[en] Major Depressive Disorder (MDD) is a severe and common mental disorder. A growing body of evidence suggests that stepped and/or collaborative care treatment models have several advantages for severely depressed patients and caretakers. However, despite the availability of these treatment strategies and guidance initiatives, many depressive patients are solely treated by the general practitioner (GP), and collaborative care is not common. In this paper, we review a selected set of international guidelines to inventory the best strategies for GPs and secondary mental health care providers to collaborate when treating depressed patients. Additionally, we systematically searched the literature, listing potential ways of cooperation, and potentially supporting tools. We conclude that the prevailing guidelines only include few and rather vague directions regarding the cooperation between GPs and specialised mental health practitioners. Inspiring recent studies, however, suggest that relatively little efforts may result in effective collaborative care and a broader implementation of the guidelines in general.
Research center :
Collaborative Antwerp Psychiatric Research Institute UR Soins primaires et Santé
Disciplines :
Human health sciences: Multidisciplinary, general & others Psychiatry
Author, co-author :
Van den Broeck, Kris; Universiteit Antwerpen - UA > Collaborative Antwerp Psychiatric Research Institute
Remmen, Roy; Universiteit Antwerpen - UA > Eerstelijns - en Interdisciplinaire zorg (ELIZA)
Vanmeerbeek, Marc ; Université de Liège > Département des sciences cliniques > Médecine générale
Destoop, Marianne; Universiteit Antwerpen - UA > Collaborative Antwerp Psychiatric Research Institute > Psychiatric Centre Brothers Alexianen, Boechout
Dom, Geert; Universiteit Antwerpen - UA > Collaborative Antwerp Psychiatric Research Institute > Psychiatric Centre Brothers Alexianen, Boechout
Language :
English
Title :
Collaborative Care regarding major depressed patients: A review of guidelines and current practices
Current evidence suggests that collaborative care is superior than treatment as usual to treat major depressive disorder.
Collaborative care for severely depressed patients, however, is not common.
Our study reveals that international guidelines’ directives to organise collaborative care were few and rather vague.
Yet, an additional systematic literature search suggests that relatively little efforts may result in collaborative care.
American Psychiatric Association, 2010. Practice Guideline for the Treatment of Patients with Major Depressive Disorder. Retrieved from: www.apa.org.
American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders 5th ed. 2013 American Psychiatric Association Washington, DC
E. Aragonès, A. Caballero, J.-L. Piñol, G. López-Cortacans, W. Badia, J.M. Hernandez, and the INDI research group Assessment of an enhanced program for depression management in primary care: a cluster randomized controlled trial. The INDI Project (Interventions for Depression Improvement) BMC Public Health 7 2007 253 10.1186/1471-2458-7-253
E. Aragonès, A. Caballero, J.-L. Piñol, and G. López-Cortacans Persistence in the long term of the effects of a collaborative care programme for depression in primary care J. Affect. Disord. 166 2014 36 40 10.1016/j.jad.2014.05.003
E. Aragonès, G. López-Cortacans, W. Badia, J.M. Hernández, A. Caballero, A. Labad, and the INDI research group Improving the role of nursing in the treatment of depression in primary care in Spain Perspect. Psychiatr. Care 44 2008 248 258 10.1111/j.1744-6163.2008.00184.x
P.E. Bebbington, H. Meltzer, T.S. Brugha, M. Farrell, R. Jenkins, C. Ceresa, and G. Lewis Unequal access and unmet need: Neurotic disorders and the use of primary care services Psychol. Med. 30 2000 1359 1367
P. Bower, S. Gilbody, D. Richards, J. Fletcher, and A. Sutton Collaborative care for depression in primary care. Making sense of a complex intervention: systematic review and meta-regression Br. J. Psychiatry 189 2006 484 493 10.1192/bjp.bp.106.023655
E. Bromet, L.H. Andrade, I. Hwang, N.A. Sampson, J. Alonso, G. de Girolamo, and R.C. Kessler Cross-national epidemiology of DSM-IV major depressive episode BMC Med. 9 2011 90 10.1186/1741-7015-9-90
M. Brouwers, M.E. Kho, G.P. Browman, F. Cluzeau, G. feder, B. Fervers, and J. Makarski AGREE II: advancing guideline development, reporting and evaluation in healthcare Can. Med. Assoc. J. 182 2010 E839 E842 10.1053/cmaj.090449 (on behalf of the AGREE Next Steps Consortium)
R. Byng, R. Jones, M. Leese, B. Hamilton, P. McCrone, and T. Craig Exploratory cluster randomised controlled trial of shared care development for long-term mental illness Br. J. Gen. Pract. 54 2004 259 266
C.A. Chew-Graham, K. Lovell, C. Roberts, R. Baldwin, M. Morley, A. Burns, and H. Burroughs A randomized controlled trial to test the feasibility of a collaborative care model for the management of depression in older people Br. J. Gen. Pract. 57 2007 364 370
Collège Nationale pour la Qualité des Soins en Psychiatrie (CNQS), 2010. La coopération Médecins Généralistes - Psychiatres: Les Courriers échangé entre Médecins Généralistes et Psychiatres lors de la Demande de première Consultation par le Médecin Généraliste pour un Patient présentant un Trouble Mental avéré ou une Souffrance Psychique. [The Cooperation between General Practitioners and Psychiatrists: The Referral Paths between GPs and Psychiatrists regarding initial Consultations of adult Patients with mental Problems]. Saint-Denis La Plaine Cedex, France: Collège Nationale pour la Qualité des Soins en Psychiatrie, Haute Authorité de Santé.
P.A. Coventry, J.L. Hudson, E. Kontopantelis, J. Archer, D.A. Richards, S. Gilbody, and P. Bower Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials PLoS One 9 2014 e108114 10.1371/journal.pone.0108114
M.A. Craven, and R. Bland Better practices in collaborative mental health care: an analysis of the evidence base Can. J. Psychiatry 51 Supplement 1 2006
DGPPN, BÄK, KBV, AWME, AkdÄ, BPtK, BApK, DAGSHG, DEGAM, DGPM, DGPs, DGRW (Hrsg) on behalf of the Guideline construction group, 2012. S3-Leitlinie/Nationale Versorgungsleitlinie. Unipolare Depression. Version 1.3. [S3 Guideline unipolar depression. Version 1.3]. DGGPN, ÄZQ, AWMF - Berlin, Düsseldorf. Retrieved from www.dgppn.de.
A. Fernández, J.M. Haro, M. Martinez-Alonso, K. Demyttenaere, T.S. Brugha, J. Autonell, and J. Alonso Treatment adequacy for anxiety and depressive disorders in six European countries Br. J. Psychiatry 190 2007 172 173 10.1192/bjp.bp.106.023507
A.J. Ferrari, F.J. Charlson, R.E. Norman, S.B. Patten, G. Freedman, C.J.L. Murray, and H.A. Whiteford Burden of depressive disorders by country, sex, age, and year: findings from the Global Burden of Disease Study 2010 PLoS Med. 10 2013 e1001547 10.1371/journal.pmed.1001547
T. Fredheim, L.J. Danbolt, O.R. Haavet, K. Kjønsberg, and L. Lien Collaboration between general practitioners and mental health care professionals: a qualitative study Int. J. Ment. Health Syst. 5 2011 13 10.1186/1752-4458-5-13
J. Gensichen, M. Beyer, C. Muth, F.M. Gerlach, M. Von Korff, and J. Ormel Case management to improve major depression in primary health care: a systematic review Psychol. Med. 36 2006 7 14 10.1017/S0033291705005568
J. Gensichen, M. von Korff, M. Peitz, C. Muth, M. Beyer, C. Güthlin, and F.M. Gerlach Case management for depression by health care assistants in small primary care practices: a cluster randomized trial Ann. Intern. Med. 151 2009 369 378 10.7326/0003-4819-151-6-200909150-00001 (on behalf of PRoMPT (Primary care Monitoring for depressive Patients Trial)
S. Gilbody, P. Bower, J. Fletcher, D. Richards, and A.J. Sutton Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes Arch. Intern. Med. 166 2006 2314 2321 10.1001/archinte.166.21.2314
C. Green, D.A. Richards, J.J. Hill, L. Gask, K. Lovell, C. Chew-Graham, and M. Barkham Cost-effectiveness of collaborative care for depression in UK primary care: economic evaluation of a randomized controlled trial (CADET) PLoS One 9 2014 e104225 10.1371/journal.pone.0104225
J. Gunn, J. Diggens, K. Hegarty, and G. Blashki A systematic review of complex interventions designed to increase recovery from depression in primary care BMC Health Serv. Res. 6 2006 88 10.1186/1472-6963-6-88
J. Heyrman, T. Declercq, R. Rogiers, L. Pas, J. Michels, M. Goetinck, and M. De Meyere Aanbeveling voor goede medische praktijkvoering: Depressie bij volwassenen: aanpak door de huisarts [Recommendations for good medical practice: depression in adults: approch by the GP] Huisarts Nu 37 2008 284 317
K.M.L. Huijbregts, F.J. de Jong, H.W.J. van Marwijk, A.T.F. Beekman, H.J. Adèr, L. Hakkaart-van Roijen, and C.M. van der Feltz-Cornelis A target-driven collaborative care model for major depressive disorder is effective in primary care in the Netherlands. A randomized clinical trial form the depression initiative J. Affect. Disord. 146 2013 328 337 10.1016/j.jad.2012.09.015
K.M.L. Huijbregts, F.J. de Jong, H.W.J. van Marwijk, A.T.F. Beekman, H.J. Adèr, and C.M. van der Feltz-Cornelis A high physical symptom count reduces the effectiveness of treatment for depression, independently of chronic medical conditions J. Psychosom. Res. 74 2013 179 185 10.1016/j.psychores.2013.01.004
M.A. IJff, K.M.L. Huijbregts, H.W.J. van Marwijk, A.T.F. Beekman, L. Hakkaart-van Roijen, F.F. Rutten, and M. van der Feltz-Cornelis Cost-effectiveness of collaborative care including PST and an antidepressant treatment algorithm for the treatment of major depressive disorder in primary care; a randomized clinical trial BMC Health Serv. Res. 7 2007 34 10.1186/1472-6963-7-34
Kaiser Permanente, 2014. Diagnosis and treatment of depression in adults. Clinical Practice Guideline. Retrieved from: healthy.kaiserpermanente.org.
W. Katon, M. Von Korff, E. Lin, and G. Simon Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse Gen. Hosp. Psychiatry 23 2001 138 144 10.1016/S0163-8343(01)00136-0
G. Klug, G. Hermann, B. Fuchs-Nieder, M. Panzer, A. Haider-Stipacek, H.G. Zapotoczky, and S. Priebe Effectiveness of home treatment for elderly people with depression: randomised controlled trial Br. J. Psychiatry 197 2010 463 467 10.1192/bjp.bp.110.083121
G. Klug, G. Hermann, B. Fuchs-Nieder, A. Stipacek, and H.G. Zapotoczky Geriatric psychiatry home treatment (GHT): a pilot study on outcomes following hospital discharge for depressive and delusional patients Arch. Gerontol. Geriatr. 47 2008 109 120 10.1016/j.archger.2007.07.002
P.M. Lewinsohn, D.O. Antonuccio, J.L. Steinmetz, and L. Teri The Coping With Depression Course: A Psychoeducational Intervention for Unipolar Depression 1984 Castalia Publishing Company USA
K. Lovell, and D.A. Richards Recovery Programme for Depression 2008 Rethink London
M. Lugtenberg, J.M. Zegers-van Schaick, G.P. Westert, and J.S. Burgers Why don't physicians adhere to guideline recommendations in practice? An analysis of barriers among Dutch general practitioners Implement. Sci. 4 2009 54 10.1186/1748-5908-4-54
McDermott, B., Baigent, M., Chanen, A., Fraser, L., Graetz, B., Hayman, N.,..., Spence, S., 2010. Clinical practice guidelines: Depression in adolescents and young adults. Melbourne: beyonblue: The National Depression Initiative (on behalf of the beyondblue Expert Working Committee).
L. McMahon, K.M. Foran, S.D. Forrest, M.L. Taylor, G. Ingram, M. Rajwal, and R.H. McAllister-Williams Graduate mental health worker case management of depression in UK primary care: a pilot study Br. J. Gen. Pract. 57 2007 880 885
N. Mead, W. MacDonald, P. Bower, K. Lovell, D. Richards, C. Roberts, and A. Bucknall The clinical effectiveness of guided self-help versus waiting-list control in the management of anxiety and depression: a randomized controlled trial Psychol. Med. 35 2005 1633 1643 10.1017/S003329170500560X
T.K. Melartin, H.J. Rytsälä, U.S. Leskelä, P.S. Lestelä-Mielonen, T.P. Sokero, and E.T. Isometsä Continuity is the main challenge in treating major depressive disorder in psychiatric care J. Clin. Psychiatry 66 2005 220 227 10.4088/JCP.v66n0210
H. Meltzer, P. Bebbington, T. Brugha, M. Farrell, R. Jenkins, and G. Lewis The reluctance to seek treatment for neurotic disorders J. Ment. Health 9 2000 319 327 10.1080/jmh.9.3.319.327
M. Menchetti, C. Sighinolfi, V. Di Michele, P. Peloso, C. Nespeca, P.V. Bandieri, and D. Berardi Effectiveness of collaborative care for depression in Italy. A randomized controlled trial Gen. Hosp. Psychiatry 35 2013 576 586 10.1016/j.genhosppsych.2013.07.009
Michigan University Guidelines for Clinical Care Ambulatory - Depression 2014 Faculty Group Practice University of Michigan Health System Michigan
A. Mitchell, A. Vaze, and S. Rao Clinical diagnosis of depression in primary care: A meta-analysis Lancet 374 2009 609 619 10.1016/S0140-6736(09)60879-5
NICE Depression in Adults. The Treatment and Management of Depression in Adults. Clinical Guideline 90 2009 NICE Manchester http://www.nice.org.uk/guidance/CG90
NICE, 2012. Depression: Evidence update April 2012. A Summary of Selected New Evidence Relevant to NICE Guideline 90 'The Treatment and Management of Depression in Adults' (2009). Retrieved from: 'http://www.nice.org.uk/guidance/CG90'.
M.M. Ohayon, C.M. Shapiro, and S.H. Kennedy Differentiating DSM-IV anxiety and depressive disorders in the general population: comorbidity and treatment consequences Can. J. Psychiatry 45 2000 166 172
D.B. Oosterbaan, M.J.P.M. Verbraak, B. Terluin, A.W. Hoogendoorn, W.J. Peyrot, A. Muntingh, and A.J.L.M. van Balkom Collaborative stepped care versus care as usual for common mental health disorders: 8-month, cluster randomised controlled trial Br. J. Psychiatry 203 2013 132 139 10.1192/bjp.bp.112.125211
D.A. Richards, J.J. Hill, L. Gask, K. Lovell, C. Chew-Graham, P. Bower, and et al. Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomized controlled trial Br. Med. J. 347 2013 f4913 10.1136/bmj.f4913
D.A. Richards, and R. Suckling Improving access to psychological therapies: phase IV prospective cohort study Br. J. Clin. Psychol. 48 2009 377 396 10.1348/014466509×405178
B.G. Saver, V. Van-Nguyen, G. Keppel, and M.P. Doescher A qualitative study of depression in primary care: missed opportunities for diagnosis and education J. Am. Board Fam. Med. 20 2007 28 35 10.3122/jabfm.2007.01.060026
W. Seekles, A. van Straten, A. Beekman, H. van Marwijk, and P. Cuijpers Stepped care for depression and anxiety: From primary care to specialized mental health care: a randomised controlled trial testing the effectiveness of a stepped care program among primary care patients with mood or anxiety disorders BMC Health Serv. Res. 9 2009 90 10.1186/1472-6963-9-90
W. Seekles, A. van Straten, A. Beekman, H. van Marwijk, and P. Cuijpers Stepped care treatment for depression and anxiety sin primary care: a randomized controlled trial Trials 12 2011 171 10.1186/1745-6215-12-171
M. Sharpe, J. Walker, C.H. Hansen, P. Martin, S. Symeonides, C. Gourley, and G. Murray Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicenter randomized controlled effectiveness trial on behalf of the SMaRT (Symptom Management Research Trials) Oncology-2 Team Lancet 384 2014 1099 1108 10.1016/S0140-6736(14)61231-9
L. Smith, A. Walker, and K. Gilhooly Clinical guidelines on depression: a qualitative study of GPs' views J. Fam. Pract. 53 2004 556 561
Spijker, J., Bockting, C.L.H., Meeuwissen, J.A.C., van Vliet, I.M., Emmelkamp, P.M.G., Hermens, M.L.M., Balkom, A.L.J.M., 2013. Multidisciplinaire richtlijn depressie. Richtlijn voor de diagnostiek, behandeling en begeleiding van volwassen patiënten met een depressieve stoornis. [Interdisciplinary Guideline Depression. Guideline for diagnosing and treating adults with a depressive disorder.] (3rd revision). Utrecht, Trimbos-instituut (on behalf of the task force 'Multidisciplinaire Richtlijnontwikkeling Angststoornissen/Depressie'). Retrieved from: www.trimbos.nl.
A. van Straten, W. Seekles, N. van 't Veer-Tazelaar, A.T.F. Beekman, and P. Cuijpers Stepped care for depression in primary care: what should be offered and how? Med. J. Aust. 192 2010 S36 S39
E. Suter, J. Arndt, N. Arthur, J. Parboosingh, E. Taylor, and S. Deutschlander Role understanding and effective communication as core competencies for collaborative practice J. Interprof. Care 23 2009 41 51 10.1080/13561820802338579
The ESEMeD/MHEDEA 2000 investigators, J. Alonso, M.C. Angermeyer, S. Bernert, R. Bruffaerts, and W.A.M. Vollebergh Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project Acta Psychiatr. Scand. 109 2004 47 54 10.1111/j.1600-0047.2004.00330.x
A. Thota, T.A. Sipe, G.J. Byard, C.S. Zometa, R.A. Hahn, L.R. McKnight-Eily, and S.P. Williams Collaborative care to improve the management of depressive disorders: a community guide systematic review and meta-analysis Am. J. Prev. Med. 42 2012 525 538 10.1016/j.amepre.2012.01.019
C. Van Audenhove, I. De Coster, H. van den Ameele, J. De Fruyt, and M. Goetinck De aanpak van depressie door de huisarts. [Management of depression by the general practitioner] 2007 LannooCampus, Leuven, Belgium
M. Von Korff, W. Katon, T. Bush, E.H.B. Lin, G.E. Simon, K. Saunders, and J. Unutzer Treatment costs, cost offset, and cost-effectiveness of collaborative management of depression Psychosom. Med. 60 1998 143 149
J. Walker, J. Cassidy, M. Sharpe, and SMaRT Oncology-3 Trialists The third symptom management research trial in oncology (SMaRT oncology-3): a randomized trial to determine the efficacy of adding a complex intervention for major depressive disorder (depression care for people with lung cancer) to usual care, compared to usual care alone in patients with lung cancer Trials 10 2009 92 10.1186/1745-6215-10-92
J. Walker, C.H. Hansen, P. Martin, S. Symeonides, C. Gourley, L. Wall, and M. Sharpe Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT ONcology-3): a multicentre randomised controlled trial in patients with lung cancer Lancet Oncol. 15 2014 1168 1176 10.1016/S1470-2045(14)70343-2 (on behalf of the SMaRT (Symptom Management Research Trials) Oncology-3 Team)
J. Walker, and M. Sharpe Depression care for people with cancer: a collaborative care intervention Gen. Hosp. Psychiatry 31 2009 436 441 10.1016/j.genhosppsych.2009.05.010
B. Watzke, D. Heddaeus, M. Steinmann, H.-H. König, K. Wegscheider, H. Schulz, and M. Härter Effectiveness and cost-effectiveness of a guideline-based stepped care model for patients with depression: study protocol of a cluster-randomized controlled trial in routine care BMC Psychiatry 14 2014 230 10.1186/s12888-014-0230-y
G.M. van der Weele, M.W.M. de Waal, W.B. van den Hout, R.C. van der Mast, A.J.M. de Craen, W.J.J. Assendelft, and J. Gussekloo Yield and costs of direct and stepped screening for depressive symptoms in subjects aged 75 years and over in general practice Int. J. Geriatr. Psychiatry 26 2011 229 238 10.1002/gps.2518
G.M. van der Weele, M.W.M. de Waal, W.B. van den Hout, A.J.M. de Craen, P. Spinhoven, T. Stijnen, and J. Gussekloo Effects of a stepped-care intervention programme among older subjects who screened positive for depressive symptoms in general practice: the PROMODE randomised controlled trial Age Ageing 41 2012 482 488 10.1093/ageing/afs027
I. Wernher, F. Bjerregaard, I. Tinsel, C. Bleich, S. Boczor, T. Kloppe, and M. Hüll Collaborative treatment of late-life depression in primary care (GermanIMPACT): study protocol of a cluster-randomized controlled trial Trials 15 2014 351 362 10.1186/1745-6215-15-351
J.W. Williams, M. Gerrity, T. Holsinger, S. Dobscha, B. Gaynes, and A. Dietrich Systematic review of multifaceted interventions to improve depression care Gen. Hosp. Psychiatry 29 2007 91 116 10.1016/j.genhosppsych.2006.12.003
World Health Organization, 2012. Health statistics and information systems. Estimates for 2000-2012. DALY estimates by region. Retrieved from 'www.who.int/healthinfo/global-burden-disease/estimates/en/index2.html'.
