Journal Article Annotations
2018, 1st Quarter

Collaborative Care / Integrated Behavioral Health

Annotations by Walter Luchsinger, MD, and Lydia Chwastiak, MD, MPH, FAPM
April 2018

Illness burden and physical outcomes associated with collaborative care in patients with comorbid depressive disorder in chronic medical conditions: a systematic review and meta-analysis

PUBLICATION #1 — Collaborative Care/Integrated Behavioral Health

Illness burden and physical outcomes associated with collaborative care in patients with comorbid depressive disorder in chronic medical conditions: a systematic review and meta-analysis

van Eck van der Sluijs JF, Castelijns H, Eijsbroek V, Rijnders CAT, van Marwijk HWJ, van der Feltz-Cornelis CM

Abstract: Gen Hosp Psychiatry 2018; 50:1-14

Objective: Collaborative care (CC) improves depressive symptoms in people with comorbid depressive disorder in chronic medical conditions, but its effect on physical symptoms has not yet systematically been reviewed. This study aims to do so.

Methods: Systematic review and meta-analysis was conducted using PubMed, the Cochrane Library, and the European and US Clinical Trial Registers. Eligible studies included randomized controlled trials (RCTs) of CC compared to care as usual (CAU), in primary care and general hospital setting, reporting on physical and depressive symptoms as outcomes. Overall treatment effects were estimated for illness burden, physical outcomes and depression, respectively.

Results: Twenty RCTs were included, with N=4774 patients. The overall effect size of CC versus CAU for illness burden was OR 1.64 (95%CI 1.47;1.83), d=0.27 (95%CI 0.21;0.33). Best physical outcomes in CC were found for hypertension with comorbid depression. Overall, depression outcomes were better for CC than for CAU. Moderator analyses did not yield statistically significant differences.

Conclusions: CC is more effective than CAU in terms of illness burden, physical outcomes and depression, in patients with comorbid depression in chronic medical conditions. More research covering multiple medical conditions is needed.

On PubMed: Gen Hosp Psychiatry 2018; 50:1-14

Annotation

Type of study: Systematic review / meta-analysis

The finding: This systemic review and meta-analysis was done to report the effects of collaborative care on chronic medical conditions and co-morbid depressive or anxiety disorders with a primary focus on physical outcomes and illness burden. Twenty randomized controlled trials were included and results showed that best physical outcomes were found with hypertension and comorbid depression. Overall, depression outcomes were better for collaborative care than for care as usual.

Strength and weaknesses: This is the first study that reports on the effectiveness of collaborative care for comorbid depression and chronic medical conditions.

Weaknesses: Only studies in English and Dutch were included. In addition, did not search in the European and American trial register. Even though an extensive search was done it is possible that studies were missed. There is a small number of good quality studies for each medical condition. There is lack of research on physical outcomes in chronic medical conditions with comorbid anxiety disorders.

Relevance: This is the first study that reports on the effectiveness of collaborative care for comorbid depression and chronic medical conditions.