At the moment, NICE recommend collaborative care only for people who have both depression and a chronic physical condition. But evidence suggests that collaborative care could be effective for people with depression alone.
A study looked at 31 randomised controlled trials that had compared the effectiveness of collaborative care with usual care in depression, then analysed whether the presence of a physical condition changed the effect of collaborative care. There didn’t appear to be any significant effect, suggesting that this approach could be useful for people with depression regardless of whether they also have a chronic physical condition.
Collaborative care could also be of benefit to older people, who are disproportionately affected by depression. In this age group, it is more likely to occur alongside physical health conditions, and is strongly associated with a poorer quality of life. Evidence suggests that providing collaborative care to older people who have mild depression – below the normal criteria for treatment – may help prevent the depression from progressing. In a recent trial, 700 people with an average age of 77 years were randomised to receive either collaborative care or usual GP care. Participants were all experiencing mild symptoms of depression. As with the other trials described here, the collaborative care comprised contact from a case manager including telephone support, symptom monitoring and behavioural activation.
At four months, there was a modest difference in depression score in favour of those participants receiving collaborative care. This was similar to the difference observed in the trials (described above) with adults with diagnosed depression, and in line with other treatments for depression. After a year, those receiving collaborative care were less likely to have developed depression severe enough to warrant treatment. Delivery of collaborative care cost an additional £500 over usual care and was found to be cost-effective in terms of the overall health gains.
A new NIHR study is now extending the research to see if a similar collaborative care package could benefit older people with more severe depression. This is likely to report in 2017.
Together, this evidence about collaborative care suggests that it can lead to small improvements in depression for people of different ages, with different levels of depression and with or without accompanying physical health issues. It also appears to be cost-effective, within the limits generally used by NICE.