Characteristics of Effective Collaborative Care for Treatment of Depression: A Systematic Review and Meta-Regression of 74 Randomised Controlled Trials

نویسندگان

  • Peter A. Coventry
  • Joanna L. Hudson
  • Evangelos Kontopantelis
  • Janine Archer
  • David A. Richards
  • Simon Gilbody
  • Karina Lovell
  • Chris Dickens
  • Linda Gask
  • Waquas Waheed
  • Peter Bower
  • Phillipa J. Hay
چکیده

BACKGROUND Collaborative care is a complex intervention based on chronic disease management models and is effective in the management of depression. However, there is still uncertainty about which components of collaborative care are effective. We used meta-regression to identify factors in collaborative care associated with improvement in patient outcomes (depressive symptoms) and the process of care (use of anti-depressant medication). METHODS AND FINDINGS Systematic review with meta-regression. The Cochrane Collaboration Depression, Anxiety and Neurosis Group trials registers were searched from inception to 9th February 2012. An update was run in the CENTRAL trials database on 29th December 2013. Inclusion criteria were: randomised controlled trials of collaborative care for adults ≥18 years with a primary diagnosis of depression or mixed anxiety and depressive disorder. Random effects meta-regression was used to estimate regression coefficients with 95% confidence intervals (CIs) between study level covariates and depressive symptoms and relative risk (95% CI) and anti-depressant use. The association between anti-depressant use and improvement in depression was also explored. Seventy four trials were identified (85 comparisons, across 21,345 participants). Collaborative care that included psychological interventions predicted improvement in depression (β coefficient -0.11, 95% CI -0.20 to -0.01, p = 0.03). Systematic identification of patients (relative risk 1.43, 95% CI 1.12 to 1.81, p = 0.004) and the presence of a chronic physical condition (relative risk 1.32, 95% CI 1.05 to 1.65, p = 0.02) predicted use of anti-depressant medication. CONCLUSION Trials of collaborative care that included psychological treatment, with or without anti-depressant medication, appeared to improve depression more than those without psychological treatment. Trials that used systematic methods to identify patients with depression and also trials that included patients with a chronic physical condition reported improved use of anti-depressant medication. However, these findings are limited by the observational nature of meta-regression, incomplete data reporting, and the use of study aggregates.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

P135: A Systematic Review and Meta-Analysis on Controlled Treatment Trials of Meta-Cognitive Therapy for Anxiety Disorders

To conduct a systematic review and meta-analysis on controlled treatment trials of meta-cognitive therapy (MCT) for anxiety disorders, studies were included if they employed controlled methodology and treated people above 18 years with anxiety disorders. Case studies (with less than 4 cases) and single case designed studies were excluded. A comprehensive literature search identified 15 trials f...

متن کامل

Effectiveness of Paromomycin on Cutaneous Leishmaniasis in Iran: A Systematic Review and Meta-Analysis

Background: Some treatment reported for cutaneous leishmaniasis. The studies examined the impact of the paromomycin has different characteristics and results. The aim of the present study was to conduct a systematic review and meta-analysis of all randomized clinical trials evaluating the effectiveness of paromomycin in the treatment of cutaneous leishmaniasis in Iran.Methods: Literature search...

متن کامل

Efficacy of Prasaplai for Treatment of Primary Dysmenorrhea: a Meta-Analysis

Prasaplai is used in Thai traditional medicine for treatment of primary dysmenorrhea; however, clinical evidence is limited regarding the efficacy of Prasaplai for primary dysmenorrheal outcomes. This study has constituted a systematic review and meta-analysis to evaluate Prasaplai as an effective treatment for primary dysmenorrhea. Randomized controlled trials were retrieved and identified thr...

متن کامل

Collaborative care for comorbid depression and coronary heart disease: a systematic review and meta-analysis of randomised controlled trials

OBJECTIVES To systematically review the efficacy of collaborative care (CC) for depression in adults with coronary heart disease (CHD) and depression. DESIGN Systematic review and meta-analysis. DATA SOURCES Electronic databases (Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, PsycINFO and CINAHL) were searched until April 2014. INCLUSION CRITERIA Population, depression co...

متن کامل

The Effect of Lifestyle Intervention on Pregnancy and Birth Outcomes on Obese Infertile Women: A Systematic Review and Meta-Analysis

Background: Obesity has been associated to negative effects on natural fertility and a worse prognosis when assisted reproduction techniques are performed. Patients attending for fertility treatments are often advised to optimize their weights to improve outcomes. There are doubts about how effective are weight-loss interventions for improving fertility in women who are overweight or obese. Mat...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:

دوره 9  شماره 

صفحات  -

تاریخ انتشار 2014