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Meta-Analysis
. 2023 Apr 14;18(4):e0282590.
doi: 10.1371/journal.pone.0282590. eCollection 2023.

Case management interventions in chronic disease reduce anxiety and depressive symptoms: A systematic review and meta-analysis

Angelika D Geerlings  1 , Jules M Janssen Daalen  1 , Jan H L Ypinga  1 , Bastiaan R Bloem  1 , Marjan J Meinders  2 , Marten Munneke  1 , Sirwan K L Darweesh  1
Affiliations
Meta-Analysis

Case management interventions in chronic disease reduce anxiety and depressive symptoms: A systematic review and meta-analysis

Angelika D Geerlings et al. PLoS One. .

Abstract

Background: There is no systematic insight into the effect of case management on common complications of chronic diseases, including depressive symptoms and symptoms of anxiety. This is a significant knowledge gap, given that people with a chronic disease such as Parkinson Disease or Alzheimer's Disease have identified care coordination as one of their highest priorities. Furthermore, it remains unclear whether the putative beneficial effects of case management would vary by crucial patient characteristics, such as their age, gender, or disease characteristics. Such insights would shift from "one size fits all" healthcare resource allocation to personalized medicine.

Objective: We systematically examined the effectiveness of case management interventions on two common complications associated PD and other chronic health conditions: Depressive symptoms and symptoms of anxiety.

Methods: We identified studies published until November 2022 from PubMed and Embase databases using predefined inclusion criteria. For each study, data were extracted independently by two researchers. First, descriptive and qualitative analyses of all included studies were performed, followed by random-effects meta-analyses to assess the impact of case management interventions on anxiety and depressive symptoms. Second, meta-regression was performed to analyze potential modifying effects of demographic characteristics, disease characteristics and case management components.

Results: 23 randomized controlled trials and four non-randomized studies reported data on the effect of case management on symptoms of anxiety (8 studies) or depressive symptoms (26 studies). Across meta-analyses, we observed a statistically significant effect of case management on reducing symptoms of anxiety (Standardized Mean Difference [SMD] = - 0.47; 95% confidence interval [CI]: -0.69, -0.32) and depressive symptoms (SMD = - 0.48; CI: -0.71, -0.25). We found large heterogeneity in effect estimates across studies, but this was not explained by patient population or intervention characteristics.

Conclusions: Among people with chronic health conditions, case management has beneficial effects on symptoms of depressive symptoms and symptoms of anxiety. Currently, research on case management interventions are rare. Future studies should assess the utility of case management for potentially preventative and common complications, focusing on the optimal content, frequency, and intensity of case management.

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Conflict of interest statement

The authors have declared that no competing interests exists.

Figures

Fig 1
Fig 1. Study flow diagram.
Fig 2
Fig 2. Forest plot on the effect of case management interventions on feelings of anxiety (random-effects model).
Fig 3
Fig 3. Forest plot on the effect of case management interventions on depressive symptoms (random-effects model).
Fig 4
Fig 4. Mediators of the effect of case management on reduction of depressive symptoms and feelings of anxiety: Hypothetical framework informed by this meta-analysis.
See this image and copyright information in PMC

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