Effectiveness of collaborative care in reducing suicidal ideation: An individual participant data meta-analysis

Christos Grigoroglou, Christina van der Feltz-Cornelis, Alexander Hodkinson, Peter A Coventry, Salwa S Zghebi, Evangelos Kontopantelis, Peter Bower, Karina Lovell, Simon Gilbody, Waquas Waheed, Christopher Dickens, Janine Archer, Amy Blakemore, David A Adler, Enric Aragones, Cecilia Björkelund, Martha L Bruce, Marta Buszewicz, Robert M Carney, Martin G ColeKarina W Davidson, Jochen Gensichen, Nancy K Grote, Joan Russo, Klaas Huijbregts, Jeff C Huffman, Marco Menchetti, Vikram Patel, David A Richards, Bruce Rollman, Annet Smit, Moniek C Zijlstra-Vlasveld, Kenneth B Wells, Thomas Zimmermann, Jurgen Unutzer, Maria Panagioti

Research output: Contribution to journalArticlepeer-review


To assess whether CC is more effective at reducing suicidal ideation in people with depression compared with usual care, and whether study and patient factors moderate treatment effects.

METHOD: We searched Medline, Embase, PubMed, PsycINFO, CINAHL, CENTRAL from inception to March 2020 for Randomised Controlled Trials (RCTs) that compared the effectiveness of CC with usual care in depressed adults, and reported changes in suicidal ideation at 4 to 6 months post-randomisation. Mixed-effects models accounted for clustering of participants within trials and heterogeneity across trials. This study is registered with PROSPERO, CRD42020201747.

RESULTS: We extracted data from 28 RCTs (11,165 patients) of 83 eligible studies. We observed a small significant clinical improvement of CC on suicidal ideation, compared with usual care (SMD, -0.11 [95%CI, -0.15 to -0.08]; I2, 0·47% [95%CI 0.04% to 4.90%]). CC interventions with a recognised psychological treatment were associated with small reductions in suicidal ideation (SMD, -0.15 [95%CI -0.19 to -0.11]). CC was more effective for reducing suicidal ideation among patients aged over 65 years (SMD, - 0.18 [95%CI -0.25 to -0.11]).

CONCLUSION: Primary care based CC with an embedded psychological intervention is the most effective CC framework for reducing suicidal ideation and older patients may benefit the most.

Original languageEnglish
Pages (from-to)27-35
Number of pages9
JournalGeneral Hospital Psychiatry
Early online date21 Apr 2021
Publication statusE-pub ahead of print - 21 Apr 2021


  • Collaborative care
  • suicidal ideation
  • Primary Care
  • Meta-analysis
  • Individual participant data analysis


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