Effectiveness of collaborative care in reducing suicidal ideation: An individual participant data meta-analysis. - 27/06/21

Doi : 10.1016/j.genhosppsych.2021.04.004

Christos Grigoroglou ^a,^{^⁎} , Christina van der Feltz-Cornelis ^c, Alexander Hodkinson ^b, Peter A. Coventry ^d, Salwa S. Zghebi ^b, Evangelos Kontopantelis ^e, Peter Bower ^b, Karina Lovell ^f,^g, Simon Gilbody ^c, Waquas Waheed ^b, Christopher Dickens ^h, Janine Archer ⁱ, Amy Blakemore ^f, David A. Adler ^j, Enric Aragones ^k, Cecilia Björkelund ^l, Martha L. Bruce ^m, Marta Buszewicz ⁿ, Robert M. Carney ^o, Martin G. Cole ^p, Karina W. Davidson ^q, Jochen Gensichen ^r, Nancy K. Grote ^s, Joan Russo ^t, Klaas Huijbregts ^u, Jeff C. Huffman ^v, Marco Menchetti ^w, Vikram Patel ^x, David A. Richards ^y,^z, Bruce Rollman ^aa, Annet Smit ^ab, Moniek C. Zijlstra-Vlasveld ^ac, Kenneth B. Wells ^ad,^ae, Thomas Zimmermann ^af, Jurgen Unutzer ^t, Maria Panagioti ^b
^a Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
^b National Institute of Health Research School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, England
^c Department of Health Sciences, Hull York Medical School, HYMS, University of York, York, England
^d Department of Health Sciences, University of York, York, England
^e Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, England
^f Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, England
^g Greater Manchester Mental Health NHS Foundation Trust, Manchester, England
^h Mental Health Research Group, University of Exeter Medical School, England
ⁱ School of Health and Society, School of Health and Society, University of Salford, England
^j Departments of Psychiatry and Medicine, Tufts Medical Center and Tufts University School of Medicine, England
^k Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAPJGol), Barcelona, Spain
^l Primary Health Care School of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
^m Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
ⁿ Institute of Epidemiology and Health, Faculty of Population and Health Sciences, University College London, London, England
^o Department of Psychiatry, Washington University in St. Louis (WUSTL), St. Louis, Missouri, USA
^p Department of Psychiatry, St. Mary's Hospital Center, McGill University, Montreal, Quebec, Canada
^q Institute of Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, New York, USA
^r Institute of General Practice and Family Medicine, LMU Klinikum, Ludwig-Maximilians, University Munich Pettenkoferstr. 10, 80336 Munich, Germany
^s School of Social Work, University of Washington, Seattle, USA
^t Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
^u Department of Psychiatry and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
^v Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
^w Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
^x The Pershing Square Professor of Global Health, Harvard Medical School, Boston, MA, USA
^y Institute of Health Research, University of Exeter College of Medicine and Health, Exeter, England
^z Western University of Norway, Bergen, Norway
^aa Center for Behavioral Health, Media and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
^ab HAN University of Applied Sciences, Nijmegen, Netherlands
^ac ZonMw, The Netherlands Organisation for Health Research and Development, The Hague, Netherlands
^ad Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, USA
^ae Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
^af Department of General Practice / Primary Care, Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany

^⁎Corresponding author at: Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and HealthUniversity of Manchester, Manchester Academic Health Science CentreWilliamson Building, Oxford RoadManchesterM13 9PLUK

Objective

To assess whether CC is more effective at reducing suicidal ideation in people with depression compared with usual care, and whether study and patient factors moderate treatment effects.

Method

We searched Medline, Embase, PubMed, PsycINFO, CINAHL, CENTRAL from inception to March 2020 for Randomised Controlled Trials (RCTs) that compared the effectiveness of CC with usual care in depressed adults, and reported changes in suicidal ideation at 4 to 6 months post-randomisation. Mixed-effects models accounted for clustering of participants within trials and heterogeneity across trials. This study is registered with PROSPERO, CRD42020201747.

Results

We extracted data from 28 RCTs (11,165 patients) of 83 eligible studies. We observed a small significant clinical improvement of CC on suicidal ideation, compared with usual care (SMD, −0.11 [95%CI, −0.15 to −0.08]; I², 0·47% [95%CI 0.04% to 4.90%]). CC interventions with a recognised psychological treatment were associated with small reductions in suicidal ideation (SMD, −0.15 [95%CI -0.19 to −0.11]). CC was more effective for reducing suicidal ideation among patients aged over 65 years (SMD, − 0.18 [95%CI -0.25 to −0.11]).

Conclusion

Primary care based CC with an embedded psychological intervention is the most effective CC framework for reducing suicidal ideation and older patients may benefit the most.

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Plan

Measuring suicidal ideation and chronic physical conditions

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Vol 71

P. 27-35 - juillet 2021 Retour au numéro

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Effectiveness of collaborative care in reducing suicidal ideation: An individual participant data meta-analysis. - 27/06/21

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