Effective Components of Collaborative Care for Depression in Primary Care: An Individual Participant Data Meta-Analysis

Hannah  Schillok; Jochen  Gensichen; Maria Panagioti; Jane Gunn; Lukas Junker; Karoline  Lukaschek; Caroline  Jung-Sievers; Philipp  Sterner; Lukas  Kaupe; Tobias  Dreischulte; Mohammed K. Ali; Enric  Aragonès; David B.  Bekelman; Birgit  Herbeck Belnap; Robert M.  Carney; Lydia A.  Chwastiak; Peter A.  Coventry; Karina W.  Davidson; Maria L.  Ekstrand; Alison  Flehr; Susan  Fletcher; Lars P.  Hölzel; Klaas  Huijbregts; Viswanathan  Mohan; Vikram  Patel; David A.  Richards; Bruce L.  Rollman; Chris  Salisbury; Gregory E.  Simon; Krishnamachari  Srinivasan; Jürgen  Unützer; Kenneth B.  Wells; Thomas  Zimmermann; Markus  Bühner; POKAL Group

doi:10.1001/jamapsychiatry.2025.0183

Effective Components of Collaborative Care for Depression in Primary Care: An Individual Participant Data Meta-Analysis

Hannah Schillok^*, Jochen Gensichen, Maria Panagioti, Jane Gunn, Lukas Junker, Karoline Lukaschek, Caroline Jung-Sievers, Philipp Sterner, Lukas Kaupe, Tobias Dreischulte, Mohammed K. Ali, Enric Aragonès, David B. Bekelman, Birgit Herbeck Belnap, Robert M. Carney, Lydia A. Chwastiak, Peter A. Coventry, Karina W. Davidson, Maria L. Ekstrand, Alison FlehrSusan Fletcher, Lars P. Hölzel, Klaas Huijbregts, Viswanathan Mohan, Vikram Patel, David A. Richards, Bruce L. Rollman, Chris Salisbury, Gregory E. Simon, Krishnamachari Srinivasan, Jürgen Unützer, Kenneth B. Wells, Thomas Zimmermann, Markus Bühner, POKAL Group

^*Corresponding author for this work

Division of Population Health, Health Services Research & Primary Care (L5)

Research output: Contribution to journal › Article › peer-review

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Abstract

IMPORTANCE: Collaborative care is a multicomponent intervention for patients with chronic disease in primary care. Previous meta-analyses have proven the effectiveness of collaborative care for depression; however, individual participant data (IPD) are needed to identify which components of the intervention are the principal drivers of this effect.

OBJECTIVE: To assess which components of collaborative care are the biggest drivers of its effectiveness in reducing symptoms of depression in primary care.

DATA SOURCES: Data were obtained from MEDLINE, Embase, Cochrane Library, PubMed, and PsycInfo as well as references of relevant systematic reviews. Searches were conducted in December 2023, and eligible data were collected until March 14, 2024.

STUDY SELECTION: Two reviewers assessed for eligibility. Randomized clinical trials comparing the effect of collaborative care and usual care among adult patients with depression in primary care were included.

DATA EXTRACTION AND SYNTHESIS: The study was conducted according to the IPD guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. IPD were collected for demographic characteristics and depression outcomes measured at baseline and follow-ups from the authors of all eligible trials. Using IPD, linear mixed models with random nested effects were calculated.

MAIN OUTCOMES AND MEASURES: Continuous measure of depression severity was assessed via validated self-report instruments at 4 to 6 months and was standardized using the instrument's cutoff value for mild depression.

RESULTS: A total of 35 datasets with 38 comparisons were analyzed (N = 20 046 participants [57.3% of all eligible, with minimal differences in baseline characteristics compared with nonretrieved data]; 13 709 [68.4%] female; mean [SD] age, 50.8 [16.5] years). A significant interaction effect with the largest effect size was found between the depression outcome and the collaborative care component therapeutic treatment strategy (-0.07; P < .001). This indicates that this component, including its key elements manual-based psychotherapy and family involvement, was the most effective component of the intervention. Significant interactions were found for all other components, but with smaller effect sizes.

CONCLUSIONS AND RELEVANCE: Components of collaborative care most associated with improved effectiveness in reducing depressive symptoms were identified. To optimize treatment effectiveness and resource allocation, a therapeutic treatment strategy, such as manual-based psychotherapy or family integration, may be prioritized when implementing a collaborative care intervention.

Original language	English
Journal	JAMA Psychiatry
Early online date	26 Mar 2025
DOIs	https://doi.org/10.1001/jamapsychiatry.2025.0183
Publication status	E-pub ahead of print - 26 Mar 2025

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20240912_Manuscript_final_REVISION_n_notrackingAccepted author manuscript, 152 KBLicence: CC BY

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Schillok, H., Gensichen, J., Panagioti, M., Gunn, J., Junker, L., Lukaschek, K., Jung-Sievers, C., Sterner, P., Kaupe, L., Dreischulte, T., Ali, M. K., Aragonès, E., Bekelman, D. B., Herbeck Belnap, B., Carney, R. M., Chwastiak, L. A., Coventry, P. A., Davidson, K. W., Ekstrand, M. L., ... POKAL Group (2025). Effective Components of Collaborative Care for Depression in Primary Care: An Individual Participant Data Meta-Analysis. JAMA Psychiatry. Advance online publication. https://doi.org/10.1001/jamapsychiatry.2025.0183

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title = "Effective Components of Collaborative Care for Depression in Primary Care: An Individual Participant Data Meta-Analysis",

abstract = "IMPORTANCE: Collaborative care is a multicomponent intervention for patients with chronic disease in primary care. Previous meta-analyses have proven the effectiveness of collaborative care for depression; however, individual participant data (IPD) are needed to identify which components of the intervention are the principal drivers of this effect.OBJECTIVE: To assess which components of collaborative care are the biggest drivers of its effectiveness in reducing symptoms of depression in primary care.DATA SOURCES: Data were obtained from MEDLINE, Embase, Cochrane Library, PubMed, and PsycInfo as well as references of relevant systematic reviews. Searches were conducted in December 2023, and eligible data were collected until March 14, 2024.STUDY SELECTION: Two reviewers assessed for eligibility. Randomized clinical trials comparing the effect of collaborative care and usual care among adult patients with depression in primary care were included.DATA EXTRACTION AND SYNTHESIS: The study was conducted according to the IPD guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. IPD were collected for demographic characteristics and depression outcomes measured at baseline and follow-ups from the authors of all eligible trials. Using IPD, linear mixed models with random nested effects were calculated.MAIN OUTCOMES AND MEASURES: Continuous measure of depression severity was assessed via validated self-report instruments at 4 to 6 months and was standardized using the instrument's cutoff value for mild depression.RESULTS: A total of 35 datasets with 38 comparisons were analyzed (N = 20 046 participants [57.3% of all eligible, with minimal differences in baseline characteristics compared with nonretrieved data]; 13 709 [68.4%] female; mean [SD] age, 50.8 [16.5] years). A significant interaction effect with the largest effect size was found between the depression outcome and the collaborative care component therapeutic treatment strategy (-0.07; P < .001). This indicates that this component, including its key elements manual-based psychotherapy and family involvement, was the most effective component of the intervention. Significant interactions were found for all other components, but with smaller effect sizes.CONCLUSIONS AND RELEVANCE: Components of collaborative care most associated with improved effectiveness in reducing depressive symptoms were identified. To optimize treatment effectiveness and resource allocation, a therapeutic treatment strategy, such as manual-based psychotherapy or family integration, may be prioritized when implementing a collaborative care intervention.",

author = "Hannah Schillok and Jochen Gensichen and Maria Panagioti and Jane Gunn and Lukas Junker and Karoline Lukaschek and Caroline Jung-Sievers and Philipp Sterner and Lukas Kaupe and Tobias Dreischulte and Ali, {Mohammed K.} and Enric Aragon{\`e}s and Bekelman, {David B.} and {Herbeck Belnap}, Birgit and Carney, {Robert M.} and Chwastiak, {Lydia A.} and Coventry, {Peter A.} and Davidson, {Karina W.} and Ekstrand, {Maria L.} and Alison Flehr and Susan Fletcher and H{\"o}lzel, {Lars P.} and Klaas Huijbregts and Viswanathan Mohan and Vikram Patel and Richards, {David A.} and Rollman, {Bruce L.} and Chris Salisbury and Simon, {Gregory E.} and Krishnamachari Srinivasan and J{\"u}rgen Un{\"u}tzer and Wells, {Kenneth B.} and Thomas Zimmermann and Markus B{\"u}hner and {POKAL Group}",

year = "2025",

month = mar,

day = "26",

doi = "10.1001/jamapsychiatry.2025.0183",

language = "English",

journal = "JAMA Psychiatry",

issn = "2168-6238",

publisher = "American Medical Association",

}

Schillok, H, Gensichen, J, Panagioti, M, Gunn, J, Junker, L, Lukaschek, K, Jung-Sievers, C, Sterner, P, Kaupe, L, Dreischulte, T, Ali, MK, Aragonès, E, Bekelman, DB, Herbeck Belnap, B, Carney, RM, Chwastiak, LA, Coventry, PA, Davidson, KW, Ekstrand, ML, Flehr, A, Fletcher, S, Hölzel, LP, Huijbregts, K, Mohan, V, Patel, V, Richards, DA, Rollman, BL, Salisbury, C, Simon, GE, Srinivasan, K, Unützer, J, Wells, KB, Zimmermann, T, Bühner, M & POKAL Group 2025, 'Effective Components of Collaborative Care for Depression in Primary Care: An Individual Participant Data Meta-Analysis', JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2025.0183

TY - JOUR

T1 - Effective Components of Collaborative Care for Depression in Primary Care

T2 - An Individual Participant Data Meta-Analysis

AU - Schillok, Hannah

AU - Gensichen, Jochen

AU - Panagioti, Maria

AU - Gunn, Jane

AU - Junker, Lukas

AU - Lukaschek, Karoline

AU - Jung-Sievers, Caroline

AU - Sterner, Philipp

AU - Kaupe, Lukas

AU - Dreischulte, Tobias

AU - Ali, Mohammed K.

AU - Aragonès, Enric

AU - Bekelman, David B.

AU - Herbeck Belnap, Birgit

AU - Carney, Robert M.

AU - Chwastiak, Lydia A.

AU - Coventry, Peter A.

AU - Davidson, Karina W.

AU - Ekstrand, Maria L.

AU - Flehr, Alison

AU - Fletcher, Susan

AU - Hölzel, Lars P.

AU - Huijbregts, Klaas

AU - Mohan, Viswanathan

AU - Patel, Vikram

AU - Richards, David A.

AU - Rollman, Bruce L.

AU - Salisbury, Chris

AU - Simon, Gregory E.

AU - Srinivasan, Krishnamachari

AU - Unützer, Jürgen

AU - Wells, Kenneth B.

AU - Zimmermann, Thomas

AU - Bühner, Markus

AU - POKAL Group

PY - 2025/3/26

Y1 - 2025/3/26

N2 - IMPORTANCE: Collaborative care is a multicomponent intervention for patients with chronic disease in primary care. Previous meta-analyses have proven the effectiveness of collaborative care for depression; however, individual participant data (IPD) are needed to identify which components of the intervention are the principal drivers of this effect.OBJECTIVE: To assess which components of collaborative care are the biggest drivers of its effectiveness in reducing symptoms of depression in primary care.DATA SOURCES: Data were obtained from MEDLINE, Embase, Cochrane Library, PubMed, and PsycInfo as well as references of relevant systematic reviews. Searches were conducted in December 2023, and eligible data were collected until March 14, 2024.STUDY SELECTION: Two reviewers assessed for eligibility. Randomized clinical trials comparing the effect of collaborative care and usual care among adult patients with depression in primary care were included.DATA EXTRACTION AND SYNTHESIS: The study was conducted according to the IPD guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. IPD were collected for demographic characteristics and depression outcomes measured at baseline and follow-ups from the authors of all eligible trials. Using IPD, linear mixed models with random nested effects were calculated.MAIN OUTCOMES AND MEASURES: Continuous measure of depression severity was assessed via validated self-report instruments at 4 to 6 months and was standardized using the instrument's cutoff value for mild depression.RESULTS: A total of 35 datasets with 38 comparisons were analyzed (N = 20 046 participants [57.3% of all eligible, with minimal differences in baseline characteristics compared with nonretrieved data]; 13 709 [68.4%] female; mean [SD] age, 50.8 [16.5] years). A significant interaction effect with the largest effect size was found between the depression outcome and the collaborative care component therapeutic treatment strategy (-0.07; P < .001). This indicates that this component, including its key elements manual-based psychotherapy and family involvement, was the most effective component of the intervention. Significant interactions were found for all other components, but with smaller effect sizes.CONCLUSIONS AND RELEVANCE: Components of collaborative care most associated with improved effectiveness in reducing depressive symptoms were identified. To optimize treatment effectiveness and resource allocation, a therapeutic treatment strategy, such as manual-based psychotherapy or family integration, may be prioritized when implementing a collaborative care intervention.

AB - IMPORTANCE: Collaborative care is a multicomponent intervention for patients with chronic disease in primary care. Previous meta-analyses have proven the effectiveness of collaborative care for depression; however, individual participant data (IPD) are needed to identify which components of the intervention are the principal drivers of this effect.OBJECTIVE: To assess which components of collaborative care are the biggest drivers of its effectiveness in reducing symptoms of depression in primary care.DATA SOURCES: Data were obtained from MEDLINE, Embase, Cochrane Library, PubMed, and PsycInfo as well as references of relevant systematic reviews. Searches were conducted in December 2023, and eligible data were collected until March 14, 2024.STUDY SELECTION: Two reviewers assessed for eligibility. Randomized clinical trials comparing the effect of collaborative care and usual care among adult patients with depression in primary care were included.DATA EXTRACTION AND SYNTHESIS: The study was conducted according to the IPD guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. IPD were collected for demographic characteristics and depression outcomes measured at baseline and follow-ups from the authors of all eligible trials. Using IPD, linear mixed models with random nested effects were calculated.MAIN OUTCOMES AND MEASURES: Continuous measure of depression severity was assessed via validated self-report instruments at 4 to 6 months and was standardized using the instrument's cutoff value for mild depression.RESULTS: A total of 35 datasets with 38 comparisons were analyzed (N = 20 046 participants [57.3% of all eligible, with minimal differences in baseline characteristics compared with nonretrieved data]; 13 709 [68.4%] female; mean [SD] age, 50.8 [16.5] years). A significant interaction effect with the largest effect size was found between the depression outcome and the collaborative care component therapeutic treatment strategy (-0.07; P < .001). This indicates that this component, including its key elements manual-based psychotherapy and family involvement, was the most effective component of the intervention. Significant interactions were found for all other components, but with smaller effect sizes.CONCLUSIONS AND RELEVANCE: Components of collaborative care most associated with improved effectiveness in reducing depressive symptoms were identified. To optimize treatment effectiveness and resource allocation, a therapeutic treatment strategy, such as manual-based psychotherapy or family integration, may be prioritized when implementing a collaborative care intervention.

U2 - 10.1001/jamapsychiatry.2025.0183

DO - 10.1001/jamapsychiatry.2025.0183

M3 - Article

C2 - 40136273

SN - 2168-6238

JO - JAMA Psychiatry

JF - JAMA Psychiatry

ER -

Effective Components of Collaborative Care for Depression in Primary Care: An Individual Participant Data Meta-Analysis

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