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Original Investigation
September 2016

Association Between Chronic Physical Conditions and the Effectiveness of Collaborative Care for DepressionAn Individual Participant Data Meta-analysis

Author Affiliations
  • 1National Institute of Health Research School for Primary Care Research, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, England
  • 2School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, England
  • 3Mental Health and Addiction Research Group, Department of Health Sciences, Hull York Medical School, University of York, York, England
  • 4Institute 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
  • 6Group Health Research Institute, Seattle, Washington
  • 7Ethnicity and Poverty, School of Social Work, University of Southern California, Los Angeles
  • 8Harvard Medical School, General Hospital/Blake 11, Boston, Massachusetts
  • 9Department of Psychiatry and Behavioral Sciences, Faculty of Social and Behavioral Sciences, Tilburg University, the Netherlands
  • 10Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts
  • 11Department of Psychiatry, Weill Cornell Medical College, White Plains, New York
  • 12Institute of Epidemiology and Health, Faculty of Population and Health Sciences, University College London, London, England
  • 13Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada
  • 14Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University, New York, New York
  • 15Interdisciplinary Center Psychopathology and Emotion Regulation, University Medical Center Groningen, Groningen, the Netherlands
  • 16Institute of General Practice, Friedrich-Schiller-University, School of Medicine, University Hospital, Jena, Germany
  • 17Netherlands Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, the Netherlands
  • 18Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
  • 19Public Health Foundation of India, Gurgaon, India
  • 20Psychiatry, Biomedical Informatics, and Clinical and Translational Science, Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 21Department of Psychology, University of Colorado, Denver
  • 22Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, England
  • 23Centre for Reviews and Dissemination, University of York, York, England

Copyright 2016 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

JAMA Psychiatry. 2016;73(9):978-989. doi:10.1001/jamapsychiatry.2016.1794

Importance  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.

Data Sources  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.

Study Selection  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.

Data Extraction and Synthesis  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.

Main Outcomes and Measures  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 and Relevance  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.