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US depression treatment effective in UK

The collaborative care approach to treating patients with depression, developed in the United States, appears to be as effective in the United Kingdom, researchers reported.

"By implementing collaborative care, primary care clinicians will see a 15% increase in the numbers of their patients recovering from depression 12 months after initiating the intervention," David Richards, PhD, RN, professor of mental health services research at the University of Exeter Medical School, said in an interview.

 

David Richards

The collaborative care model has been supported by studies in the United States, and even in developing countries, but there has been insufficient evidence in the United Kingdom. According to background information in the study, between 90% and 95% of depression cases are handled through primary care in the United Kingdom. Richards and colleagues responded to a request by the UK National Institute for Health and Clinical Excellence to provide more supportive evidence for the intervention.

The cluster randomized controlled trial included 581 adults with depression from across 51 practices. Depending on the setting, patients received either collaborative care for 14 weeks or usual treatment through their general practitioner. Collaborative care included a structured treatment management plan, six to 12 scheduled follow-ups and enhanced communication between health professionals. In each case, a care manager was selected to liaise between primary care clinicians and mental health specialists.

At 4 months, participants in collaborative care had a mean depression score 1.33 points lower (95% CI, 0.35-2.31) on the Patient Health Questionnaire-9 vs. participants enrolled in usual treatment. At 12 months, patients in collaborative care had a mean score 1.36 points lower (95% CI, 0.07-2.64) than controls.

Also, 15% more patients in collaborative care were more likely to meet criteria for recovery and treatment response at 12 months, and significantly more likely to be satisfied with their treatment (P<.001).

The researchers observed no significant improvements in anxiety or physical health between the two groups.

"Collaborative care is as effective in the UK health care system, an example of an integrated health system with a well-developed primary care sector, as in the US," the researchers wrote. "Our study adds to the emerging international literature from countries such as Chile and India, indicating that collaborative care is a model that reliably generalizes outside the US."

Disclosure: The study was supported by the National Institute for Health. The researchers report no relevant financial disclosures.