Manualized psychotherapy and caregiver involvement in the patients’ treatment may be the secret sauce for treating depression with collaborative care, suggests a meta-analysis issued today by JAMA Psychiatry.
“Collaborative care has been shown to be significantly more effective for depression than usual care” in primary care settings, wrote Hannah Schillok, MSc, of Ludwig Maximilian University Hospital in Munich, Germany, and colleagues. “However, its implementation remains rare, primarily due to limited resources and unclear understanding of its components.”
Collaborative care interventions use a multiprofessional approach in which a primary care physician works alongside one or more other health professionals—such as a psychiatrist care manager, a nurse, a psychologist, and/or a social worker—to provide the patient with an evidence-based, structured treatment plan, symptom monitoring, and scheduled follow-ups.
The meta-analysis included data from 35 studies involving 20,046 adults who had depression, mixed anxiety/mood disorder, or symptoms thereof; all were treated in a primary care setting, receiving either a collaborative care approach or usual care. Studies used depression scores from validated inventories as an outcome, from which Schillok and colleagues collected participants’ scores at four to six months.
The researchers then calculated the intensity of each collaborative care model used among four broad components:
- Patient-centered care that respects patient preferences, needs, and values
- Measurement-based care using data-driven decisions for patient management
- Integrated mental health care in the primary setting
- A therapeutic treatment strategy that employs structured treatment strategies such as manual-based psychotherapy, routine follow-ups, and involving friends and family.
Their analysis found that, based on the levels of patient improvement in different models, the most influential component of collaborative care for reducing depression severity was therapeutic treatment strategy, especially the subcomponents of manual-based psychotherapy and involvement of family or friends. The other three components also contributed to a lesser degree.
“Practitioners and policymakers should ensure this key component is consistently included in future intervention designs to optimize effectiveness,” the researchers wrote. “Additionally, these findings offer an initial basis for engaging health insurers to evaluate coverage decisions. Funding critical components may enhance the impact of collaborative care on depression outcomes and support sustainable implementation in routine practice.”
For related information, see the Psychiatric News article “Three Health Systems Find Success With Collaborative Care.”
(Image: Getty Images/iStock/shapecharge)
Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.