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Meta-Analysis
. 2025 Sep 1;82(9):868-876.
doi: 10.1001/jamapsychiatry.2025.0183.

Effective Components of Collaborative Care for Depression in Primary Care: An Individual Participant Data Meta-Analysis

Hannah Schillok  1   2 , Jochen Gensichen  1   2   3 , Maria Panagioti  4   5 , Jane Gunn  6 , Lukas Junker  2   7 , Karoline Lukaschek  1   2 , Caroline Jung-Sievers  2   8   9 , Philipp Sterner  7   10 , Lukas Kaupe  1   2 , Tobias Dreischulte  1   2 , Mohammed K Ali  11   12 , Enric Aragonès  13 , David B Bekelman  14   15   16 , Birgit Herbeck Belnap  17 , Robert M Carney  18 , Lydia A Chwastiak  19   20 , Peter A Coventry  21   22 , Karina W Davidson  23 , Maria L Ekstrand  24   25 , Alison Flehr  6 , Susan Fletcher  6 , Lars P Hölzel  26   27   28 , Klaas Huijbregts  29 , Viswanathan Mohan  30 , Vikram Patel  31 , David A Richards  32 , Bruce L Rollman  17 , Chris Salisbury  33 , Gregory E Simon  34 , Krishnamachari Srinivasan  24   35 , Jürgen Unützer  20 , Christina M van der Feltz-Cornelis  21 , Kenneth B Wells  36   37 , Thomas Zimmermann  38 , Markus Bühner  2   3   7 ; POKAL Group
Collaborators, Affiliations
Meta-Analysis

Effective Components of Collaborative Care for Depression in Primary Care: An Individual Participant Data Meta-Analysis

Hannah Schillok et al. JAMA Psychiatry. .

Erratum in

  • Erratum: Omission in Byline.
    [No authors listed] [No authors listed] JAMA Psychiatry. 2025 Sep;82(9):947. doi: 10.1001/jamapsychiatry.2025.1960. Epub 2025 Jul 23. JAMA Psychiatry. 2025. PMID: 40699558 Free PMC article.

Abstract

Importance: Collaborative care is a multicomponent intervention for patients with chronic disease in primary care. Previous meta-analyses have proven the effectiveness of collaborative care for depression; however, individual participant data (IPD) are needed to identify which components of the intervention are the principal drivers of this effect.

Objective: To assess which components of collaborative care are the biggest drivers of its effectiveness in reducing symptoms of depression in primary care.

Data sources: Data were obtained from MEDLINE, Embase, Cochrane Library, PubMed, and PsycInfo as well as references of relevant systematic reviews. Searches were conducted in December 2023, and eligible data were collected until March 14, 2024.

Study selection: Two reviewers assessed for eligibility. Randomized clinical trials comparing the effect of collaborative care and usual care among adult patients with depression in primary care were included.

Data extraction and synthesis: The study was conducted according to the IPD guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. IPD were collected for demographic characteristics and depression outcomes measured at baseline and follow-ups from the authors of all eligible trials. Using IPD, linear mixed models with random nested effects were calculated.

Main outcomes and measures: 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.

Results: A total of 35 datasets with 38 comparisons were analyzed (N = 20 046 participants [57.3% of all eligible, with minimal differences in baseline characteristics compared with nonretrieved data]; 13 709 [68.4%] female; mean [SD] age, 50.8 [16.5] years). A significant interaction effect with the largest effect size was found between the depression outcome and the collaborative care component therapeutic treatment strategy (-0.07; P < .001). This indicates that this component, including its key elements manual-based psychotherapy and family involvement, was the most effective component of the intervention. Significant interactions were found for all other components, but with smaller effect sizes.

Conclusions and relevance: Components of collaborative care most associated with improved effectiveness in reducing depressive symptoms were identified. To optimize treatment effectiveness and resource allocation, a therapeutic treatment strategy, such as manual-based psychotherapy or family integration, may be prioritized when implementing a collaborative care intervention.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Ali reported receiving grants from the National Institute of Mental Health during the conduct of the study. Dr Aragonès reported receiving personal fees from Lundbeck, Esteve, and Boehringer Ingelheim outside the submitted work. Dr Bekelman reported receiving grants from the US Department of Veterans Affairs and the National Institutes of Health during the conduct of the study. Dr Herbeck Belnap reported receiving funding from the Germany Ministry of Education and Research and Horizon Europe outside the submitted work. Dr Ekstrand reported receiving grants from the National Institute of Mental Health during the conduct of the study. Dr Hölzel reported receiving grants from the Federal Ministry of Education and Research during the conduct of the study. Dr Rollman reported receiving funding from the National Institute of Mental Health and the National Heart, Lung, and Blood Institute outside the submitted work. Dr Salisbury reported receiving grants from the National Institute for Health Research during the conduct of the study. Dr Simon reported receiving grants from the National Institute of Mental Health during the conduct of the study; and receiving grants from the National Institute of Mental Health outside the submitted work. Dr Srinivasan reported receiving grants from the National Institute of Mental Health during the conduct of the study. No other disclosures were reported.

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