CDC COMMUNITY GUIDE: Mental Health & Mental Illness: Collaborative Care for the Management of Depressive Disorders

Collaborative care for the management of depressive disorders is a multicomponent, healthcare system-level intervention that uses case managers to link primary care providers, patients, and mental health specialists. This collaboration is designed to:
1. Improve the routine screening and diagnosis of depressive disorders
2. Increase provider use of evidence-based protocols for the proactive management of diagnosed depressive disorders
3. Improve clinical and community support for active patient engagement in treatment goal setting and self-management

Collaborative care models typically have case managers, who support primary care providers with functions such as:
• Patient education
• Patient follow up to track depression outcomes and adherence to treatment
• Adjustment of treatment plans for patients who do not improve

Primary care providers are usually responsible for:
• Routine screening for and diagnosing of depressive disorders
• Initiating treatment for depression
• Referring patients to mental health specialists as needed

These mental health specialists provide clinical advice and decision support to primary care providers and case managers. These processes are frequently coordinated by technology-based resources such as electronic medical records, telephone contact, and provider reminder mechanisms.

The U.S. Preventive Services Task Force (USPSTF) recommends screening for depression in adults and adolescents in outpatient primary care settings when adequate systems are in place for efficient diagnosis, treatment and follow-up for depressive disorders. The implementation of collaborative care models is one way to ensure that such systems are in place.

The Task Force on Community Preventive Services recommends collaborative care for the management of depressive disorders based on strong evidence of effectiveness in improving depression symptoms, adherence to treatment, response to treatment, and remission and recovery from depression.

Results from the Systematic Reviews & Meta-Analyses:
Earlier Review (Bower et al. 2006):
Thirty-seven studies were identified for the systematic review and meta-analysis. Results show that collaborative care led to the following favorable and statistically significant effects:
• Reduction in the number of depression symptoms patients experienced (from 34 studies)
• Increased antidepressant use and improved adherence to treatment (28 studies)

Community Guide Review (2004-2009):
Thirty-two studies qualified for this systematic review and meta-analysis. Results show that effects due to collaborative care compared to usual care were favorable and statistically significant for the following depression outcomes:
• Depression symptoms - patients receiving collaborative care had fewer depression symptoms
• Adherence to prescribed treatment - patients more often took the medication prescribed for their depression
• Response to treatment - more patients showed a response to treatment, defined as a decrease in half or more of their depression symptoms
• Remission or recovery - patients were more likely to have remission of symptoms (short-term absence of symptoms) or recovery (long-term disappearance of symptoms) from depression
• Quality-of-life and functional status-patients receiving collaborative care had small improvements in these outcomes.
• Satisfaction with treatment -- patients receiving collaborative care reported higher satisfaction with their treatment