Association between chronic physical conditions and the effectiveness of collaborative care for depression: An individual participant data meta-analysis

M. Panagioti, P. Bower, E. Konopantelis, K. Lovell, S. Gilbody, W. Waheed, C. Dickens, J. Archer, G. Simon, K. Ell, J.C. Huffman, D.A. Richards, C.M. van der Feltz-Cornelis, D.A. Adler, M. Bruce, M. Buszewicz, M.G. Cole, K.W. Davidson, P. de Jonge, J. GensichenK. Huijbregts, M. Menchetti, V. Patel, B. Rollman, J. Schaffer, M.C. Zijlstra-Vlasveld, P.A. Coventry

Research output: Contribution to journalArticleScientificpeer-review

Abstract

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.
Original languageEnglish
Pages (from-to)978-989
JournalJAMA Psychiatry
Volume73
Issue number9
DOIs
Publication statusPublished - Aug 2016

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Depression
Panic
Information Storage and Retrieval
Case Management
PubMed
MEDLINE
Comorbidity
Mental Health
Delivery of Health Care
Physicians

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Panagioti, M. ; Bower, P. ; Konopantelis, E. ; Lovell, K. ; Gilbody, S. ; Waheed, W. ; Dickens, C. ; Archer, J. ; Simon, G. ; Ell, K. ; Huffman, J.C. ; Richards, D.A. ; van der Feltz-Cornelis, C.M. ; Adler, D.A. ; Bruce, M. ; Buszewicz, M. ; Cole, M.G. ; Davidson, K.W. ; de Jonge, P. ; Gensichen, J. ; Huijbregts, K. ; Menchetti, M. ; Patel, V. ; Rollman, B. ; Schaffer, J. ; Zijlstra-Vlasveld, M.C. ; Coventry, P.A. / Association between chronic physical conditions and the effectiveness of collaborative care for depression : An individual participant data meta-analysis. In: JAMA Psychiatry. 2016 ; Vol. 73, No. 9. pp. 978-989.
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title = "Association between chronic physical conditions and the effectiveness of collaborative care for depression: An individual participant data meta-analysis",
abstract = "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.",
author = "M. Panagioti and P. Bower and E. Konopantelis and K. Lovell and S. Gilbody and W. Waheed and C. Dickens and J. Archer and G. Simon and K. Ell and J.C. Huffman and D.A. Richards and {van der Feltz-Cornelis}, C.M. and D.A. Adler and M. Bruce and M. Buszewicz and M.G. Cole and K.W. Davidson and {de Jonge}, P. and J. Gensichen and K. Huijbregts and M. Menchetti and V. Patel and B. Rollman and J. Schaffer and M.C. Zijlstra-Vlasveld and P.A. Coventry",
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language = "English",
volume = "73",
pages = "978--989",
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}

Panagioti, M, Bower, P, Konopantelis, E, Lovell, K, Gilbody, S, Waheed, W, Dickens, C, Archer, J, Simon, G, Ell, K, Huffman, JC, Richards, DA, van der Feltz-Cornelis, CM, Adler, DA, Bruce, M, Buszewicz, M, Cole, MG, Davidson, KW, de Jonge, P, Gensichen, J, Huijbregts, K, Menchetti, M, Patel, V, Rollman, B, Schaffer, J, Zijlstra-Vlasveld, MC & Coventry, PA 2016, 'Association between chronic physical conditions and the effectiveness of collaborative care for depression: An individual participant data meta-analysis', JAMA Psychiatry, vol. 73, no. 9, pp. 978-989. https://doi.org/10.1001/jamapsychiatry.2016.1794

Association between chronic physical conditions and the effectiveness of collaborative care for depression : An individual participant data meta-analysis. / Panagioti, M. ; Bower, P.; Konopantelis, E.; Lovell, K.; Gilbody, S. ; Waheed, W.; Dickens, C.; Archer, J.; Simon, G.; Ell, K.; Huffman, J.C.; Richards, D.A.; van der Feltz-Cornelis, C.M.; Adler, D.A. ; Bruce, M.; Buszewicz, M.; Cole, M.G.; Davidson, K.W.; de Jonge, P.; Gensichen, J.; Huijbregts, K.; Menchetti, M.; Patel, V.; Rollman, B.; Schaffer, J.; Zijlstra-Vlasveld, M.C.; Coventry, P.A.

In: JAMA Psychiatry, Vol. 73, No. 9, 08.2016, p. 978-989.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Association between chronic physical conditions and the effectiveness of collaborative care for depression

T2 - An individual participant data meta-analysis

AU - Panagioti, M.

AU - Bower, P.

AU - Konopantelis, E.

AU - Lovell, K.

AU - Gilbody, S.

AU - Waheed, W.

AU - Dickens, C.

AU - Archer, J.

AU - Simon, G.

AU - Ell, K.

AU - Huffman, J.C.

AU - Richards, D.A.

AU - van der Feltz-Cornelis, C.M.

AU - Adler, D.A.

AU - Bruce, M.

AU - Buszewicz, M.

AU - Cole, M.G.

AU - Davidson, K.W.

AU - de Jonge, P.

AU - Gensichen, J.

AU - Huijbregts, K.

AU - Menchetti, M.

AU - Patel, V.

AU - Rollman, B.

AU - Schaffer, J.

AU - Zijlstra-Vlasveld, M.C.

AU - Coventry, P.A.

PY - 2016/8

Y1 - 2016/8

N2 - 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.

AB - 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.

U2 - 10.1001/jamapsychiatry.2016.1794

DO - 10.1001/jamapsychiatry.2016.1794

M3 - Article

VL - 73

SP - 978

EP - 989

JO - JAMA Psychiatry

JF - JAMA Psychiatry

SN - 2168-6238

IS - 9

ER -