Effective Components of Collaborative Care for Depression in Primary Care: An Individual Participant Data Meta-Analysis.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Schillok Hannah, Gensichen Jochen, Panagioti Maria, Gunn Jane, Junker Lukas, Lukaschek Karoline, Jung-Sievers Caroline, Sterner Philipp, Kaupe Lukas, Dreischulte Tobias, Ali Mohammed K, Aragonès Enric, Bekelman David B, Herbeck Belnap Birgit, Carney Robert M, Chwastiak Lydia A, Coventry Peter A, Davidson Karina W, Ekstrand Maria L, Flehr Alison, Fletcher Susan, Hölzel Lars P, Huijbregts Klaas, Mohan Viswanathan, Patel Vikram, Richards David A, Rollman Bruce L, Salisbury Chris, Simon Gregory E, Srinivasan Krishnamachari, Unützer Jürgen, van der Feltz-Cornelis Christina M, Wells Kenneth B, Zimmermann Thomas, Bühner Markus, POKAL Group
Аннотация
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.