randomised Controlled Trials
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BACKGROUND: Collaborative care is a complex intervention based on chronic disease management models and is effective in the management of depression. However, there is still uncertainty about which components of collaborative care are effective. We used meta-regression to identify factors in collaborative care associated with improvement in patient outcomes (depressive symptoms) and the process of care (use of anti-depressant medication). METHODS AND FINDINGS: Systematic review with meta-regression. The Cochrane Collaboration Depression, Anxiety and Neurosis Group trials registers were searched from inception to 9th February 2012. An update was run in the CENTRAL trials database on 29th December 2013. Inclusion criteria were: randomised controlled trials of collaborative care for adults ≥18 years with a primary diagnosis of depression or mixed anxiety and depressive disorder. Random effects meta-regression was used to estimate regression coefficients with 95% confidence intervals (CIs) between study level covariates and depressive symptoms and relative risk (95% CI) and anti-depressant use. The association between anti-depressant use and improvement in depression was also explored. Seventy four trials were identified (85 comparisons, across 21,345 participants). Collaborative care that included psychological interventions predicted improvement in depression (β coefficient -0.11, 95% CI -0.20 to -0.01, p = 0.03). Systematic identification of patients (relative risk 1.43, 95% CI 1.12 to 1.81, p = 0.004) and the presence of a chronic physical condition (relative risk 1.32, 95% CI 1.05 to 1.65, p = 0.02) predicted use of anti-depressant medication. CONCLUSION: Trials of collaborative care that included psychological treatment, with or without anti-depressant medication, appeared to improve depression more than those without psychological treatment. Trials that used systematic methods to identify patients with depression and also trials that included patients with a chronic physical condition reported improved use of anti-depressant medication. However, these findings are limited by the observational nature of meta-regression, incomplete data reporting, and the use of study aggregates.
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Prior systematic reviews have found support for collaborative care in treating depression and anxiety.
“Previous reviews have supported collaborative care for depression and anxiety,32,73”
From Task-sharing approaches to improve mental health care in rural and other low-resource settings: a systematic review (2018) · cites this paper as [73]
A systematic review published in 2014 showed that trials of collaborative care that include psychological treatment, with or without anti-depressant medication, appear to improve depression more than those without psychological treatment.
“a systematic review published in 2014 showed that trials of collaborative care that include psychological treatment, with or without anti-depressant medication, appear to improve depression more than those without psychological treatment.”
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 [38]
Interventions that used systematic methods to identify patients with depression, and trials that included patients with a chronic physical condition, reported improved use of anti-depressant medication.
“Interventions that used systematic methods to identify patients with depression, and also trials that included patients with a chronic physical condition reported improved use of anti-depressant medication 38 .”
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 [38]
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“Furthermore, collaborative care programs are complex because they include several components; therefore, it is necessary to identify the most active components of the programs in order to prioritize them in treatment [24].”
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- Authors
- Coventry, P. A., Hudson, J. L., Kontopantelis, E., Archer, J., Richards, D. A., Gilbody, S., Lovell, K., Dickens, C., Gask, L., Waheed, W., & Bower, P.
- Affiliations
- Manchester Academic Health Science Centre (GB)
- King's College London (GB)
- University of Manchester (GB)
- University of Exeter (GB)
- University of York (GB)
- Lancashire Care NHS Foundation Trust (GB)
- Corresponding author
- Coventry, Peter A.
- ORCID
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2014-09-29
- Volume
- 9
- Issue
- 9
- Pages
- e108114
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC4180075
- OpenAlex
- W2096684104
- Cited by
- 221
- References
- 56
- Citations by year
- 2026: 12 · 2025: 7 · 2024: 22 · 2023: 15 · 2022: 20 · 2021: 30 · 2020: 25 · 2019: 17 · 2018: 18 · 2017: 23 · 2016: 23 · 2015: 9
- FWCI
- 2.62
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Open Research Exeter (University of Exeter) (publishedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- Figshare (submittedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Research Explorer (The University of Manchester) (submittedVersion, cc-by)
- Funders
- National Institute for Health and Care Research (NF-SI-0611-10203, 08/19/04, 10/57/43, RCF_R10_PC)
- Medical Research Council (MR/K006665/1, 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, mixed anxiety-depressive disorder, psychological intervention, antidepressant use, chronic physical illness, patient identification, depressive symptoms, complex interventions
- MeSH terms
- Antidepressive Agents, Cooperative Behavior, Depression, Humans, Randomized Controlled Trials as Topic
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