Association Between Chronic Physical Conditions and the Effectiveness of Collaborative Care for Depression: An Individual Participant Data Meta-analysis.
OBJECTIVE
Collaborative care is an intensive care model involving several health care professionals working together, typically a physician, a case manager, and a mental health professional. Meta-analyses of aggregate data have shown that collaborative care is particularly effective in people with depression and comorbid chronic physical conditions. However, only participant-level analyses can rigorously test whether the treatment effect is influenced by participant characteristics, such as chronic physical conditions.


OBJECTIVE
To assess whether the effectiveness of collaborative care for depression is moderated by the presence, type, and number of chronic physical conditions.


METHODS
Data were obtained from MEDLINE, EMBASE, PubMed, PsycINFO, CINAHL Complete, and Cochrane Central Register of Controlled Trials, and references from relevant systematic reviews. The search and collection of eligible studies was ongoing until May 22, 2015.


METHODS
This was an update to a previous meta-analysis. Two independent reviewers were involved in the study selection process. Randomized clinical trials that compared the effectiveness of collaborative care with usual care in adults with depression and reported measured changes in depression severity symptoms at 4 to 6 months after randomization were included in the analysis. Key search terms included depression, dysthymia, anxiety, panic, phobia, obsession, compulsion, posttraumatic, care management, case management, collaborative care, enhanced care, and managed care.


METHODS
Individual participant data on baseline demographics and chronic physical conditions as well as baseline and follow-up depression severity symptoms were requested from authors of the eligible studies. One-step meta-analysis of individual participant data using appropriate mixed-effects models was performed.


METHODS
Continuous outcomes of depression severity symptoms measured using self-reported or observer-rated measures.


RESULTS
Data sets from 31 randomized clinical trials including 36 independent comparisons (N = 10 962 participants) were analyzed. Individual participant data analyses found no significant interaction effects, indicating that the presence (interaction coefficient, 0.02 [95% CI, -0.10 to 0.13]), numbers (interaction coefficient, 0.01 [95% CI, -0.01 to 0.02]), and types of chronic physical conditions do not influence the treatment effect.


CONCLUSIONS
There is evidence that collaborative care is effective for people with depression alone and also for people with depression and chronic physical conditions. Existing guidance that recommends limiting collaborative care to people with depression and physical comorbidities is not supported by this individual participant data meta-analysis.
National Institute of Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, England.
Maria
M
Panagioti
National Institute of Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, England.
Peter
P
Bower
National Institute of Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, England.
Evangelos
E
Kontopantelis
School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, England.
Karina
K
Lovell
Mental Health and Addiction Research Group, Department of Health Sciences, Hull York Medical School, University of York, York, England.
Simon
S
Gilbody
National Institute of Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, England.
Waquas
W
Waheed
Institute of Health Research, University of Exeter Medical School, Exeter, England 5National Institute of Health Research Collaboration for Leadership in Applied Health Research and Care for the South West Peninsula, University of Exeter, Exeter, England.
Chris
C
Dickens
School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, England.
Janine
J
Archer
Group Health Research Institute, Seattle, Washington.
Gregory
G
Simon
Ethnicity and Poverty, School of Social Work, University of Southern California, Los Angeles.
Kathleen
K
Ell
Harvard Medical School, General Hospital/Blake 11, Boston, Massachusetts.
Jeff C
JC
Huffman
Institute of Health Research, University of Exeter Medical School, Exeter, England.
David A
DA
Richards
Department of Psychiatry and Behavioral Sciences, Faculty of Social and Behavioral Sciences, Tilburg University, the Netherlands.
Christina
C
van der Feltz-Cornelis
Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts.
David A
DA
Adler
Department of Psychiatry, Weill Cornell Medical College, White Plains, New York.
Martha
M
Bruce
Institute of Epidemiology and Health, Faculty of Population and Health Sciences, University College London, London, England.
Marta
M
Buszewicz
Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada.
Martin G
MG
Cole
Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University, New York, New York.
Karina W
KW
Davidson
Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, the Netherlands.
Peter
P
de Jonge
Institute of General Practice, Friedrich-Schiller-University, School of Medicine, University Hospital, Jena, Germany.
Jochen
J
Gensichen
Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, the Netherlands.
Klaas
K
Huijbregts
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Marco
M
Menchetti
Public Health Foundation of India, Gurgaon, India.
Vikram
V
Patel
Psychiatry, Biomedical Informatics, and Clinical and Translational Science, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania.
Bruce
B
Rollman
Department of Psychology, University of Colorado, Denver.
Jonathan
J
Shaffer
Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, the Netherlands.
Moniek C
MC
Zijlstra-Vlasveld
Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, England23Centre for Reviews and Dissemination, University of York, York, England.
Peter A
PA
Coventry
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D002908:Chronic Disease / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011320:Primary Health Care; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D055815:Young Adult