In this issue of the ARCHIVES, Gilbody et al1 report a systematic review and meta-analysis of 37 randomized controlled trials that tested the effect of collaborative care models vs usual primary care treatment in 12 355 patients with depression. Collaborative care was found to increase adherence to antidepressant medication at 6 months by almost 2-fold and to result in improved depression outcomes at 6 months. In the 11 studies that reported long-term results, collaborative care was associated with improved depressive outcomes at 12, 18, and 24 months (although the 24-month comparison did not quite reach statistical significance) and in 1 large trial at 5 years. A strength of this meta-analysis was that it sought to better understand the heterogeneity of findings from the 37 trials. Collaborative care programs that had evidence of more robust improvements in depression outcomes were found to have the following: improvements in antidepressant medication adherence; care managers with more mental health training; and regular caseload supervision, in most cases by psychiatrists.
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