TY - JOUR
AU - H. Schillok
AU - J. Gensichen
AU - M. Panagioti
AU - J. Gunn
AU - L. Junker
AU - K. Lukaschek
AU - C. Jung-Sievers
AU - P. Sterner
AU - L. Kaupe
AU - T. Dreischulte
AU - M. K. Ali
AU - E. Aragones
AU - D. B. Bekelman
AU - Herbeck Belnap
AU - R. M. Carney
AU - L. A. Chwastiak
AU - P. A. Coventry
AU - K. W. Davidson
AU - M. L. Ekstrand
AU - A. Flehr
AU - S. Fletcher
AU - L. P. Hölzel
AU - K. Huijbregts
AU - V. Mohan
AU - V. Patel
AU - D. A. Richards
AU - B. L. Rollman
AU - C. Salisbury
AU - G. E. Simon
AU - K. Srinivasan
AU - J. Unutzer
AU - K. B. Wells
AU - T. Zimmermann
AU - M. Bühner
A1 - 
AB - IMPORTANCE: Collaborative care is a multicomponent intervention for patients with chronic disease in primary care. Previous meta-analyses have proven the effectiveness of collaborative care for depression; however, individual participant data (IPD) are needed to identify which components of the intervention are the principal drivers of this effect. OBJECTIVE: To assess which components of collaborative care are the biggest drivers of its effectiveness in reducing symptoms of depression in primary care. DATA SOURCES: Data were obtained from MEDLINE, Embase, Cochrane Library, PubMed, and PsycInfo as well as references of relevant systematic reviews. Searches were conducted in December 2023, and eligible data were collected until March 14, 2024. STUDY SELECTION: Two reviewers assessed for eligibility. Randomized clinical trials comparing the effect of collaborative care and usual care among adult patients with depression in primary care were included. DATA EXTRACTION AND SYNTHESIS: The study was conducted according to the IPD guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. IPD were collected for demographic characteristics and depression outcomes measured at baseline and follow-ups from the authors of all eligible trials. Using IPD, linear mixed models with random nested effects were calculated. MAIN OUTCOMES AND MEASURES: Continuous measure of depression severity was assessed via validated self-report instruments at 4 to 6 months and was standardized using the instrument's cutoff value for mild depression. RESULTS: A total of 35 datasets with 38 comparisons were analyzed (N = 20 046 participants [57.3% of all eligible, with minimal differences in baseline characteristics compared with nonretrieved data]; 13 709 [68.4%] female; mean [SD] age, 50.8 [16.5] years). A significant interaction effect with the largest effect size was found between the depression outcome and the collaborative care component therapeutic treatment strategy (-0.07; P < .001). This indicates that this component, including its key elements manual-based psychotherapy and family involvement, was the most effective component of the intervention. Significant interactions were found for all other components, but with smaller effect sizes. CONCLUSIONS AND RELEVANCE: Components of collaborative care most associated with improved effectiveness in reducing depressive symptoms were identified. To optimize treatment effectiveness and resource allocation, a therapeutic treatment strategy, such as manual-based psychotherapy or family integration, may be prioritized when implementing a collaborative care intervention.
AD - Institute of General Practice and Family Medicine, LMU University Hospital, LMU Munich, Munich, Germany.; Graduate Program, POKAL-Predictors and Outcomes in Primary Care Depression Care, Munich, Germany.; German Center for Mental Health, Munich/Augsburg, Germany.; National Institute of Health and Care Research (NIHR) School for Primary Care Research, NIHR Greater Manchester Patient Safety Research Collaborations, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom.; National Institute of Health and Care Research Greater Manchester Patient Safety Translational Research Centre, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, United Kingdom.; Department of General Practice and Primary Care, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.; Department of Psychology, LMU Munich, Munich, Germany.; Institute of Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany.; Pettenkofer School of Public Health Munich, Munich, Germany.; German Center for Mental Health, Bochum, Germany.; Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Georgia.; Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia.; Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Barcelona, Spain.; Department of Medicine, Eastern Colorado Health Care System, Denver.; Division of General Internal Medicine, Department of Medicine, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora.; Department of Veterans Affairs, Eastern Colorado Health Care System, Denver.; Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.; Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, Missouri.; Department of Global Health, University of Washington, Seattle.; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle.; Mental Health and Addiction Research Group, Department of Health Sciences, University of York, York, United Kingdom.; York Environmental Sustainability Institute, University of York, York, United Kingdom.; Northwell, New Hyde Park, New York.; Division of Mental Health and Neurosciences, St John's Research Institute, Bengaluru, India.; Division of Prevention Sciences, Department of Medicine, University of California, San Francisco.; Health Services Research, Oberberg Clinic Group, Berlin, Germany.; Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany.; Department of Psychiatry and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.; Scelta (part of GGNet Mental Health Care), Apeldoorn, Warnsveld, the Netherlands.; Department of Diabetology, Madras Diabetes Research Foundation and Dr Mohan's Diabetes Specialities Centre, Chennai, India.; Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.; Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.; Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom.; Kaiser Permanente Washington Health Research Institute, Seattle.; Department of Psychiatry, St John's Medical College, Bengaluru, India.; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles.; Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.; Department of General Practice and Primary Care, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
AN - 40136273
BT - JAMA Psychiatry
C5 - Education & Workforce
DA - Mar 26
DO - 10.1001/jamapsychiatry.2025.0183
DP - NLM
ET - 20250326
JF - JAMA Psychiatry
LA - eng
N2 - IMPORTANCE: Collaborative care is a multicomponent intervention for patients with chronic disease in primary care. Previous meta-analyses have proven the effectiveness of collaborative care for depression; however, individual participant data (IPD) are needed to identify which components of the intervention are the principal drivers of this effect. OBJECTIVE: To assess which components of collaborative care are the biggest drivers of its effectiveness in reducing symptoms of depression in primary care. DATA SOURCES: Data were obtained from MEDLINE, Embase, Cochrane Library, PubMed, and PsycInfo as well as references of relevant systematic reviews. Searches were conducted in December 2023, and eligible data were collected until March 14, 2024. STUDY SELECTION: Two reviewers assessed for eligibility. Randomized clinical trials comparing the effect of collaborative care and usual care among adult patients with depression in primary care were included. DATA EXTRACTION AND SYNTHESIS: The study was conducted according to the IPD guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. IPD were collected for demographic characteristics and depression outcomes measured at baseline and follow-ups from the authors of all eligible trials. Using IPD, linear mixed models with random nested effects were calculated. MAIN OUTCOMES AND MEASURES: Continuous measure of depression severity was assessed via validated self-report instruments at 4 to 6 months and was standardized using the instrument's cutoff value for mild depression. RESULTS: A total of 35 datasets with 38 comparisons were analyzed (N = 20 046 participants [57.3% of all eligible, with minimal differences in baseline characteristics compared with nonretrieved data]; 13 709 [68.4%] female; mean [SD] age, 50.8 [16.5] years). A significant interaction effect with the largest effect size was found between the depression outcome and the collaborative care component therapeutic treatment strategy (-0.07; P < .001). This indicates that this component, including its key elements manual-based psychotherapy and family involvement, was the most effective component of the intervention. Significant interactions were found for all other components, but with smaller effect sizes. CONCLUSIONS AND RELEVANCE: Components of collaborative care most associated with improved effectiveness in reducing depressive symptoms were identified. To optimize treatment effectiveness and resource allocation, a therapeutic treatment strategy, such as manual-based psychotherapy or family integration, may be prioritized when implementing a collaborative care intervention.
PY - 2025
SN - 2168-622X (Print); 2168-622x
ST - Effective Components of Collaborative Care for Depression in Primary Care: An Individual Participant Data Meta-Analysis
T1 - Effective Components of Collaborative Care for Depression in Primary Care: An Individual Participant Data Meta-Analysis
T2 - JAMA Psychiatry
TI - Effective Components of Collaborative Care for Depression in Primary Care: An Individual Participant Data Meta-Analysis
U1 - Education & Workforce
U3 - 10.1001/jamapsychiatry.2025.0183
VO - 2168-622X (Print); 2168-622x
Y1 - 2025
ER -