title: Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials.
abstract: BACKGROUND
  Collaborative care is a complex intervention based on chronic disease management models and is effective in the management of depression. However, there is still uncertainty about which components of collaborative care are effective. We used meta-regression to identify factors in collaborative care associated with improvement in patient outcomes (depressive symptoms) and the process of care (use of anti-depressant medication).
  
  
  RESULTS
  Systematic review with meta-regression. The Cochrane Collaboration Depression, Anxiety and Neurosis Group trials registers were searched from inception to 9th February 2012. An update was run in the CENTRAL trials database on 29th December 2013. Inclusion criteria were: randomised controlled trials of collaborative care for adults ≥18 years with a primary diagnosis of depression or mixed anxiety and depressive disorder. Random effects meta-regression was used to estimate regression coefficients with 95% confidence intervals (CIs) between study level covariates and depressive symptoms and relative risk (95% CI) and anti-depressant use. The association between anti-depressant use and improvement in depression was also explored. Seventy four trials were identified (85 comparisons, across 21,345 participants). Collaborative care that included psychological interventions predicted improvement in depression (β coefficient -0.11, 95% CI -0.20 to -0.01, p = 0.03). Systematic identification of patients (relative risk 1.43, 95% CI 1.12 to 1.81, p = 0.004) and the presence of a chronic physical condition (relative risk 1.32, 95% CI 1.05 to 1.65, p = 0.02) predicted use of anti-depressant medication.
  
  
  CONCLUSIONS
  Trials of collaborative care that included psychological treatment, with or without anti-depressant medication, appeared to improve depression more than those without psychological treatment. Trials that used systematic methods to identify patients with depression and also trials that included patients with a chronic physical condition reported improved use of anti-depressant medication. However, these findings are limited by the observational nature of meta-regression, incomplete data reporting, and the use of study aggregates.
authors.affiliation: Collaboration for Leadership in Applied Health Research and Care, Centre for Primary Care and Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Coventry
authors.affiliation: Health Psychology Section, Psychology Department, Institute of Psychiatry, King's College London, London, United Kingdom.
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Hudson
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care and Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kontopantelis
authors.affiliation: School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom.
authors.forename: Janine
authors.initials: J
authors.lastname: Archer
authors.affiliation: Institute of Health Service Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom.
authors.forename: David A
authors.initials: DA
authors.lastname: Richards
authors.affiliation: Mental Health Research Group, Department of Health Sciences and Hull York Medical School, University of York, York, United Kingdom.
authors.forename: Simon
authors.initials: S
authors.lastname: Gilbody
authors.affiliation: School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, United Kingdom.
authors.forename: Karina
authors.initials: K
authors.lastname: Lovell
authors.affiliation: Institute of Health Service Research, University of Exeter Medical School, University of Exeter, Exeter, United Kingdom.
authors.forename: Chris
authors.initials: C
authors.lastname: Dickens
authors.affiliation: Collaboration for Leadership in Applied Health Research and Care, Centre for Primary Care and Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Linda
authors.initials: L
authors.lastname: Gask
authors.affiliation: Lancashire Care NHS Foundation Trust, Preston, United Kingdom.
authors.forename: Waquas
authors.initials: W
authors.lastname: Waheed
authors.affiliation: NIHR School for Primary Care Research, Centre for Primary Care and Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D003299:Cooperative Behavior; D003863:Depression / Q000188:drug therapy*; D006801:Humans; D016032:Randomized Controlled Trials as Topic
chemical_list: D000928:Antidepressive Agents