title: Does collaborative care improve social functioning in adults with depression? The application of the WHO ICF framework and meta-analysis of outcomes.
abstract: BACKGROUND
  Collaborative care has proven efficacy in improving symptoms of depression, yet patients value improvements in their social function also. We used the World Health Organisation's International classification of functioning, disability, and health (WHO ICF) to robustly identify measures of social function and explored whether collaborative care interventions improve social functioning using meta-analysis.
  
  
  METHODS
  We performed a secondary data analysis on studies identified from our previous Cochrane review of collaborative care interventions for depression and search update (December 2013). The WHO ICF framework was applied to identify studies that included self-report measures of social functioning. Outcomes were extracted at short-term (6 months) and medium-term (≥7 months) and analysed using random-effects meta-analysis. The relationship between improvements in depression outcomes and improvements in social functioning was also explored using bivarable meta-regression.
  
  
  RESULTS
  Eighteen trials were identified that measured social functioning and met our remaining inclusion criteria. Collaborative care was associated with small improvements in social functioning in the short (Standardised Mean Difference, SMD=0.23, 95% confidence interval 0.12 to 0.34) and medium term (SMD=0.19, 95% confidence interval 0.09 to 0.29). Improvements in depressive symptoms were associated with moderate improvements in social function (ß=-0.55, 95% confidence interval -0.82 to -0.28) but cross-sectionally only.
  
  
  CONCLUSIONS
  The small number of studies (N=18) prevented more complex analyses to explore moderators of social functioning outcomes.
  
  
  CONCLUSIONS
  Collaborative care improves social functioning but the mechanisms through which this occurs are unknown. Future depression interventions need to consider a person's degree of social function equally alongside their depressive symptoms.
authors.affiliation: Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK; NIHR School for Primary Care Research and Manchester Academic Health Science Centre University of Manchester, UK.
authors.forename: Joanna L
authors.initials: JL
authors.lastname: Hudson
authors.affiliation: NIHR School for Primary Care Research and Manchester Academic Health Science Centre University of Manchester, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
authors.affiliation: School of Nursing, Midwifery & Social Work, University of Manchester, Manchester M13 9PL, UK.
authors.forename: Janine
authors.initials: J
authors.lastname: Archer
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) - Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, UK. Electronic address: peter.a.coventry@manchester.ac.uk.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Coventry
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008297:Male; D012917:Social Adjustment
keywords: Collaborative care; Depression; Social functioning; Systematic review