Now Published: Collaborative Care to Manage Depression

Recommended by Community Preventive Services Task Force

In these times of limited resources, it is critical to know of public health interventions that work to manage depressive disorders. After all, depression affects individuals, families, workplaces and communities. In the U.S., an estimated 14.8 million Americans experience major depression in a given year. Also, every year approximately 1.5% of the adult U.S. population experience dysthymic disorder a chronic depressive illness that is less severe than major depressive disorder. Major depression and dysthymic disorder can also adversely affect the course and outcome of other chronic conditions such as asthma, arthritis, cancer, cardiovascular disease, diabetes and obesity — and can cause absenteeism from work, decreased productivity and short-term disability.

Community-Based Prevention that Works

Collaborative care improves management of depressive disorders, according to the Community Preventive Services Task Force, which issued the following recommendation:

The Task Force based its findings on a systematic review of all available scientific studies on collaborative care for managing depression. Led by scientists from the Guide to Community Preventive Services (Community Guide) at the Centers for Disease Control and Prevention (CDC), the review team included internal and external partners with expertise in mental health.

Systematic reviews of the evidence and economics of collaborative care were published in the May 2012 issue of the American Journal of Preventive Medicine along with the Task Force finding and three additional commentaries.

Collaborative Care

So what is collaborative care? Collaborative care is a multicomponent, healthcare system-level intervention that uses case managers to link primary care providers, patients, and mental health specialists. This team-based approach is designed to:

• Improve routine screening and diagnosis of depressive disorders
• Increase provider use of evidence-based protocols for active management of diagnosed depressive disorders
• Improve clinical and community support for active patient engagement in treatment goal setting and self-management

One example is Group Health Cooperative (GHC) , which uses collaborative care at primary care clinics to manage depression in patients with diabetes. GHC is a prepaid health plan that includes HMO and PPO models and serves 500,000 members in Washington and Idaho. A GHC nurse case manager coordinates a patient care team to work with each patient to help manage both diabetes and depression.

A primary care physician and mental health specialist complete the team. The latter, either a psychiatrist or psychologist, functions as supervisor and consultant. Patient care provided by the team includes: prescribing antidepressants as needed, providing psychotherapy, medical care for diabetes and ongoing patient follow up by the case manager to monitor progress and intervene when challenges to the treatment plan arise. A research trial of this GHC intervention in 9 clinics, the Pathways study, is among the studies included in the Community Guide systematic review.* While this is an example of successful use of collaborative care by a prepaid b health plan in a primary care setting for patients who have both diabetes and depression, the Community Guide systematic review showed that this model works in most settings and situations.

More on Depression and Mental Health from CDC and the Community Guide

Click on the following for more information about the Task Force recommendation on collaborative care, other Community Guide mental health reviews or depression in general:

• Collaborative care review, Task Force recommendation statement, and full-text articles
• Additional Community Guide mental health reviews and Task Force findings

The Community Guide

Visit Community Guide topics to learn more about other Community Guide systematic reviews.

Scientific Methods

The Community Guide conducts state-of-the-art systematic reviews that: analyze all available scientific evidence on what works to promote health and prevent disease, injury and disability; assess the economic benefits of the interventions found to be effective; and identify critical evidence gaps. Community Guide review teams are led or supported by Community Guide scientists, and include government, academic, policy and practice-based partners.

*Simon GE, Katon WJ, Lin EH, Rutter C, Manning WG, Von Korff M, Ciechanowski P, Ludman EJ, Young BA. Cost effectiveness of systematic depression treatment among people with diabetes mellitus. Archives of General Psychiatry 2007;64(1):65-72.