TY - JOUR
T1 - Association between chronic physical conditions and the effectiveness of collaborative care for depression: An individual participant data meta-analysis
T2 - An Individual Participant Data Meta-analysis
AU - Panagioti, Maria
AU - Bower, Peter
AU - Kontopantelis, Evangelos
AU - Lovell et al, Karina
AU - Gilbody, Simon
AU - Waheed, Waquas
AU - Dickens, Chris
AU - Archer, Janine
AU - Simon, Gregory
AU - Ell, Kathleen
AU - Huffman, Jeff C.
AU - Richards, David A.
AU - van der Feltz-Cornelis, Christina
AU - Adler, David A.
AU - Bruce, Martha
AU - Buszewicz, Marta
AU - Cole, Martin G.
AU - Davidson, Karina W.
AU - de Jonge, Peter
AU - Gensichen, Jochen
AU - Huijbregts, Klaas
AU - Menchetti, Marco
AU - Patel, Vikram
AU - Rollman, Bruce
AU - Shaffer, Jonathan
AU - Zijlstra-Vlasveld, Moniek C.
AU - Coventry, Peter A.
PY - 2016/9
Y1 - 2016/9
N2 - IMPORTANCE: Collaborative care is an intensive care model involving several health care professionals working together, typically a physician, a case manager, and a mental health professional. Meta-analyses of aggregate data have shown that collaborative care is particularly effective in people with depression and comorbid chronic physical conditions. However, only participant-level analyses can rigorously test whether the treatment effect is influenced by participant characteristics, such as chronic physical conditions.OBJECTIVE: To assess whether the effectiveness of collaborative care for depression is moderated by the presence, type, and number of chronic physical conditions.DATA SOURCES: Data were obtained from MEDLINE, EMBASE, PubMed, PsycINFO, CINAHL Complete, and Cochrane Central Register of Controlled Trials, and references from relevant systematic reviews. The search and collection of eligible studies was ongoing until May 22, 2015.STUDY SELECTION: This was an update to a previous meta-analysis. Two independent reviewers were involved in the study selection process. Randomized clinical trials that compared the effectiveness of collaborative care with usual care in adults with depression and reported measured changes in depression severity symptoms at 4 to 6 months after randomization were included in the analysis. Key search terms included depression, dysthymia, anxiety, panic, phobia, obsession, compulsion, posttraumatic, care management, case management, collaborative care, enhanced care, and managed care.DATA EXTRACTION AND SYNTHESIS: Individual participant data on baseline demographics and chronic physical conditions as well as baseline and follow-up depression severity symptoms were requested from authors of the eligible studies. One-step meta-analysis of individual participant data using appropriate mixed-effects models was performed.MAIN OUTCOMES AND MEASURES: Continuous outcomes of depression severity symptoms measured using self-reported or observer-rated measures.RESULTS: Data sets from 31 randomized clinical trials including 36 independent comparisons (N = 10 962 participants) were analyzed. Individual participant data analyses found no significant interaction effects, indicating that the presence (interaction coefficient, 0.02 [95% CI, -0.10 to 0.13]), numbers (interaction coefficient, 0.01 [95% CI, -0.01 to 0.02]), and types of chronic physical conditions do not influence the treatment effect.CONCLUSIONS AND RELEVANCE: There is evidence that collaborative care is effective for people with depression alone and also for people with depression and chronic physical conditions. Existing guidance that recommends limiting collaborative care to people with depression and physical comorbidities is not supported by this individual participant data meta-analysis.
AB - IMPORTANCE: Collaborative care is an intensive care model involving several health care professionals working together, typically a physician, a case manager, and a mental health professional. Meta-analyses of aggregate data have shown that collaborative care is particularly effective in people with depression and comorbid chronic physical conditions. However, only participant-level analyses can rigorously test whether the treatment effect is influenced by participant characteristics, such as chronic physical conditions.OBJECTIVE: To assess whether the effectiveness of collaborative care for depression is moderated by the presence, type, and number of chronic physical conditions.DATA SOURCES: Data were obtained from MEDLINE, EMBASE, PubMed, PsycINFO, CINAHL Complete, and Cochrane Central Register of Controlled Trials, and references from relevant systematic reviews. The search and collection of eligible studies was ongoing until May 22, 2015.STUDY SELECTION: This was an update to a previous meta-analysis. Two independent reviewers were involved in the study selection process. Randomized clinical trials that compared the effectiveness of collaborative care with usual care in adults with depression and reported measured changes in depression severity symptoms at 4 to 6 months after randomization were included in the analysis. Key search terms included depression, dysthymia, anxiety, panic, phobia, obsession, compulsion, posttraumatic, care management, case management, collaborative care, enhanced care, and managed care.DATA EXTRACTION AND SYNTHESIS: Individual participant data on baseline demographics and chronic physical conditions as well as baseline and follow-up depression severity symptoms were requested from authors of the eligible studies. One-step meta-analysis of individual participant data using appropriate mixed-effects models was performed.MAIN OUTCOMES AND MEASURES: Continuous outcomes of depression severity symptoms measured using self-reported or observer-rated measures.RESULTS: Data sets from 31 randomized clinical trials including 36 independent comparisons (N = 10 962 participants) were analyzed. Individual participant data analyses found no significant interaction effects, indicating that the presence (interaction coefficient, 0.02 [95% CI, -0.10 to 0.13]), numbers (interaction coefficient, 0.01 [95% CI, -0.01 to 0.02]), and types of chronic physical conditions do not influence the treatment effect.CONCLUSIONS AND RELEVANCE: There is evidence that collaborative care is effective for people with depression alone and also for people with depression and chronic physical conditions. Existing guidance that recommends limiting collaborative care to people with depression and physical comorbidities is not supported by this individual participant data meta-analysis.
KW - Adolescent
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Anxiety Disorders/epidemiology
KW - Chronic Disease/epidemiology
KW - Comorbidity
KW - Depressive Disorder/epidemiology
KW - Female
KW - Humans
KW - Interdisciplinary Communication
KW - Intersectoral Collaboration
KW - Male
KW - Middle Aged
KW - Patient Care Team
KW - Primary Health Care
KW - Randomized Controlled Trials as Topic
KW - Treatment Outcome
KW - Young Adult
U2 - 10.1001/jamapsychiatry.2016.1794
DO - 10.1001/jamapsychiatry.2016.1794
M3 - Article
C2 - 27602561
SN - 2168-6238
VL - 73
SP - 978
EP - 989
JO - JAMA Psychiatry
JF - JAMA Psychiatry
IS - 9
ER -