• Online Features  This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (250)  • Contact me when this article is cited  Related Content  • Related letters  • Related article  • Similar articles in this journal  Topic Collections  • Psychiatry  • Depression  • Quality of Care  • Evidence-Based Medicine  • Prognosis/ Outcomes  • Alert me on articles by topic  Social Bookmarking   What's this?

A Cumulative Meta-analysis and Review of Longer-term Outcomes

Simon Gilbody, MBChB, MRCPsych, DPhil; Peter Bower, PhD; Janine Fletcher, MSc; David Richards, PhD; Alex J. Sutton, PhD

Arch Intern Med. 2006;166:2314-2321.

Background  Depression is common in primary care but is suboptimally managed. Collaborative care, that is, structured care involving a greater role of nonmedical specialists to augment primary care, has emerged as a potentially effective candidate intervention to improve quality of primary care and patient outcomes.

Methods  To quantify the short-term and longer-term effectiveness of collaborative care compared with standard care and to understand mechanisms of action by exploring between-study heterogeneity, we conducted a systematic review of randomized controlled trials that compared collaborative care with usual primary care in patients with depression. We searched MEDLINE (from the beginning of 1966), EMBASE (from the beginning of 1980), CINAHL (from the beginning of 1980), PsycINFO (from the beginning of 1980), the Cochrane Library (from the beginning of 1966), and DARE (Database of Abstracts of Reviews of Effectiveness) (from the beginning of 1985) databases from study inception to February 6, 2006.

Results  We found 37 randomized studies including 12 355 patients with depression receiving primary care. Random effects meta-analysis showed that depression outcomes were improved at 6 months (standardized mean difference, 0.25; 95% confidence interval, 0.18-0.32), and evidence of longer-term benefit was found for up to 5 years (standardized mean difference, 0.15; 95% confidence interval, 0.001-0.31). When exploring determinants of effectiveness, effect size was directly related to medication compliance and to the professional background and method of supervision of case managers. The addition of brief psychotherapy did not substantially improve outcome, nor did increased numbers of sessions. Cumulative meta-analysis showed that sufficient evidence had emerged by 2000 to demonstrate the statistically significant benefit of collaborative care.

Conclusions  Collaborative care is more effective than standard care in improving depression outcomes in the short and longer terms. Future research needs to address the implementation of collaborative care, particularly in settings other than the United States.

Author Affiliations: Department of Health Sciences, University of York, York (Drs Gilbody and Richards); National Primary Care Research and Development Centre (Dr Bower) and School of Nursing and Midwifery (Ms Fletcher), University of Manchester, Manchester; and Department of Health Sciences, University of Leicester, Leicester (Dr Sutton); England.

CiteULike    Connotea    Delicious    Digg    Facebook    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Clarification of Study and Citation
Patrick R. Finley and Lisa Bero
Arch Intern Med. 2007;167(22):2531.
EXTRACT | FULL TEXT  

Clarification of Study and Citation—Reply
Simon Gilbody, Peter Bower, Alex Sutton, Janine Fletcher, and David Richards
Arch Intern Med. 2007;167(22):2531-2532.
EXTRACT | FULL TEXT  

Misleading Report on the Prevention of Major Depression Among Patients With Head and Neck Cancer
James C. Coyne
Arch Otolaryngol Head Neck Surg. 2008;134(12):1345.
EXTRACT | FULL TEXT  

RELATED ARTICLE

Collaborative Care Models for Depression: Time to Move From Evidence to Practice
Wayne Katon and Jürgen Unützer
Arch Intern Med. 2006;166(21):2304-2306.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Postpartum depression screening: a Comment on Leung et al.
Thombs
J Public Health (Oxf) 2012;0:fdr110v1-fdr110.
FULL TEXT  

Newer antidepressants for the treatment of depression in adults
Hatcher and Arroll
BMJ 2012;344:d8300-d8300.
FULL TEXT  

Treatment Adjustment and Medication Adherence for Complex Patients With Diabetes, Heart Disease, and Depression: A Randomized Controlled Trial
Lin et al.
Ann Fam Med 2012;10:6-14.
ABSTRACT | FULL TEXT  

Ten-Year Trends in Quality of Care and Spending for Depression: 1996 Through 2005
Fullerton et al.
Arch Gen Psychiatry 2011;68:1218-1226.
ABSTRACT | FULL TEXT  

Variations in depression care and outcomes among high-risk mothers from different racial/ethnic groups
Huang et al.
Fam Pract 2011;0:cmr108v1-cmr108.
ABSTRACT | FULL TEXT  

Antidepressant non-adherence is common among veterans, with ineffectiveness and side effects as commonly reported reasons
Zivin
Evid. Based Ment. Health 2011;14:91-91.
FULL TEXT  

Practice-based depression case management in primary care: a qualitative study on family doctors' perspectives
Gensichen et al.
Fam Pract 2011;28:565-571.
ABSTRACT | FULL TEXT  

Evidence-based clinical guidelines for immigrants and refugees
Pottie et al.
CMAJ 2011;183:E824-E925.
FULL TEXT  

Accuracy and Prognostic Value of American Heart Association-Recommended Depression Screening in Patients With Coronary Heart Disease: Data From the Heart and Soul Study
Elderon et al.
Circ Cardiovasc Qual Outcomes 2011;4:533-540.
ABSTRACT | FULL TEXT  

Interventions for War-Related Posttraumatic Stress Disorder: Meeting Veterans Where They Are
Hoge
JAMA 2011;306:549-551.
FULL TEXT  

The Bypassing the Blues trial: Collaborative care for post-CABG depression and implications for future research
ROLLMAN and HERBECK BELNAP
Cleveland Clinic Journal of Medicine 2011;78:S4-S12.
ABSTRACT | FULL TEXT  

Seizing Interdisciplinary Opportunities in the Changing Landscape of Health and Aging: A Social Work Perspective
Berkman
The Gerontologist 2011;51:433-440.
ABSTRACT | FULL TEXT  

Proportion Of Antidepressants Prescribed Without A Psychiatric Diagnosis Is Growing
Mojtabai and Olfson
Health Aff (Millwood) 2011;30:1434-1442.
ABSTRACT | FULL TEXT  

Randomized controlled trial of a collaborative care intervention to manage cancer-related symptoms: lessons learned
Steel et al.
Clin Trials 2011;8:298-310.
ABSTRACT | FULL TEXT  

Collaborative Depression Care Management and Disparities in Depression Treatment and Outcomes
Bao et al.
Arch Gen Psychiatry 2011;68:627-636.
ABSTRACT | FULL TEXT  

Increased Anxiety and Length of Treatment Associated With Depressed Patients Who are Readmitted to Collaborative Care
Angstman et al.
Journal of Primary Care & Community Health 2011;2:82-86.
ABSTRACT  

Impact of a Depression Care Management Program for Hospitalized Cardiac Patients
Huffman et al.
Circ Cardiovasc Qual Outcomes 2011;4:198-205.
ABSTRACT | FULL TEXT  

Ways of working at the interface between primary and specialist mental healthcare
Gask and Khanna
Br. J. Psychiatry 2011;198:3-5.
FULL TEXT  

Effectiveness of Pharmacist Care in the Improvement of Adherence to Antidepressants: A Systematic Review and Meta-Analysis
Rubio-Valera et al.
The Annals of Pharmacotherapy 2011;45:39-48.
ABSTRACT | FULL TEXT  

Destiny Is Now
Guccione
ptjournal 2010;90:1678-1690.
FULL TEXT  

Postpartum Depression Screening: Initial Implementation in a Multispecialty Practice With Collaborative Care Managers
Wichman et al.
Journal of Primary Care & Community Health 2010;1:158-163.
ABSTRACT  

Update in Palliative Medicine
Fromme et al.
AM J HOSP PALLIAT CARE 2010;27:420-427.
 

Effects of befriending on depressive symptoms: a precautionary note on promising findings
El-Baalbaki et al.
Br. J. Psychiatry 2010;197:247-247.
FULL TEXT  

Effect of Telecare Management on Pain and Depression in Patients With Cancer: A Randomized Trial
Kroenke et al.
JAMA 2010;304:163-171.
ABSTRACT | FULL TEXT  

Collaborative Care Management for Depression: Comparison of Cost Metrics and Clinical Response to Usual Care
Angstman et al.
Journal of Primary Care & Community Health 2010;1:73-77.
ABSTRACT  

The American Heart Association science advisory on depression and coronary heart disease: An exploration of the issues raised
BIGGER and GLASSMAN
Cleveland Clinic Journal of Medicine 2010;77:S12-S19.
ABSTRACT | FULL TEXT  

Barriers to Physical and Mental Condition Integrated Service Delivery
Kathol et al.
Psychosom. Med. 2010;72:511-518.
ABSTRACT | FULL TEXT  

Rates of Major Depressive Disorder and Clinical Outcomes Following Traumatic Brain Injury
Bombardier et al.
JAMA 2010;303:1938-1945.
ABSTRACT | FULL TEXT  

Interdisciplinary Stepped Care for Depression After Acute Coronary Syndrome
Whooley and Unutzer
Arch Intern Med 2010;170:585-586.
FULL TEXT  

Collaborative Care for Post-CABG Depression--Reply
Rollman et al.
JAMA 2010;303:1252-1253.
FULL TEXT  

Patients in a Depression Collaborative Care Model of Care: Comparison of 6-Month Cost Utilization Data With Usual Care
Angstman and Williams
Journal of Primary Care & Community Health 2010;1:12-16.
ABSTRACT  

Polyclinics and psychiatry: risks and opportunities
Gask et al.
The Psychiatrist 2010;34:106-109.
ABSTRACT | FULL TEXT  

Healthcare assistant case management may reduce depression symptoms in primary care patients with major depression more than usual care
Kendrick
Evid. Based Med. 2010;15:10-11.
FULL TEXT  

Effects of befriending on depressive symptoms and distress: systematic review and meta-analysis
Mead et al.
Br. J. Psychiatry 2010;196:96-101.
ABSTRACT | FULL TEXT  

Depression Care in the United States: Too Little for Too Few
Gonzalez et al.
Arch Gen Psychiatry 2010;67:37-46.
ABSTRACT | FULL TEXT  

Translating Intergenerational Research on Depression Into Clinical Practice
Weissman and Olfson
JAMA 2009;302:2695-2696.
FULL TEXT  

Telephone-Delivered Collaborative Care for Treating Post-CABG Depression: A Randomized Controlled Trial
Rollman et al.
JAMA 2009;302:2095-2103.
ABSTRACT | FULL TEXT  

Incremental Benefit and Cost of Telephone Care Management and Telephone Psychotherapy for Depression in Primary Care
Simon et al.
Arch Gen Psychiatry 2009;66:1081-1089.
ABSTRACT | FULL TEXT  

Case Management for Depression by Health Care Assistants in Small Primary Care Practices: A Cluster Randomized Trial
Gensichen et al.
ANN INTERN MED 2009;151:369-378.
ABSTRACT | FULL TEXT  

Stepped Care Treatment of Postpartum Depression: Impact on Treatment, Health, and Work Outcomes
Gjerdingen et al.
J Am Board Fam Med 2009;22:473-482.
ABSTRACT | FULL TEXT  

To Screen or Not to Screen?: Depression in Patients With Cardiovascular Disease
Whooley
J Am Coll Cardiol 2009;54:891-893.
ABSTRACT | FULL TEXT  

Concurrent Validity of the PSYCH-6, a Very Short Scale for Detecting Anxiety and Depression, Among Oncology Outpatients
Clover et al.
Aust N Z J Psychiatry 2009;43:682-688.
ABSTRACT | FULL TEXT  

Optimized Antidepressant Therapy and Pain Self-management in Primary Care Patients With Depression and Musculoskeletal Pain: A Randomized Controlled Trial
Kroenke et al.
JAMA 2009;301:2099-2110.
ABSTRACT | FULL TEXT  

Improving Mental Health Treatments Through Comparative Effectiveness Research
Wang et al.
Health Aff (Millwood) 2009;28:783-791.
ABSTRACT | FULL TEXT  

Cognitive Behavior Therapy for Generalized Anxiety Disorder Among Older Adults in Primary Care: A Randomized Clinical Trial
Stanley et al.
JAMA 2009;301:1460-1467.
ABSTRACT | FULL TEXT  

The Bypassing the Blues Treatment Protocol: Stepped Collaborative Care for Treating Post-CABG Depression
Rollman et al.
Psychosom. Med. 2009;71:217-230.
ABSTRACT | FULL TEXT  

Primary Care Physicians' Evaluation and Treatment of Depression: Results of an Experimental Study Using Video Vignettes
Epstein et al.
Med Care Res Rev 2008;65:674-695.
ABSTRACT  

Misleading Report on the Prevention of Major Depression Among Patients With Head and Neck Cancer
Coyne
Arch Otolaryngol Head Neck Surg 2008;134:1345-1345.
FULL TEXT  

Depression Screening and Patient Outcomes in Cardiovascular Care: A Systematic Review
Thombs et al.
JAMA 2008;300:2161-2171.
ABSTRACT | FULL TEXT  

Relationship Between the Presence of Practice Systems and the Quality of Care for Depression
Solberg et al.
American Journal of Medical Quality 2008;23:420-426.
ABSTRACT  

Anxiety and Depression in COPD: Current Understanding, Unanswered Questions, and Research Needs
Maurer et al.
Chest 2008;134:43S-56S.
ABSTRACT | FULL TEXT  

So Much to Do, So Little Time: Care for the Socially Disadvantaged and the 15-Minute Visit
Fiscella and Epstein
Arch Intern Med 2008;168:1843-1852.
ABSTRACT | FULL TEXT  

Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2000 British Association for Psychopharmacology guidelines
Anderson et al.
J Psychopharmacol 2008;22:343-396.
ABSTRACT  

Depression in older adults: collaborative care model seems effective
Gilbody
Evid. Based Ment. Health 2008;11:44-44.
FULL TEXT  

Screening and case-finding instruments for depression: a meta-analysis
Gilbody et al.
CMAJ 2008;178:997-1003.
ABSTRACT | FULL TEXT  

Working together: INVITED COMMENTARY ON...THE PRIMARY CARE MANAGEMENT OF ANXIETY AND DEPRESSION
Gask and Lester
Adv. Psychiatr. Treat. 2008;14:106-108.
ABSTRACT | FULL TEXT  

Psychosocial interventions for the prevention of relapse in bipolar disorder: systematic review of controlled trials
Beynon et al.
Br. J. Psychiatry 2008;192:5-11.
ABSTRACT | FULL TEXT  

Clarification of Study and Citation
Finley and Bero
Arch Intern Med 2007;167:2531-2531.
FULL TEXT  

Clarification of Study and Citation Reply
Gilbody et al.
Arch Intern Med 2007;167:2531-2532.
FULL TEXT  

Telephone Screening, Outreach, and Care Management for Depressed Workers and Impact on Clinical and Work Productivity Outcomes: A Randomized Controlled Trial
Wang et al.
JAMA 2007;298:1401-1411.
ABSTRACT | FULL TEXT  

Is depression overdiagnosed? No
Hickie
BMJ 2007;335:329-329.
FULL TEXT  

Review: collaborative care was effective for depression in primary care in the short and longer term
Rubenstein
Evid. Based Med. 2007;12:109-109.
FULL TEXT  

Collaborative care for depression in patients with diabetes increased depression free days and had economic benefit
O'Malley
Evid. Based Med. 2007;12:86-86.
FULL TEXT  

IMPACT collaborative care programme reduces suicide ideation in depressed older adults
Gilbody
Evid. Based Ment. Health 2007;10:51-51.
FULL TEXT  

Anxiety Disorders: Efficient Screening Is the First Step in Improving Outcomes
Katon and Roy-Byrne
ANN INTERN MED 2007;146:390-392.
FULL TEXT  

Regular Symposia
Aust N Z J Psychiatry 2007;41:A133-A213.
FULL TEXT  

Collaborative Care Models for Depression: Time to Move From Evidence to Practice
Katon and Unutzer
Arch Intern Med 2006;166:2304-2306.
FULL TEXT