This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (51)  • Contact me when this article is cited  Related Content  • Related letters  • Related article  • Similar articles in this journal  Topic Collections  • Psychiatry  • Depression  • Evidence-Based Medicine  • Prognosis/ Outcomes  • Alert me on articles by topic

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.

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

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  

Antidepressant Use in Black and White Populations in the United States
Gonzalez et al.
Psychiatr. Serv. 2008;59:1131-1138.
ABSTRACT | FULL TEXT  

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  

Depression and Ischemic Heart Disease Mortality: Evidence From the EPIC-Norfolk United Kingdom Prospective Cohort Study
Surtees et al.
Am. J. Psychiatry 2008;165:515-523.
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  

Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq
Hoge et al.
NEJM 2008;358:453-463.
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  

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