title: Collaborative care for comorbid depression and coronary heart disease: a systematic review and meta-analysis of randomised controlled trials.
abstract: OBJECTIVE
  To systematically review the efficacy of collaborative care (CC) for depression in adults with coronary heart disease (CHD) and depression.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  Electronic databases (Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, PsycINFO and CINAHL) were searched until April 2014.
  
  
  METHODS
  Population, depression comorbid with CHD; intervention, randomised controlled trial (RCT) of CC; comparison, either usual care, wait-list control group or no further treatment; and outcome, (primary) major adverse cardiac events (MACE), (secondary) standardised measure of depression, anxiety, quality of life (QOL) and cost-effectiveness.
  
  
  METHODS
  RevMan V.5.3 was used to synthesise the data as risk ratios (RRs), ORs and standardised mean differences (SMD) with 95% CIs in random effect models.
  
  
  RESULTS
  Six RCTs met the inclusion criteria and comprised 655 participants randomised to CC and 629 participants randomised to the control group (total 1284). Collaborative depression care led to a significant reduction in MACE in the short term (three trials, RR 0.54; 95% CI 0.31 to 0.95, p=0.03) that was not sustained in the longer term. Small reductions in depressive symptoms were evident in the short term (6 trials, pooled SMD -0.31; 95% CI -0.43 to -0.19, p<0.00001) and depression remission was more likely to be achieved with CC (5 trials, OR 1.77; 95% CI 1.28 to 2.44, p=0.0005). Likewise, a significant effect was observed for anxiety symptoms (SMD -0.36) and mental QOL (SMD 0.24). The timing of the intervention was a source of between-group heterogeneity for depression symptoms (between groups p=0.04, I(2)=76.5%).
  
  
  CONCLUSIONS
  Collaborative depression care did not lead to a sustained reduction in the primary MACE end point. Small effects were observed for depression, depression remission, anxiety and mental QOL.
  
  
  BACKGROUND
  PROSPERO CRD42014013653.
authors.affiliation: Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia INSERM, U897-Epidemiology and Biostatistics, Bordeaux, France.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Tully
authors.affiliation: Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg, Germany Faculty of Medicine, Medical Psychology and Medical Sociology, University of Freiburg, Freiburg, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Baumeister
mesh_terms: D001007:Anxiety / Q000175:diagnosis* / Q000628:therapy; D019090:Case Management / Q000458:organization & administration*; D015897:Comorbidity; D003299:Cooperative Behavior; D003324:Coronary Artery Disease / Q000150:complications*; D003863:Depression / Q000175:diagnosis* / Q000628:therapy; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration; D011613:Psychotherapy / Q000379:methods; D017594:Publication Bias; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
keywords: CARDIOLOGY; MENTAL HEALTH