Summary / Overview

Current clinical guidelines for depression address depression treatment for patients detected in primary care and NICE guidelines. Research to date indicates that, under usual care conditions, less than half of primary care patients found to have major depression complete minimally adequate medications or psychotherapy. A variety of organizational changes aimed at improving care for depression in primary care have been tested. Yet evidence-based guidance for healthcare organizations and their primary care practices about which organizational changes are necessary for achieving improved depression outcomes is lacking. The purpose of this review is to establish a basis for organizational guidelines or best practices for achieving improved depression care.

The key questions addressed were:

1. What is the core set of intervention features that characterize collaborative care interventions, and which additional features are most linked to enhanced outcome effects?
2. Are there specific evaluation features among randomized trials of collaborative care that are associated with effect size differences, independently of intervention features?
3. To what extent is collaborative care more effective than usual care for decreasing depressive symptoms among patients with comorbid mental health conditions (PTSD, dementia, anxiety, dysthymia, substance abuse) or medical conditions?