Collaborative care for mood disorders
ABSTRACT Psychiatric and health services research literature was reviewed to identify recent studies regarding effectiveness, cost-effectiveness, and generalizability of collaborative care programs to improve treatment of mood disorders.
Meta-analyses of previous randomized trials as well as recently conducted trials strongly support the effectiveness of collaborative care programs for depression across a broad range of primary care settings. Over time, the direct costs of providing more effective treatment for depression appear to be balanced by decreases in the use of general medical services, especially for patients with comorbid chronic medical illness. Given that the added costs of collaborative care are incurred early and economic benefits appear slowly, successful implementation of collaborative care programs will depend on adequate funding and availability of dedicated staff. Growing evidence supports the effectiveness of collaborative care programs to improve management of bipolar disorder in mental health specialty settings.
Given the strong evidence for the effectiveness, cost-effectiveness, and generalizability of collaborative care programs for depression in primary care, attention should turn to dissemination and implementation. Additional research is needed regarding effectiveness of collaborative care programs for more severe psychiatric disorders.
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ABSTRACT: Older adults with Diabetes Mellitus (DM) experience greater risk for comorbid depression compared to those who do not have DM. Undetected, untreated or under-treated depression impinges an individual's ability to manage their DM successfully, hinders their adherence to treatment regime, and undermines provider-patient relationships. Thus, in the context of caring for older adults with DM, comorbid depression presents special challenges and opportunities for clinicians. In this article, we summarize the clinical presentation of late-life depression, potential mechanisms of comorbidity of depression and DM, importance of depression in the successful management of DM, and available best practice models for depression treatment. Copyright © 2015 Elsevier Inc. All rights reserved.Clinics in Geriatric Medicine 11/2014; DOI:10.1016/j.cger.2014.08.022 · 3.19 Impact Factor
Article: Enhanced care for depression[Show abstract] [Hide abstract]
ABSTRACT: The purpose of this study is to review recent evidence of the effects of enhanced depression care, focusing (1) on symptomatic, functional and economic outcomes and (2) across different countries, (3) ethnic groups and (4) settings. Collaborative care is currently by far the most influential and best studied method to enhance depression care. Recent trials and reviews provide firm evidence that collaborative care is more effective than care as usual (CAU), though with small effects. These effects generalized across several important health outcomes are probably more pronounced in patients with more complex or severe disorders. Cost-effectiveness and cost utility data demonstrate that collaborative care is of good value for money, and this is probably more pronounced in patients with higher a-priori levels of healthcare utilization. Collaborative care is readily exported to other healthcare systems, other regions of the world and other cultures. Given parallel development and successful testing of other cheaper and more simple interventions targeting depression (such as guided self-help and e-mental health), it may be that collaborative care will focus on the more severe, complex or recurrent forms of affective disorder in the future. Including effects of collaborative care on other outcomes, especially on work-related functioning and economic productivity, seems fruitful.Current opinion in psychiatry 01/2013; 26(1):7-12. DOI:10.1097/YCO.0b013e32835b2c8c · 3.55 Impact Factor
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ABSTRACT: This article outlines the importance of primary health care in addressing the public health challenge presented by pediatric depressive disorders. The current realities of depression management in primary care are discussed. The models emerging from intervention research and the barriers to their implementation in practice are then reviewed. Drawing on this background, recent new standards for primary care management of pediatric depressive disorders are discussed, along with resources that have been developed to support their achievement.Child and adolescent psychiatric clinics of North America 04/2012; 21(2):401-19, ix-x. DOI:10.1016/j.chc.2012.01.008 · 2.88 Impact Factor