Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials.

<h4>Background</h4>Collaborative care is a complex intervention based on chronic disease management models and is effective in the management of depression. However, there is still uncertainty about which components of collaborative care are effective. We used meta-regression to identify...

Descripción completa

Guardado en:
Detalles Bibliográficos
Autores principales: Peter A Coventry, Joanna L Hudson, Evangelos Kontopantelis, Janine Archer, David A Richards, Simon Gilbody, Karina Lovell, Chris Dickens, Linda Gask, Waquas Waheed, Peter Bower
Formato: article
Lenguaje:EN
Publicado: Public Library of Science (PLoS) 2014
Materias:
R
Q
Acceso en línea:https://doaj.org/article/945037cd42e842aa8139726c7fa6cef9
Etiquetas: Agregar Etiqueta
Sin Etiquetas, Sea el primero en etiquetar este registro!
id oai:doaj.org-article:945037cd42e842aa8139726c7fa6cef9
record_format dspace
spelling oai:doaj.org-article:945037cd42e842aa8139726c7fa6cef92021-11-25T05:59:02ZCharacteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials.1932-620310.1371/journal.pone.0108114https://doaj.org/article/945037cd42e842aa8139726c7fa6cef92014-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0108114https://doaj.org/toc/1932-6203<h4>Background</h4>Collaborative care is a complex intervention based on chronic disease management models and is effective in the management of depression. However, there is still uncertainty about which components of collaborative care are effective. We used meta-regression to identify factors in collaborative care associated with improvement in patient outcomes (depressive symptoms) and the process of care (use of anti-depressant medication).<h4>Methods and findings</h4>Systematic review with meta-regression. The Cochrane Collaboration Depression, Anxiety and Neurosis Group trials registers were searched from inception to 9th February 2012. An update was run in the CENTRAL trials database on 29th December 2013. Inclusion criteria were: randomised controlled trials of collaborative care for adults ≥18 years with a primary diagnosis of depression or mixed anxiety and depressive disorder. Random effects meta-regression was used to estimate regression coefficients with 95% confidence intervals (CIs) between study level covariates and depressive symptoms and relative risk (95% CI) and anti-depressant use. The association between anti-depressant use and improvement in depression was also explored. Seventy four trials were identified (85 comparisons, across 21,345 participants). Collaborative care that included psychological interventions predicted improvement in depression (β coefficient -0.11, 95% CI -0.20 to -0.01, p = 0.03). Systematic identification of patients (relative risk 1.43, 95% CI 1.12 to 1.81, p = 0.004) and the presence of a chronic physical condition (relative risk 1.32, 95% CI 1.05 to 1.65, p = 0.02) predicted use of anti-depressant medication.<h4>Conclusion</h4>Trials of collaborative care that included psychological treatment, with or without anti-depressant medication, appeared to improve depression more than those without psychological treatment. Trials that used systematic methods to identify patients with depression and also trials that included patients with a chronic physical condition reported improved use of anti-depressant medication. However, these findings are limited by the observational nature of meta-regression, incomplete data reporting, and the use of study aggregates.Peter A CoventryJoanna L HudsonEvangelos KontopantelisJanine ArcherDavid A RichardsSimon GilbodyKarina LovellChris DickensLinda GaskWaquas WaheedPeter BowerPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 9, p e108114 (2014)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Peter A Coventry
Joanna L Hudson
Evangelos Kontopantelis
Janine Archer
David A Richards
Simon Gilbody
Karina Lovell
Chris Dickens
Linda Gask
Waquas Waheed
Peter Bower
Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials.
description <h4>Background</h4>Collaborative care is a complex intervention based on chronic disease management models and is effective in the management of depression. However, there is still uncertainty about which components of collaborative care are effective. We used meta-regression to identify factors in collaborative care associated with improvement in patient outcomes (depressive symptoms) and the process of care (use of anti-depressant medication).<h4>Methods and findings</h4>Systematic review with meta-regression. The Cochrane Collaboration Depression, Anxiety and Neurosis Group trials registers were searched from inception to 9th February 2012. An update was run in the CENTRAL trials database on 29th December 2013. Inclusion criteria were: randomised controlled trials of collaborative care for adults ≥18 years with a primary diagnosis of depression or mixed anxiety and depressive disorder. Random effects meta-regression was used to estimate regression coefficients with 95% confidence intervals (CIs) between study level covariates and depressive symptoms and relative risk (95% CI) and anti-depressant use. The association between anti-depressant use and improvement in depression was also explored. Seventy four trials were identified (85 comparisons, across 21,345 participants). Collaborative care that included psychological interventions predicted improvement in depression (β coefficient -0.11, 95% CI -0.20 to -0.01, p = 0.03). Systematic identification of patients (relative risk 1.43, 95% CI 1.12 to 1.81, p = 0.004) and the presence of a chronic physical condition (relative risk 1.32, 95% CI 1.05 to 1.65, p = 0.02) predicted use of anti-depressant medication.<h4>Conclusion</h4>Trials of collaborative care that included psychological treatment, with or without anti-depressant medication, appeared to improve depression more than those without psychological treatment. Trials that used systematic methods to identify patients with depression and also trials that included patients with a chronic physical condition reported improved use of anti-depressant medication. However, these findings are limited by the observational nature of meta-regression, incomplete data reporting, and the use of study aggregates.
format article
author Peter A Coventry
Joanna L Hudson
Evangelos Kontopantelis
Janine Archer
David A Richards
Simon Gilbody
Karina Lovell
Chris Dickens
Linda Gask
Waquas Waheed
Peter Bower
author_facet Peter A Coventry
Joanna L Hudson
Evangelos Kontopantelis
Janine Archer
David A Richards
Simon Gilbody
Karina Lovell
Chris Dickens
Linda Gask
Waquas Waheed
Peter Bower
author_sort Peter A Coventry
title Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials.
title_short Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials.
title_full Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials.
title_fullStr Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials.
title_full_unstemmed Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials.
title_sort characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials.
publisher Public Library of Science (PLoS)
publishDate 2014
url https://doaj.org/article/945037cd42e842aa8139726c7fa6cef9
work_keys_str_mv AT peteracoventry characteristicsofeffectivecollaborativecarefortreatmentofdepressionasystematicreviewandmetaregressionof74randomisedcontrolledtrials
AT joannalhudson characteristicsofeffectivecollaborativecarefortreatmentofdepressionasystematicreviewandmetaregressionof74randomisedcontrolledtrials
AT evangeloskontopantelis characteristicsofeffectivecollaborativecarefortreatmentofdepressionasystematicreviewandmetaregressionof74randomisedcontrolledtrials
AT janinearcher characteristicsofeffectivecollaborativecarefortreatmentofdepressionasystematicreviewandmetaregressionof74randomisedcontrolledtrials
AT davidarichards characteristicsofeffectivecollaborativecarefortreatmentofdepressionasystematicreviewandmetaregressionof74randomisedcontrolledtrials
AT simongilbody characteristicsofeffectivecollaborativecarefortreatmentofdepressionasystematicreviewandmetaregressionof74randomisedcontrolledtrials
AT karinalovell characteristicsofeffectivecollaborativecarefortreatmentofdepressionasystematicreviewandmetaregressionof74randomisedcontrolledtrials
AT chrisdickens characteristicsofeffectivecollaborativecarefortreatmentofdepressionasystematicreviewandmetaregressionof74randomisedcontrolledtrials
AT lindagask characteristicsofeffectivecollaborativecarefortreatmentofdepressionasystematicreviewandmetaregressionof74randomisedcontrolledtrials
AT waquaswaheed characteristicsofeffectivecollaborativecarefortreatmentofdepressionasystematicreviewandmetaregressionof74randomisedcontrolledtrials
AT peterbower characteristicsofeffectivecollaborativecarefortreatmentofdepressionasystematicreviewandmetaregressionof74randomisedcontrolledtrials
_version_ 1718414355389743104