Collaborative care for depression in medically ill patients.
OBJECTIVE
Depression is common in medically ill patients and associated with a negative prognosis. Recent findings indicate that single interventions have little effect on outcomes in these patients. Alternatively, complex interventions based on a collaborative care model are promising. This review summarizes recent findings regarding collaborative care in medically ill patients with comorbid depression.


RESULTS
Recent trials provide evidence for a significantly beneficial effect on depression outcomes with moderate effect sizes regarding depressive symptoms [standardized mean differences (SMDs): -0.46 to -0.74, n = 5] and depression response [odds ratios (ORs): 1.29 to 4.75, n = 6]. Psychosocial quality of life (SMDs: 0.09 to 0.54, n = 5) and satisfaction with care (ORs: 2.55-7.43, n = 3; SMDs: 0.05 and 0.2, n = 1) were increased in intervention patients compared with usual care, whereas physical quality of life (SMDs: -0.17 to 0.06) was not. The evidence regarding medication adherence and somatic, disease-specific outcomes is sparse and conclusions cannot be drawn so far.


CONCLUSIONS
Collaborative care interventions are efficacious in medically ill patients with depression. However, there is no data concerning their cost-effectiveness. Furthermore, as trials on collaborative care comprise a heterogeneous set of components, the most effective characteristics should be identified. Moreover, these interventions should be adapted to other healthcare systems than the United States.
Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany. baumeister@psychologie.uni-freiburg.de
Harald
H
Baumeister
Nico
N
Hutter
D003153:Community Health Services / Q000458:organization & administration*; D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000628:therapy*; D006801:Humans; D010346:Patient Care Management / Q000458:organization & administration*; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000458:organization & administration; D011788:Quality of Life