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Collaborative care for depression in primary care

Making sense of a complex intervention: systematic review and meta-regression

National Primary Care Research and Development Centre, University of Manchester

Simon Gilbody, DPhil, MRCPsych and David Richards, PhD

Department of Health Sciences, University of York

Janine Fletcher, MRes

Department of Nursing, Midwifery and Health Visiting, University of Manchester

Alex Sutton, PhD

Department of Health Sciences, University of Leicester, UK

Correspondence: Dr Peter Bower, National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL, UK. Email: peter.bower{at}manchester.ac.uk

Declaration of interest None.

Background The management of depression in primary care is a significant issue for health services worldwide. ‘Collaborative care’ interventions are effective, but little is known about which aspects of these complex interventions are essential.

Aims To use meta-regressionto identify ‘active ingredients’ in collaborative care models for depression in primary care.

Method Studies were identified using systematic searches of electronic databases. The content of collaborative care interventions was coded, together with outcome data on antidepressant use and depressive symptoms. Meta-regression was used to examine relationships between intervention content and outcomes.

Results There was no significant predictor of the effect of collaborative care on antidepressant use. Key predictors of depressive symptom outcomes included systematic identification of patients, professional background of staff and specialist supervision.

Conclusions Meta-regression may be usefulin examining‘active ingredients’ in complex interventions in mental health.

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