What is the role of consultation-liaison psychiatry in the management of depression in primary care? A systematic review and meta-analysis.
OBJECTIVE
To assess the effectiveness of consultation-liaison services, involving mental health professionals working to advise and support primary care professionals in the management of depression.


METHODS
Studies of consultation-liaison for depression in primary care were identified from a systematic search of electronic databases, augmented by identification of papers from reference lists, published reviews and from hand searching. Data on study quality, intervention characteristics and outcomes were extracted by two reviewers, and outcome data were meta-analyzed.


RESULTS
Five studies met the criteria. There was no significant effect of consultation-liaison on antidepressant use (risk ratio 1.23, 95% CI 0.91 to 1.66) or depression outcomes in the short- (standardized mean difference -0.04, 95% CI -0.21 to 0.14) or long-term (standardized mean difference 0.06, 95% CI -0.13 to 0.26).


CONCLUSIONS
Evidence concerning consultation-liaison for depression in primary care remains limited, but the existing studies do not suggest it is more effective than usual care. Further research is required to explore the mechanisms by which consultation-liaison might be made more effective, including the potential role of consultation-liaison in combination with other models of care, and in other patient populations.
Cape
John
J
Camden and Islington NHS Foundation Trust, London and Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
Whittington
Craig
C
Bower
Peter
P
D003299:Cooperative Behavior; D003863:Depression; D006801:Humans; D011320:Primary Health Care; D024382:Professional Role; D011570:Psychiatry; D012017:Referral and Consultation / Q000458:organization & administration*