Collaborative care is effective for adults with depression and anxiety: new Cochrane systematic review

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The new batch of Cochrane systematic reviews are published today and there are a couple of important new mental health reviews that I’ll be blogging about over the next few days. First comes a piece of research looking at the effectiveness of collaborative care for patients with depression or anxiety.

Collaborative care involves a range of different healthcare professionals working with an individual to help them recover. For mental health conditions this team will often involve:

  • A medical doctor
  • A case manager (who will be trained in mental healthcare and will spend the most time with the patient, organising care, medication and/or psychotherapy)
  • A mental health specialist (such as a psychiatrist)

Collaborative care is a relatively well researched area, but this new review brings together the best available research looking at its use in people with depression and anxiety, to provide the most definitive answer to date about its value for people with depression and anxiety.

The reviewers conducted a reliable Cochrane search for randomised controlled trials (RCTs) of collaborative care for participants of all ages with depression or anxiety. Their search cut off point was February 2012. They found 79 RCTs (involving a total of 24,308 patients) to include in their analysis and data was collected and analysed in the usual water-tight Cochrane fashion. The studies varied in terms of quality. Most of them compared collaborative care with usual care or some other alternative treatment like consultation-liaison. The allocation of patients to collaborative care or routine care was sometimes open to bias, and in some trials patients did not complete follow-up or provide information about their outcomes.

Here’s what they found:

  • For adults with depression, collaborative care showed significantly greater improvement compared to usual care in the:
    • Short-term (SMD -0.34, 95% CI -0.41 to -0.27; RR 1.32, 95% CI 1.22 to 1.43)
    • Medium-term (SMD -0.28, 95% CI -0.41 to -0.15; RR 1.31, 95% CI 1.17 to 1.48)
    • Long-term (SMD -0.35, 95% CI -0.46 to – 0.24; RR 1.29, 95% CI 1.18 to 1.41)
    • But not in the very long-term (RR 1.12, 95% CI 0.98 to 1.27)
  • For adults with anxiety, collaborative care showed significantly greater improvement compared to usual care in the:
    • Short-term (SMD -0.30, 95% CI -0.44 to -0.17; RR 1.50, 95% CI 1.21 to 1.87)
    • Medium-term (SMD -0.33, 95% CI -0.47 to -0.19; RR 1.41, 95% CI 1.18 to 1.69)
    • Long-term (SMD -0.20, 95% CI -0.34 to -0.06; RR 1.26, 95% CI 1.11 to 1.42)
    • Very long-term outcomes were not examined by any of the included research

The authors concluded:

Collaborative care is associated with significant improvement in depression and anxiety outcomes compared with usual care, and represents a useful addition to clinical pathways for adult patients with depression and anxiety.

I’ve seen reports today that, in England, the number of registered patients with depression has gone up by 11.5%; a rise of nearly half a million people in the last three years. It’s possible that these numbers are an underestimates, as many people with depression will not present to their GP.  With this in mind, we need to do everything we can to work in a smarter way to help people with common mental health conditions, so evidence such as this new Cochrane review should be food and drink for mental health commissioners and policy-makers.

Link

Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database of Systematic Reviews 2012, Issue 10. Art. No.: CD006525. DOI: 10.1002/14651858.CD006525.pub2.

The great depression: is the UK facing a mental health crisis? SSentif Intelligence, Oct 2012.

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