title: Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis.
abstract: BACKGROUND
  To improve the quality of depression management, collaborative care models have been developed from the Chronic Care Model over the past 20 years. Collaborative care is a multicomponent, healthcare system-level intervention that uses case managers to link primary care providers, patients, and mental health specialists. In addition to case management support, primary care providers receive consultation and decision support from mental health specialists (i.e., psychiatrists and psychologists). This collaboration is designed to (1) improve routine screening and diagnosis of depressive disorders; (2) increase provider use of evidence-based protocols for the proactive management of diagnosed depressive disorders; and (3) improve clinical and community support for active client/patient engagement in treatment goal-setting and self-management.
  
  
  METHODS
  A team of subject matter experts in mental health, representing various agencies and institutions, conceptualized and conducted a systematic review and meta-analysis on collaborative care for improving the management of depressive disorders. This team worked under the guidance of the Community Preventive Services Task Force, a nonfederal, independent, volunteer body of public health and prevention experts. Community Guide systematic review methods were used to identify, evaluate, and analyze available evidence.
  
  
  RESULTS
  An earlier systematic review with 37 RCTs of collaborative care studies published through 2004 found evidence of effectiveness of these models in improving depression outcomes. An additional 32 studies of collaborative care models conducted between 2004 and 2009 were found for this current review and analyzed. The results from the meta-analyses suggest robust evidence of effectiveness of collaborative care in improving depression symptoms (standardized mean difference [SMD]=0.34); adherence to treatment (OR=2.22); response to treatment (OR=1.78); remission of symptoms (OR=1.74); recovery from symptoms (OR=1.75); quality of life/functional status (SMD=0.12); and satisfaction with care (SMD=0.39) for patients diagnosed with depression (all effect estimates were significant).
  
  
  CONCLUSIONS
  Collaborative care models are effective in achieving clinically meaningful improvements in depression outcomes and public health benefits in a wide range of populations, settings, and organizations. Collaborative care interventions provide a supportive network of professionals and peers for patients with depression, especially at the primary care level.
authors.affiliation: Community Guide Branch, Epidemiology and Analysis Program Office, Office of Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, Georgia 30333, USA. athota@cdc.gov
authors.forename: Anilkrishna B
authors.initials: AB
authors.lastname: Thota
authors.forename: Theresa Ann
authors.initials: TA
authors.lastname: Sipe
authors.forename: Guthrie J
authors.initials: GJ
authors.lastname: Byard
authors.forename: Carlos S
authors.initials: CS
authors.lastname: Zometa
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hahn
authors.forename: Lela R
authors.initials: LR
authors.lastname: McKnight-Eily
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Chapman
authors.forename: Ana F
authors.initials: AF
authors.lastname: Abraido-Lanza
authors.forename: Jane L
authors.initials: JL
authors.lastname: Pearson
authors.forename: Clinton W
authors.initials: CW
authors.lastname: Anderson
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Gelenberg
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Hennessy
authors.forename: Farifteh F
authors.initials: FF
authors.lastname: Duffy
authors.forename: Mary E
authors.initials: ME
authors.lastname: Vernon-Smiley
authors.forename: Donald E
authors.initials: DE
authors.lastname: Nease
authors.forename: Samantha P
authors.initials: SP
authors.lastname: Williams
mesh_terms: D000367:Age Factors; D003153:Community Health Services / Q000458:organization & administration*; D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000628:therapy*; D006801:Humans; D010346:Patient Care Management / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration; D010349:Patient Compliance; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration; D011788:Quality of Life; D012737:Sex Factors; D012959:Socioeconomic Factors; D014481:United States