Clinical Question

Is the collaborative care model effective for treating patients with depression, anxiety, or both?

Evidence-Based Answer

The collaborative care model is effective for treating adults with depression and/or anxiety using a multiprofessional approach to patient care, a structured management plan, scheduled patient follow-ups, and enhanced interprofessional communication. (Strength of Recommendation: A, based on consistent, good-quality patient-oriented evidence.)

Practice Pointers

Depression and anxiety pose a challenge to the health care system; primary care clinicians often must detect, manage, and prevent these conditions without assistance from other professionals trained to treat these specific disorders. Depression and anxiety, which often present together,¹ have a significant impact on physical health, social and occupational functioning, and mortality.²

The complexity of treating mental health problems and the need to improve the current health care delivery system have prompted researchers to develop a collaborative care model. The term is used to describe any approach to patient care that involves collaboration between primary care clinicians and psychiatrists, psychologists, nurses, social workers, and other health care professionals. This Cochrane review evaluated 79 randomized controlled trials with 24,308 patients. Collaborative care was compared with routine care by a primary care clinician alone or alternative treatments for depression and anxiety, such as cognitive behavior therapy.

Three-fourths of the trials were conducted in the United States. Patients who met criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., for depression or anxiety were recruited from primary care, community, and subspecialty settings. The intervention groups involved the collaboration of at least three different care providers—the primary care clinician, case manager, and mental health professional—and included psychopharmacology, individual and group psychotherapy, cognitive behavior therapy, and support from social workers and nurses. U.S. and international studies had similar results. The primary outcome evaluated was the decrease in depression or anxiety.

Outcomes for depression with the collaborative care model were better than those of usual care/primary care at zero to six months (standardized mean difference [SMD] = −0.34; 95% confidence interval [CI], −0.41 to −0.27), at seven to 12 months (SMD = −0.28; 95% CI, −0.41 to −0.15), and at 13 to 24 months (SMD = −0.35; 95% CI, −0.46 to −0.24). Outcomes for anxiety were also significantly better for collaborative care at zero to six months (SMD = −0.30; 95% CI, −0.44 to −0.17), at seven to 12 months (SMD = −0.33; 95% CI, −0.47 to −0.19), and at 13 to 24 months (SMD = −0.20; 95% CI, −0.34 to −0.06). Beyond 25 months, there were no outcomes reported for collaborative care vs. usual care for anxiety or depression.

The Institute for Clinical Systems Improvement recognizes the collaborative care model as an important means of treating depression.³ It recommends coordination of patient care with other clinicians to assess for barriers to treatment, such as lack of motivation, medication adverse effects, and social and environmental issues. This allows for better outcomes through more accurate referrals and appropriation of resources for patients to improve treatment adherence and overall quality of life.⁴