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

Abstract

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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