Collaborative care for mood disorders

Group Health Cooperative Center for Health Studies, Seattle, WA 98101, USA.
Current opinion in psychiatry (Impact Factor: 3.94). 02/2009; 22(1):37-41. DOI: 10.1097/YCO.0b013e328313e3f0
Source: PubMed


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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    • "Many of the empirically supported interventions to date can be characterized as "collaborative care," as they center around the activities of a care manager, usually a nurse or social worker, who maintains relatively frequent contact with the patient; performs a range of psychoeducational, therapeutic, and monitoring functions; and works as a liaison between the primary care provider and a consulting mental health professional, usually a psychiatrist. While most of the research and implementation work in the field thus far has concerned itself with collaborative care for depression [13-15], a growing literature supports collaborative-care interventions for panic disorder [16,17] and for both panic disorder and generalized anxiety disorder [18]. Authors of the current manuscript [19] conducted a large randomized controlled trial of a collaborative-care intervention in 17 community primary clinics for four anxiety disorders (generalized anxiety disorder, panic disorder, posttraumatic stress disorder, and/or social anxiety disorder) and recently published data showing it is effective, with small to medium effects sizes, in comparison to treatment as usual [20]. "
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    ABSTRACT: Investigators recently tested the effectiveness of a collaborative-care intervention for anxiety disorders: Coordinated Anxiety Learning and Management(CALM) []) in 17 primary care clinics around the United States. Investigators also conducted a qualitative process evaluation. Key research questions were as follows: (1) What were the facilitators/barriers to implementing CALM? (2) What were the facilitators/barriers to sustaining CALM after the study was completed? Key informant interviews were conducted with 47 clinic staff members (18 primary care providers, 13 nurses, 8 clinic administrators, and 8 clinic staff) and 14 study-trained anxiety clinical specialists (ACSs) who coordinated the collaborative care and provided cognitive behavioral therapy. The interviews were semistructured and conducted by phone. Data were content analyzed with line-by-line analyses leading to the development and refinement of themes. Similar themes emerged across stakeholders. Important facilitators to implementation included the perception of "low burden" to implement, provider satisfaction with the intervention, and frequent provider interaction with ACSs. Barriers to implementation included variable provider interest in mental health, high rates of part-time providers in clinics, and high social stressors of lower socioeconomic-status patients interfering with adherence. Key sustainability facilitators were if a clinic had already incorporated collaborative care for another disorder and presence of onsite mental health staff. The main barrier to sustainability was funding for the ACS. The CALM intervention was relatively easy to incorporate during the effectiveness trial, and satisfaction was generally high. Numerous implementation and sustainability barriers could limit the reach and impact of widespread adoption. Findings should be interpreted with the knowledge that the ACSs in this study were provided and trained by the study. Future research should explore uptake of CALM and similar interventions without the aid of an effectiveness trial.
    Implementation Science 03/2012; 7(1):1-11. DOI:10.1186/1748-5908-7-14 · 4.12 Impact Factor
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    • "There may be several reasons for this state of affairs. There is a perception that we already have effective treatments for depression, using existing pharmacological or psychotherapeutic approaches, and therefore all that is really needed is to get more clinicians to use these highly effective approaches (e.g., Simon, 2009). Clinicians skilled in the use of hypnosis may be reluctant to treat depression based on earlier, albeit unsubstantiated concerns that hypnosis may be harmful to depressed individuals (Yapko, 1992). "
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    ABSTRACT: Depressive disorders constitute a serious problem in the United States and around the world. The appearance of practice guidelines and lists of evidenced-based therapies suggests that adequate treatments for depression exist. However, a careful consideration of what is known and not known about the treatment of depression leaves plenty of room for improved approaches to addressing this condition. Although there has been a dearth of research on the treatment of depression using hypnosis, there are several compelling arguments for the inclusion of hypnotic approaches in the array of current strategies for dealing with depression. However, traditional "gold-standard" research methods, namely randomized controlled trials, have many shortcomings for identifying the potential impact of hypnosis on depression. Other strategies, notably single-case design and benchmarking approaches, may offer a more practical solution to the problem of determining "what works for depression."
    International Journal of Clinical and Experimental Hypnosis 04/2010; 58(2):147-64. DOI:10.1080/00207140903523186 · 1.38 Impact Factor
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    ABSTRACT: Treatment and services research in the general medical sector has emphasized the importance of addressing organizational capacity to improve interventions for patients with chronic conditions. Efficacious interventions for child and adolescent mental disorders without substantial enhancements in mental health organizational capacity will not result in improvements for children. This paper (a) lists some organizational enhancements that have resulted in improved medical care, (b) briefly underscores recent market trends such as state healthcare reform efforts, increased use of electronic records and contracting initiatives that push consolidation of agencies, and (c) describes one example of the organizational development of child behavioral services that will enhance treatment delivery.
    Administration and Policy in Mental Health and Mental Health Services Research 02/2010; 37(1-2):89-94. DOI:10.1007/s10488-010-0284-1 · 3.44 Impact Factor
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