Collaborative stepped care <i>v</i>. care as usual for common mental disorders: 8-month, cluster randomised controlled trial

Oosterbaan, D.B.; Verbraak, Marc; Terluin, Berend; Hoogendoorn, Adriaan W.; Peyrot, Wouter J.; Muntingh, Anna; Balkom, A.J.L.M. van

doi:10.1192/bjp.bp.112.125211

Cited by 50 publications

(80 citation statements)

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“…The majority of collaborative care trials have been carried out in a health-care setting and they tend to be targeted at depression and anxiety disorders 32,[41][42][43][44][45][46][47][48] (Table 2). Accordingly, most outcomes were condition-specific measures.…”

Section: Summary Of the Results Of The Reviewmentioning

confidence: 99%

Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial

et al. 2018

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BackgroundDespite high levels of employment among working-age adults in the UK, there is still a significant minority who are off work with ill health at any one time (so-called ‘sickness absence’). Long-term sickness absence results in significant costs to the individual, to the employer and to wider society.ObjectiveThe overall objective of the intervention was to improve employee well-being with a view to aiding return to work. To meet this aim, a collaborative case management intervention was adapted to the needs of UK employees who were entering or experiencing long-term sickness absence.DesignA pilot randomised controlled trial, using permuted block randomisation. Recruitment of patients with long-term conditions in settings such as primary care was achieved by screening of routine records, followed by mass mailing of invitations to participants. However, the proportion of patients responding to such invitations can be low, raising concerns about external validity. Recruitment in the Case Management to Enhance Occupational Support (CAMEOS) study used this method to test whether or not it would transfer to a population with long-term sickness absence in the context of occupational health (OH).ParticipantsEmployed people on long-term sickness absence (between 4 weeks and 12 months). The pilot was run with two different collaborators: a large organisation that provided OH services for a number of clients and a non-profit community-based organisation.InterventionCollaborative case management was delivered by specially trained case managers from the host organisations. Sessions were delivered by telephone and supported use of a self-help handbook. The comparator was usual care as provided by participants’ general practitioner (GP) or OH provider. This varied for participants according to the services available to them. Neither participants nor the research team were blind to randomisation.Main outcome measuresRecruitment rates, intervention delivery and acceptability to participants were the main outcomes. Well-being, as measured by the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM), and return-to-work rates were also recorded.ResultsIn total, over 1000 potentially eligible participants were identified across the sites and invited to participate. However, responses were received from just 61 of those invited (5.5%), of whom 16 (1.5%) were randomised to the trial (seven to treatment, nine to control). Detailed information on recruitment methods, intervention delivery, engagement and acceptability is presented. No harms were reported in either group.ConclusionsThis pilot study faced a number of barriers, particularly in terms of recruitment of employers to host the research. Our ability to respond to these challenges faced several barriers related to the OH context and the study set up. The intervention seemed feasible and acceptable when delivered, although caution is required because of the small number of randomised participants. However, employees’ lack of engagement in the research might imply that they did not see the intervention as valuable.Future workDeveloping effective and acceptable ways of reducing sickness absence remains a high priority. We discuss possible ways of overcoming these challenges in the future, including incentives for employers, alternative study designs and further modifications to recruitment methods.Trial registrationCurrent Controlled Trials ISRCTN33560198.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 6, No. 2. See the NIHR Journals Library website for further project information.

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Section: Summary Of the Results Of The Reviewmentioning

confidence: 99%

Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial

et al. 2018

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“…Dataset D consisted of the baseline data of general practice patients who were included in a randomized clinical trial aimed to evaluate a stepped care program for mood, anxiety and stress-related disorders [34]. The diagnostic interview used was the Mini-International Neuropsychiatric Interview (MINI) [35], administered face-to-face.…”

Section: Methodsmentioning

confidence: 99%

To what extent does the anxiety scale of the Four-Dimensional Symptom Questionnaire (4DSQ) detect specific types of anxiety disorder in primary care? A psychometric study

et al. 2014

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BackgroundAnxiety scales may help primary care physicians to detect specific anxiety disorders among the many emotionally distressed patients presenting in primary care. The anxiety scale of the Four-Dimensional Symptom Questionnaire (4DSQ) consists of an admixture of symptoms of specific anxiety disorders. The research questions were: (1) Is the anxiety scale unidimensional or multidimensional? (2) To what extent does the anxiety scale detect specific DSM-IV anxiety disorders? (3) Which cut-off points are suitable to rule out or to rule in (which) anxiety disorders?MethodsWe analyzed 5 primary care datasets with standardized psychiatric diagnoses and 4DSQ scores. Unidimensionality was assessed through confirmatory factor analysis (CFA). We examined mean scores and anxiety score distributions per disorder. Receiver operating characteristic (ROC) analysis was used to determine optimal cut-off points.ResultsTotal n was 969. CFA supported unidimensionality. The anxiety scale performed slightly better in detecting patients with panic disorder, agoraphobia, social phobia, obsessive compulsive disorder (OCD) and post traumatic stress disorder (PTSD) than patients with generalized anxiety disorder (GAD) and specific phobia. ROC-analysis suggested that ≥4 was the optimal cut-off point to rule out and ≥10 the cut-off point to rule in anxiety disorders.ConclusionsThe 4DSQ anxiety scale measures a common trait of pathological anxiety that is characteristic of anxiety disorders, in particular panic disorder, agoraphobia, social phobia, OCD and PTSD. The anxiety score detects the latter anxiety disorders to a slightly greater extent than GAD and specific phobia, without being able to distinguish between the different anxiety disorder types. The cut-off points ≥4 and ≥10 can be used to separate distressed patients in three groups with a relatively low, moderate and high probability of having one or more anxiety disorders.

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“…The US studies were also considerably more homogeneous than the European studies, which may be related to similarities and differences in healthcare systems between the US and Europe [16]. The studies in the US were mainly conducted in large clinics (often university-affiliated) using specifically trained and employed care managers, which may have facilitated effective implementation of the intervention, while the European studies were performed in more diverse settings in rather small primary care practices with collaborating professionals who were only involved in collaborative care on a part-time basis [21]. However, the heterogeneity between the European studies may also be related by other study characteristics such as design and intervention details.…”

Section: Comparison With the Literaturementioning

confidence: 99%

Collaborative Care for Anxiety Disorders in Primary Care: a Systematic Review and Meta-Analysis

Muntingh¹,

Feltz-Cornelis²,

Marwijk³

et al. 2017

FOC

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Background: Studies evaluating collaborative care for anxiety disorders are recently emerging. A systematic review and meta-analysis to estimate the effect of collaborative care for adult patients with anxiety disorders in primary care is therefore warranted. Methods: A literature search was performed. Data sources: PubMed, Psycinfo, Embase, Cinahl, and the Cochrane library. Study eligibility criteria: Randomized controlled trials examining the effects of collaborative care for adult primary care patients with an anxiety disorder, compared to care as usual or another intervention. Synthesis methods: Standardized mean differences (SMD) on an anxiety scale closest to twelve months follow-up were calculated and pooled in a random effects meta-analysis. Results: Of the 3073 studies found, seven studies were included with a total of 2105 participants. Included studies were of moderate to high quality. Collaborative care was superior to care as usual, with a small effect size (SMD = 0.35 95 % CI 0.14-0.56) for all anxiety disorders combined and a moderate effect size (SMD = 0.59, 95 % CI 0.41-0.78) in a subgroup analysis (five studies) on patients with panic disorder. Conclusions: Collaborative care seems to be a promising strategy for improving primary care for anxiety disorders, in particular panic disorder. However, the number of studies is still small and further research is needed to evaluate the effectiveness in other anxiety disorders.

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Collaborative stepped care v. care as usual for common mental disorders: 8-month, cluster randomised controlled trial

Abstract: Treatment within a CSC model resulted in an earlier treatment response compared with CAU.

Cited by 50 publications

References 23 publications

Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial

Collaborative case management to aid return to work after long-term sickness absence: a pilot randomised controlled trial

To what extent does the anxiety scale of the Four-Dimensional Symptom Questionnaire (4DSQ) detect specific types of anxiety disorder in primary care? A psychometric study

Collaborative Care for Anxiety Disorders in Primary Care: a Systematic Review and Meta-Analysis

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