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Review
. 2024 May 7;5(5):CD009531.
doi: 10.1002/14651858.CD009531.pub3.

Collaborative care approaches for people with severe mental illness

Siobhan Reilly  1   2   3 , Charley Hobson-Merrett  4   5 , Bliss Gibbons  6 , Ben Jones  7 , Debra Richards  4 , Humera Plappert  8 , John Gibson  9 , Maria Green  10 , Linda Gask  11 , Peter J Huxley  12 , Benjamin G Druss  13 , Claire L Planner  14
Affiliations
Review

Collaborative care approaches for people with severe mental illness

Siobhan Reilly et al. Cochrane Database Syst Rev. .

Abstract

Background: Collaborative care for severe mental illness (SMI) is a community-based intervention that promotes interdisciplinary working across primary and secondary care. Collaborative care interventions aim to improve the physical and/or mental health care of individuals with SMI. This is an update of a 2013 Cochrane review, based on new searches of the literature, which includes an additional seven studies.

Objectives: To assess the effectiveness of collaborative care approaches in comparison with standard care (or other non-collaborative care interventions) for people with diagnoses of SMI who are living in the community.

Search methods: We searched the Cochrane Schizophrenia Study-Based Register of Trials (10 February 2021). We searched the Cochrane Common Mental Disorders (CCMD) controlled trials register (all available years to 6 June 2016). Subsequent searches on Ovid MEDLINE, Embase and PsycINFO together with the Cochrane Central Register of Controlled Trials (with an overlap) were run on 17 December 2021.

Selection criteria: Randomised controlled trials (RCTs) where interventions described as 'collaborative care' were compared with 'standard care' for adults (18+ years) living in the community with a diagnosis of SMI. SMI was defined as schizophrenia, other types of schizophrenia-like psychosis or bipolar affective disorder. The primary outcomes of interest were: quality of life, mental state and psychiatric admissions at 12 months follow-up.

Data collection and analysis: Pairs of authors independently extracted data. We assessed the quality and certainty of the evidence using RoB 2 (for the primary outcomes) and GRADE. We compared treatment effects between collaborative care and standard care. We divided outcomes into short-term (up to six months), medium-term (seven to 12 months) and long-term (over 12 months). For dichotomous data we calculated the risk ratio (RR) and for continuous data we calculated the standardised mean difference (SMD), with 95% confidence intervals (CIs). We used random-effects meta-analyses due to substantial levels of heterogeneity across trials. We created a summary of findings table using GRADEpro.

Main results: Eight RCTs (1165 participants) are included in this review. Two met the criteria for type A collaborative care (intervention comprised of the four core components). The remaining six met the criteria for type B (described as collaborative care by the trialists, but not comprised of the four core components). The composition and purpose of the interventions varied across studies. For most outcomes there was low- or very low-certainty evidence. We found three studies that assessed the quality of life of participants at 12 months. Quality of life was measured using the SF-12 and the WHOQOL-BREF and the mean endpoint mental health component scores were reported at 12 months. Very low-certainty evidence did not show a difference in quality of life (mental health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.03, 95% CI -0.26 to 0.32; 3 RCTs, 227 participants). Very low-certainty evidence did not show a difference in quality of life (physical health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.08, 95% CI -0.18 to 0.33; 3 RCTs, 237 participants). Furthermore, in the medium term (at 12 months) low-certainty evidence did not show a difference between collaborative care and standard care in mental state (binary) (RR 0.99, 95% CI 0.77 to 1.28; 1 RCT, 253 participants) or in the risk of being admitted to a psychiatric hospital at 12 months (RR 5.15, 95% CI 0.67 to 39.57; 1 RCT, 253 participants). One study indicated an improvement in disability (proxy for social functioning) at 12 months in the collaborative care arm compared to usual care (RR 1.38, 95% CI 0.97 to 1.95; 1 RCT, 253 participants); we deemed this low-certainty evidence. Personal recovery and satisfaction/experience of care outcomes were not reported in any of the included studies. The data from one study indicated that the collaborative care treatment was more expensive than standard care (mean difference (MD) international dollars (Int$) 493.00, 95% CI 345.41 to 640.59) in the short term. Another study found the collaborative care intervention to be slightly less expensive at three years.

Authors' conclusions: This review does not provide evidence to indicate that collaborative care is more effective than standard care in the medium term (at 12 months) in relation to our primary outcomes (quality of life, mental state and psychiatric admissions). The evidence would be improved by better reporting, higher-quality RCTs and the assessment of underlying mechanisms of collaborative care. We advise caution in utilising the information in this review to assess the effectiveness of collaborative care.

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Conflict of interest statement

SR was one of the researchers involved in one of the ongoing studies: PARTNERS2, NIHR‐funded study.

CHM was one of the researchers involved in one of the ongoing studies: PARTNERS2, NIHR‐funded study.

BG was one of the researchers involved in one of the ongoing studies: PARTNERS2, NIHR‐funded study.

BJ was one of the researchers involved in one of the ongoing studies: PARTNERS2, NIHR‐funded study.

DR was one of the researchers involved in one of the ongoing studies: PARTNERS2, NIHR‐funded study.

HP was one of the researchers involved in one of the ongoing studies: PARTNERS2, NIHR‐funded study.

JG was one of the researchers involved in one of the ongoing studies: PARTNERS2, NIHR‐funded study.

MG was one of the researchers involved in one of the ongoing studies: PARTNERS2, NIHR‐funded study.

LG was co‐author on the 'Collaborative care for depression and anxiety problems in primary care' review (Archer 2012), and is one of the researchers involved in one of the ongoing studies: PARTNERS2, NIHR‐funded study.

PH was one of the researchers involved in one of the ongoing studies: PARTNERS2, NIHR‐funded study.

BD has no known conflicts of interest.

CP was one of the researchers involved in one of the ongoing studies: PARTNERS2, NIHR‐funded study.

Those authors involved in the PARTNERS2 study will not be involved in the extraction or ratings of the risk of bias for that study.

Figures

1
1
Study flow diagram
1.1
1.1. Analysis
Comparison 1: Collaborative care versus usual care (primary outcomes), Outcome 1: Quality of life: average change in mental health component ‐ 12 months
1.2
1.2. Analysis
Comparison 1: Collaborative care versus usual care (primary outcomes), Outcome 2: Mental state: clinically important change (binary) ‐ 12 months
1.3
1.3. Analysis
Comparison 1: Collaborative care versus usual care (primary outcomes), Outcome 3: Psychiatric hospital admissions ‐ 12 months
2.1
2.1. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 1: Quality of life
2.2
2.2. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 2: Mental state
2.3
2.3. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 3: Psychiatric hospital admissions: number of participants admitted to hospital (greater than 12 months)
2.4
2.4. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 4: Other hospital admissions
2.5
2.5. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 5: Personal recovery
2.6
2.6. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 6: Physical health status
2.7
2.7. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 7: Global state
2.8
2.8. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 8: Medication adherence (patient‐reported) (DAI‐10)
2.9
2.9. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 9: Medication adherence (patient‐reported) (MARS)
2.10
2.10. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 10: Social functioning (binary)
2.11
2.11. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 11: Social functioning/disability
2.12
2.12. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 12: Substance use (alcohol/illicit drugs/cigarettes/tobacco)
2.13
2.13. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 13: Adverse effect/event(s)
2.14
2.14. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 14: Death
2.15
2.15. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 15: Service use outside of mental health (i.e. primary care, emergency services, walk‐in centres, social services)
2.16
2.16. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 16: Cost of treatment
2.17
2.17. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 17: Cost of treatment (international dollars)
2.18
2.18. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 18: Experience of care/satisfaction
2.19
2.19. Analysis
Comparison 2: Collaborative care versus usual care (secondary outcomes), Outcome 19: Attrition/leaving the study early
3.1
3.1. Analysis
Comparison 3: Collaborative care versus usual care (sensitivity analyses), Outcome 1: Mental state: clinically important change (sensitivity analysis: assumptions for attrition)
3.2
3.2. Analysis
Comparison 3: Collaborative care versus usual care (sensitivity analyses), Outcome 2: Psychiatric hospital admissions (sensitivity analysis: assumptions for attrition)
4.1
4.1. Analysis
Comparison 4: Collaborative care versus usual care (subgroup analyses), Outcome 1: Quality of life, physical health at 6 months ‐ subgroup analysis: quality of study
4.2
4.2. Analysis
Comparison 4: Collaborative care versus usual care (subgroup analyses), Outcome 2: Quality of life, mental health at 6 months ‐ subgroup analysis: quality of study
4.3
4.3. Analysis
Comparison 4: Collaborative care versus usual care (subgroup analyses), Outcome 3: Quality of life, physical health at 6 months ‐ subgroup analysis: variations in implementation of the collaborative care intervention and healthcare systems
4.4
4.4. Analysis
Comparison 4: Collaborative care versus usual care (subgroup analyses), Outcome 4: Quality of life, mental health at 6 months ‐ subgroup analysis: variations in implementation of the collaborative care intervention and healthcare systems
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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NCT02440906 {published data only}
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NCT02543840 {published data only}
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NCT03590041 2020 {published data only}
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NCT03881657 2020 {published data only}
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NCT04324944 2021 {published data only}
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NCT04600414 2020 {published data only}
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