Collaborative Care to Improve the Management of Depressive Disorders: A Systematic Review and Meta-Analysis

Background Collaborative Care models have developed from the Chronic Care Model over the last twenty years to improve the quality of depression management. Collaborative Care is a multicomponent, healthcare system-level intervention that uses case managers to link primary care providers, patients, and mental health specialists. In addition to case management support, primary care providers receive consultation and decision support from mental health specialists (i.e., psychiatrists, psychologists). This collaboration is designed to 1) improve the routine screening for and diagnosis of depressive disorders; 2) increase provider use of evidence-based protocols for the proactive management of diagnosed depressive disorders; and 3) improve clinical and community support for active client/patient engagement in treatment goal setting and self-management. Objective To examine the effectiveness of Collaborative Care models in improving the management of depression via a systematic review of the literature and a meta-analysis for several depression-related outcomes. Methods An earlier review (Bower et al. 2006) with 37 RCTs of Collaborative Care studies was identified. This body of evidence was updated with a systematic review and a meta-analysis of Collaborative Care studies from 2004 to 2009. This systematic review of the literature and meta-analysis was conceptualized and conducted by a team of subject matter experts in mental health representing various agencies and institutions. This team worked under the guidance of the Task Force on Community Preventive Services, a non-federal, independent, volunteer body of public health and prevention experts. Methods developed at the Guide to Community Preventive Services (Community Guide) of the CDC were employed to identify, evaluate and analyze the evidence available. Results We found 32 studies of Collaborative Care models between 2004 and 2009. The results from the meta-analyses suggest robust evidence of effectiveness of Collaborative Care in improving depression symptoms [Standardized Mean Difference (SMD)=0.34], adherence to treatment [Odds Ratio(OR)=2.22)], response to treatment [OR=1.78], remission of symptoms [OR=1.74], recovery [OR=1.75],quality of life/functional status [SMD=0.12] and satisfaction with care [SMD=0.39] for patients diagnosed with depression (all effect estimates were statistically significant). Conclusion Based on Community Guide rules of evidence, there is strong evidence that collaborative care models are effective in improving depression symptoms, adherence to treatment, response, remission, recovery, quality of life/functional status, and satisfaction with care for depressed patients. Collaborative care models seem to be applicable to a wide-range of populations and settings and organizations that implement them.