Collaborative Care Proven Effective for Managing Depressive Disorders
Recommended by Task Force on Community Preventive Services

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 percent 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 Task Force on Community Preventive Services (Task Force), which recently issued the following recommendation: Based on strong evidence of effectiveness in improving depression symptoms, adherence to treatment, response to treatment, and remission and recovery from depression, the Task Force on Community Preventive Services (Task Force) recommends collaborative care for the management of depressive disorders. The Task Force also finds that collaborative care models provide good economic value based on the weight of evidence from studies that assessed both costs and benefits.

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, the review team included internal and external partners with expertise in mental health.

Collaborative Care
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, or 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 nine 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 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.

The Community Guide
 The Community Guide is an essential resource for people who want to know what works in public health. It provides evidence-based recommendations and findings about public health interventions and policies to improve health and promote safety. The Task Force on Community Preventive Services (Task Force) -- an independent, nonfederal body of public health and prevention experts -- makes these findings and recommendations based on systematic reviews of scientific literature conducted under the auspices of the Community Guide. CDC provides ongoing scientific, administrative and technical support for the Task Force.

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 research gaps. Community Guide review teams are led or supported by Community Guide scientists, and include government, academic, policy and practice-based partners.

Visit All Community Guide Topics at www.thecommunityguide.org to learn more about other Community Guide systematic reviews.

*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.