Collaborative care for anxiety disorders in primary care: a systematic review and meta-analysis

Muntingh, Anna; Feltz-Cornelis, Christina M. van der; Marwijk, Harm van; Spinhoven, Philip; Balkom, A.J.L.M. van

doi:10.1186/s12875-016-0466-3

Cited by 70 publications

(46 citation statements)

References 42 publications

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“…In the national Depression Initiative, from 2006 to 2012 ( 20 ), a CC model was implemented and evaluated in which the GP could collaborate with a nurse care-manager and a consultant psychiatrist for treatment of a depressive disorder in primary care ( 19 ). This model has proved to be successful ( 17 , 21 – 23 ), and so was a similar model for anxiety disorders ( 24 , 25 ) and somatoform disorders ( 26 ) in the primary care setting. As a result of these positive outcomes, and the cost-effectiveness of the model ( 27 – 30 ), CC including psychiatric consultation was taken into account in a rigorous reorganization cutback of mental health care provisions in the Netherlands ( 31 ) and was made the preferred collaboration model for primary care and specialty mental health care in the Netherlands since 2014 by the Ministry of Health and the medical insurance companies.…”

Section: Introductionmentioning

confidence: 95%

Comparative Effect of Collaborative Care, Pain Medication, and Duloxetine in the Treatment of Major Depressive Disorder and Comorbid (Sub)Chronic Pain: Results of an Exploratory Randomized, Placebo-Controlled, Multicenter Trial (CC:PAINDIP)

et al. 2018

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ObjectiveEvidence exists for the efficacy of collaborative care (CC) for major depressive disorder (MDD), for the efficacy of the consequent use of pain medication against pain, and for the efficacy of duloxetine against both MDD and neuropathic pain. Their relative effectiveness in comorbid MDD and pain has never been established so far. This study explores the effectiveness of CC with pain medication and duloxetine, and CC with pain medication and placebo, compared with duloxetine alone, on depressive and pain symptoms. This study was prematurely terminated because of massive reorganizations and reimbursement changes in mental health care in the Netherlands during the study period and is therefore of exploratory nature.MethodsThree-armed, randomized, multicenter, placebo-controlled trial at three specialized mental health outpatient clinics with patients who screened positive for MDD. Interventions lasted 12 weeks. Pain medication was administered according to an algorithm that avoids opiate prescription as much as possible, where paracetamol, COX inhibitors, and pregabalin are offered as steps before opiates are considered. Patients who did not show up for three or more sessions were registered as non-compliant. Explorative, intention-to-treat and per protocol, multilevel regression analyses were performed. The trial is listed in the trial registration (; NTR number: NTR1089).ResultsSixty patients completed the study. Patients in all treatment groups reported significantly less depressive and pain symptoms after 12 weeks. CC with placebo condition showed the fastest decrease in depressive symptoms compared with the duloxetine alone group (b = −0.78; p = 0.01). Non-compliant patients (n = 31) did not improve over the 12-week period, in contrast to compliant patients (n = 29). Pain outcomes did not differ between the three groups.ConclusionIn MDD and pain, patient’s compliance and placebo effects are more important in attaining effect than choice of one of the treatments. Active pain management with COX inhibitors and pregabalin as alternatives to tramadol or other opiates might provide an attractive alternative to the current WHO pain ladder as it avoids opiate prescription as much as possible. The generalizability is limited due to the small sample size. Larger studies are needed.

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Section: Introductionmentioning

confidence: 95%

Comparative Effect of Collaborative Care, Pain Medication, and Duloxetine in the Treatment of Major Depressive Disorder and Comorbid (Sub)Chronic Pain: Results of an Exploratory Randomized, Placebo-Controlled, Multicenter Trial (CC:PAINDIP)

et al. 2018

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“…In such cases of comorbidity, the treatment response is often less favourable for both the chronic medical condition [21] and the mental disorder [22][23][24]. Research has shown that CC is effective, as compared to CAU, in improving depressive and anxiety disorders [25][26][27][28][29][30][31][32][33], and the National Institute for…”

Section: Rationalementioning

confidence: 99%

Illness burden and physical outcomes associated with collaborative care in patients with comorbid depressive disorder in chronic medical conditions: A systematic review and meta-analysis

Sluijs

Castelijns

Eijsbroek

et al. 2018

General Hospital Psychiatry

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Objective Collaborative care (CC) improves depressive symptoms in people with comorbid depressive disorder in chronic medical conditions, but its effect on physical symptoms has not yet systematically been reviewed. This study aims to do so. Methods Systematic review and meta-analysis was conducted using Pubmed, the Cochrane Library, and the European and US Clinical Trial Registers. Eligible studies included randomized controlled trials (RCTs) of CC compared to care as usual (CAU), in primary care and general hospital setting, reporting on physical and depressive symptoms as outcomes. Overall treatment effects were estimated for illness burden, physical outcomes and depression, respectively. Results Twenty RCTs were included, with N = 4774 patients. The overall effect size of CC versus CAU for illness burden was OR 1.64 (95%CI 1.47;1.83), d = 0.27 (95%CI 0.21;0.33). Overall, depression outcomes were better for CC than for CAU. Moderator analyses did not yield statistically significant differences. Conclusions CC is more effective than CAU in terms of illness burden, physical outcomes and depression, in patients with comorbid depression in chronic medical conditions. More research covering multiple physical disorders is needed. Corresponding AuthorChristina Van der Feltz-Cornelis Corresponding Author's InstitutionClinical Centre of excellence for Body, Mind and Health, GGz Breburg, Tilburg, The Netherlands Appendix A_searchterm.docx [Figure] Appendix B_PRISMA 2009 checklist.docx [Figure] Appendix C_risk of bias assessment.docx [Figure] Forest plot 1.docx [Figure] Forest plot 2.docx [Figure] Forest plot 3.docx [Figure] Forest plot 4.docx [Figure] Forest plot 5.docx [Figure] Funnel plot 1.docx [Figure] PRISMA flow diagram.docx [Figure] Table] To view all the submission files, including those not included in the PDF, click on the manuscript title on your EVISE Homepage, then click 'Download zip file'. Order of AuthorsDear Dr. Huffman,We have received your comments with regard to our manuscript 'Physical outcomes of collaborative care and illness burden in patients with comorbid depressive disorder in chronic medical conditions: a systematic review and meta-analysis' (GHP_2017_110_R1).We would like to thank you for the fast and careful review of our manuscript, and are pleased that your Journal is interested in considering a revised version. We have carefully attended to the remarks, which were most helpful for improving the manuscript. Enclosed you will also find the revised version of the manuscript, in which we have marked the revisions in yellow.During the revision process we have also changed the title to: 'Illness burden and physical outcomes associated with collaborative care in patients with comorbid depressive disorder in chronic medical conditions: A systematic review and meta-analysis'. We hope that our revised manuscript is suitable for publication in General Hospital Psychiatry. Editor comments and our response:Thank you very much for your comprehensive re...

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“…While a strong body of evidence has supported the integration of behavioral health services into primary care to treat depression [17][18][19][20][21], anxiety [22,23], and chronic health conditions [24,25], no randomized control trials (RCTs) have investigated the efficacy of integrated services for refugee populations. Few trials exist in the field of refugee health due to the ethical and practical challenges of conducting experimental research with this population [26,27].…”

Section: Introductionmentioning

confidence: 99%

Intensive psychotherapy and case management for Karen refugees with major depression in primary care: a pragmatic randomized control trial

et al. 2020

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Background: Despite an unparalleled global refugee crisis, there are almost no studies in primary care addressing real-world conditions and longer courses of treatment that are typical when resettled refugees present to their physician with critical psychosocial needs and complex symptoms. We studied the effects of a year of psychotherapy and case management in a primary care setting on common symptoms and functioning for Karen refugees (a newly arrived population in St Paul, Minnesota) with depression.Methods: A pragmatic parallel-group randomized control trial was conducted at two primary care clinics with large resettled Karen refugee patient populations, with simple random allocation to 1 year of either: (1) intensive psychotherapy and case management (IPCM), or (2) care-as-usual (CAU). Eligibility criteria included Major Depression diagnosis determined by structured diagnostic clinical interview, Karen refugee, ages 18-65. IPCM (n = 112) received a year of psychotherapy and case management coordinated onsite between the case manager, psychotherapist, and primary care providers; CAU (n = 102) received care-as-usual from their primary care clinic, including behavioral health referrals and/or brief onsite interventions. Blinded assessors collected outcomes of mean changes in depression and anxiety symptoms (measured by Hopkins Symptom Checklist-25), PTSD symptoms (Posttraumatic Diagnostic Scale), pain (internally developed 5-item Pain Scale), and social functioning (internally developed 37-item instrument standardized on refugees) at baseline, 3, 6 and 12 months. After propensity score matching, data were analyzed with the intention-to-treat principle using repeated measures ANOVA with partial eta-squared estimates of effect size. Results: Of 214 participants, 193 completed a baseline and follow up assessment (90.2%). IPCM patients showed significant improvements in depression, PTSD, anxiety, and pain symptoms and in social functioning at all time points, with magnitude of improvement increasing over time. CAU patients did not show significant improvements. The largest mean differences observed between groups were in depression (difference, 5.5, 95% CI, 3.9 to 7.1, P < .001) and basic needs/safety (difference, 5.4, 95% CI, 3.8 to 7.0, P < .001).Conclusions: Adult Karen refugees with depression benefited from intensive psychotherapy and case management coordinated and delivered under usual conditions in primary care. Intervention effects strengthened at each interval, suggesting robust recovery is possible.

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Collaborative care for anxiety disorders in primary care: a systematic review and meta-analysis

Cited by 70 publications

References 42 publications

Comparative Effect of Collaborative Care, Pain Medication, and Duloxetine in the Treatment of Major Depressive Disorder and Comorbid (Sub)Chronic Pain: Results of an Exploratory Randomized, Placebo-Controlled, Multicenter Trial (CC:PAINDIP)

Comparative Effect of Collaborative Care, Pain Medication, and Duloxetine in the Treatment of Major Depressive Disorder and Comorbid (Sub)Chronic Pain: Results of an Exploratory Randomized, Placebo-Controlled, Multicenter Trial (CC:PAINDIP)

Illness burden and physical outcomes associated with collaborative care in patients with comorbid depressive disorder in chronic medical conditions: A systematic review and meta-analysis

Intensive psychotherapy and case management for Karen refugees with major depression in primary care: a pragmatic randomized control trial

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