Effective components of collaborative care for depression in primary care: an individual participant data meta-analysis

Schillok, Hannah Diana Dorothea (2025): Effective components of collaborative care for depression in primary care: an individual participant data meta-analysis. Dissertation, LMU München: Faculty of Medicine

Abstract

Background: Collaborative care is a multicomponent intervention designed to enhance care quality and continuity for chronic conditions within primary care. While its positive impact on patient outcomes, particularly for depression, is well-documented, implementation in clinical practice remains limited. A key barrier is uncertainty regarding which components are most essential for implementation. Although prior studies have addressed this question, individual participant data (IPD) are needed to accurately identify the most effective components. Research Aim: This study aimed first to use IPD to gain detailed insights into the progression of depression over time. Second, we sought to identify the most effective components of collaborative care interventions for depression within primary care settings. Methods: We conducted a systematic literature review using five major databases -Medline, Embase, Cochrane Library, PubMed, and PsycInfo- and cross-referenced relevant systematic reviews. Eligible studies were randomized controlled trials comparing collaborative care with usual care for adults with depression in primary care. We requested IPD on demographics, depression outcomes, and follow-up periods from all eligible studies, with data collection completed on March 14, 2024. Linear mixed models with random nested effects were used for data analysis. Results: We obtained IPD from 35 datasets (38 comparisons), including 20,046 participants. Patients of the collaborative care group had significant better depression outcomes compared to those receiving usual care, with benefits persisting up to 12 months post-randomization. Two components - Therapeutic Treatment Strategy (-0.07, P≤.00) and Measurement-Based Care (-0.04, P=.03) - were significantly associated with improved depression outcomes at 4-6 months after baseline, highlighting their importance in collaborative care implementation. Conclusion: This study identified collaborative care components associated with better depression outcomes. To assure successful treatment, implementation of collaborative care for depression should prioritize Therapeutic Treatment Strategies, such as manual-based psychotherapy or family involvement, and Measurement-Based Care, including regular monitoring and immediate access to emergency support.

• Item Type: Theses (Dissertation, LMU Munich)
• Keywords: Collaborative Care, Depression, Primary Care, Individual Participant Data
• Subjects: 600 Technology, Medicine; 600 Technology, Medicine > 610 Medical sciences and medicine
• Faculties: Faculty of Medicine
• Language: English
• Date of oral examination: 12. May 2025
• 1. Referee: Gensichen, Jochen
• Signature of the printed copy: 0700/UMD 22784