Collaborative Care Approaches Ranked by Depression Outcomes in Primary Care

The most effective elements of collaborative care in treating depression were identified in a new meta-analysis.¹ The study of over 20,000 patients analyzed data from 35 datasets and found that structured therapeutic treatment strategies—specifically manual-based psychotherapy and family involvement—had the most significant impact on reducing depressive symptoms in primary care settings.

By prioritizing therapeutic treatment strategies, providers can enhance the impact of collaborative care interventions.

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The findings were published in JAMA Psychiatry.

Collaborative care is a team-based approach that integrates primary care providers, mental health specialists, and care managers to support patients with chronic conditions, including depression. The primary care setting has been acknowledged as a gap in treating depression and other mental health conditions, prompting increased focus on ways to improve in recent years.² While the overall effectiveness of collaborative care has been well established, this study aimed to determine which specific components had the most impact.¹

Therapeutic Treatment Strategy for Depression

Researchers found that among 4 key collaborative care components—patient-centered care, therapeutic treatment strategy, measurement-based care, and integrated mental health care—the therapeutic treatment strategy showed the strongest association with improved depression outcomes (−0.07; P < .001). Patients who received manual-based psychotherapy and whose family members were involved in their care experienced the greatest reductions in depressive symptoms.

Other components of collaborative care also contributed to positive outcomes but had smaller effects (−0.04). The study suggests that prioritizing structured therapy and family engagement could maximize the effectiveness of collaborative care interventions. The average (SD) age of participants was 50.8 years (16.5); 68.4% were women.

The researchers obtained data from MEDLINE, Embase, Cochrane Library, PubMed, PsycINFO, and relevant systematic reviews. Searches were conducted in December 2023, and eligible data were collected until March 14, 2024. A pair of researchers assessed the eligibility for inclusion of randomized clinical trials comparing the effect of collaborative care and usual care among adult patients with depression in primary care.

The study collected individual participant data (IPD) on demographics and depression outcomes from all eligible trials at the beginning and during follow-ups and employed linear mixed models with random effects to analyze the IPD. A continuous measure of depression severity was assessed via validated self-report instruments at 4 to 6 months and was standardized using the instrument’s cutoff value for mild depression.

Mental Health in Primary Care

While all collaborative care components play a role, the study suggests that emphasizing therapeutic treatment strategies could significantly improve outcomes for patients with depression. Further research may help refine these interventions to optimize their impact in real-world health care settings. The researchers noted that the critical role of family and friend involvement has not been evaluated extensively and could prove to be a useful focus for future research.

"It may be helpful to further untangle collaborative care, separating active ingredients from delivery approaches to assess their relative importance," they wrote. "This may require experimental approaches that manipulate specific intervention components, such as factorial experiments allowing for testing of combinations and interactions of core components, or adaptive approaches, including sequential multiple assignment randomized trials and the multiphase optimization strategy."

This study represents one of the most rigorous evaluations of collaborative care components to date, using a robust methodological framework. However, it also acknowledged its limitations. Data were available for 57% of eligible trials, which, while common in similar meta-analyses, may impact the generalizability of the results. Additionally, some factors—such as the physician-patient relationship and trust between collaborative care team members—were not fully accounted for, and further research could explore their influence on care outcomes.

Conversely, by using IPD, the meta-analysis provides more precise insights into the active ingredients of collaborative care, emphasizing the central role of manual-based psychotherapy and family involvement.

"To our knowledge, this IPD meta-analysis provides the most rigorous and conclusive insights into the most effective components of collaborative care for depression in primary care that should be considered by implementers of this complex intervention," the study concluded. "A strong focus should thus lie on the derived component therapeutic treatment strategy, including patient and family involvement."

References

1. Schillok H, Gensichen J, Panagioti M, et al. Effective components of collaborative care for depression in primary care: an individual participant data meta-analysis. JAMA Psychiatry. Published online March 26, 2025. doi:10.1001/jamapsychiatry.2025.0183

2. Trautmann S, Beesdo-Baum K. The treatment of depression in primary care. Dtsch Arztebl Int. 2017;114(43):721-728. doi:10.3238/arztebl.2017.0721