Association Between Chronic Physical Conditions and the Effectiveness of Collaborative Care for Depression An Individual Participant Data Meta-analysis
Association Between Chronic Physical Conditions and the Effectiveness of Collaborative Care for Depression An Individual Participant Data Meta-analysis
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DOI：
10.1001/jamapsychiatry.2016.1794
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发表时间：
2016-09-01
期刊：
影响因子：
25.8
通讯作者：
Coventry, Peter A.
中科院分区：
文献类型：
--
作者：
Panagioti, Maria;Bower, Peter;Coventry, Peter A.
协作护理是一种重症监护模式，涉及多名医疗保健专业人员一起工作，通常是一名医生，一名病例管理员和一名心理健康专业人员。汇总数据的荟萃分析表明，协作护理对抑郁症和共病慢性身体状况的人特别有效。然而，只有参与者水平的分析可以严格测试治疗效果是否受到参与者特征的影响，例如慢性身体状况.OBJECTIVE为了评估抑郁症的协作护理的有效性是否受到慢性身体状况的存在、类型和数量的调节。数据来源数据来自MEDLINE，EMBASE，PubMed，PsycINFO，CINAHL Complete，和科克伦对照试验中心注册库，以及相关系统评价的参考文献。符合条件的研究的检索和收集一直持续到2015年5月22日。研究选择这是对先前荟萃分析的更新。两名独立评审员参与了研究选择过程。随机临床试验比较了协作护理与常规护理在成年抑郁症患者中的有效性，并报告了随机化后4至6个月抑郁症严重程度症状的测量变化。关键检索词包括抑郁症，心境恶劣，焦虑，恐慌，恐惧症，强迫症，强迫症，创伤后，护理管理，个案管理，协作护理，加强护理，和managedcare.DATA提取和合成个别参与者的数据基线人口统计学和慢性身体状况，以及基线和后续抑郁症的严重程度症状，要求从符合条件的研究的作者。使用适当的混合效应models.Main结局和措施的抑郁症的严重程度症状的连续结果测量使用自我报告或bever-rated measurements.Results数据集从31个随机临床试验，包括36个独立的比较（N = 10 962参与者）进行了分析。个体参与者数据分析没有发现显着的相互作用效应，表明存在（相互作用系数，0.02 [95% CI，-0.10至0.13]），数量（相互作用系数，0.01 [95% CI，-0.01至0.02]），结论和相关性有证据表明，合作护理是有效的，患有抑郁症的人，以及患有抑郁症和慢性身体疾病的人。现有的指南建议将协作治疗限制在抑郁症和身体合并症患者中，但这一个体参与者数据荟萃分析不支持。
IMPORTANCE Collaborative care is an intensive care model involving several health care professionals working together, typically a physician, a case manager, and a mental health professional. Meta-analyses of aggregate data have shown that collaborative care is particularly effective in people with depression and comorbid chronic physical conditions. However, only participant-level analyses can rigorously test whether the treatment effect is influenced by participant characteristics, such as chronic physical conditions.OBJECTIVE To assess whether the effectiveness of collaborative care for depression is moderated by the presence, type, and number of chronic physical conditions.DATA SOURCES Data were obtained from MEDLINE, EMBASE, PubMed, PsycINFO, CINAHL Complete, and Cochrane Central Register of Controlled Trials, and references from relevant systematic reviews. The search and collection of eligible studies was ongoing until May 22, 2015.STUDY SELECTION This was an update to a previous meta-analysis. Two independent reviewers were involved in the study selection process. Randomized clinical trials that compared the effectiveness of collaborative care with usual care in adults with depression and reported measured changes in depression severity symptoms at 4 to 6 months after randomization were included in the analysis. Key search terms included depression, dysthymia, anxiety, panic, phobia, obsession, compulsion, posttraumatic, care management, case management, collaborative care, enhanced care, and managed care.DATA EXTRACTION AND SYNTHESIS Individual participant data on baseline demographics and chronic physical conditions as well as baseline and follow-up depression severity symptoms were requested from authors of the eligible studies. One-step meta-analysis of individual participant data using appropriate mixed-effects models was performed.MAIN OUTCOMES AND MEASURES Continuous outcomes of depression severity symptoms measured using self-reported or observer-rated measures.RESULTS Data sets from 31 randomized clinical trials including 36 independent comparisons (N = 10 962 participants) were analyzed. Individual participant data analyses found no significant interaction effects, indicating that the presence (interaction coefficient, 0.02 [95% CI, -0.10 to 0.13]), numbers (interaction coefficient, 0.01 [95% CI, -0.01 to 0.02]), and types of chronic physical conditions do not influence the treatment effect.CONCLUSIONS AND RELEVANCE There is evidence that collaborative care is effective for people with depression alone and also for people with depression and chronic physical conditions. Existing guidance that recommends limiting collaborative care to people with depression and physical comorbidities is not supported by this individual participant data meta-analysis.