Dwight‐Johnson 2010.
| Methods | Study design: Randomised controlled trial | |
| Participants | Setting: Primary care Diagnosis: Probable major depressive disorder or dysthymia, which was determined by using the Primary care evaluation of Mental Disorders (PRIME‐MD) and Patient Health Questionnaire–9 (PHQ‐9) Inclusion criteria: Low income Latino patients aged 18 or older and able to speak English or Spanish Exclusion criteria: Probable bipolar disorder, cognitive impairment, lifetime psychotic symptoms or disorder, or suicidal ideation. Age: Mean 49.8 (SD 12.6) years Gender: 84% female Ethnicity: 100% Latino Country: United States Sample size (randomised): Total participants 339, intervention 173, control 166 |
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| Interventions | Treatment: Collaborative care Contains the four elements of collaborative care: 1) a multi‐professional approach to patient care: Primary care provider (PCP), social worker (CM), psychiatrist (MH specialist) 2) a structured management plan: CMs educated patients about depression and its treatment, elicited treatment preferences, and provided active outreach and systematic assessment. Depending on patients’ treatment preferences, the CM provided short‐term manualised CBT, supported AD medication treatment, or both. Supported AD treatment involved encouraging adherence, assessing side effects and treatment response, and sharing this information with primary care providers. CBT was provided at no cost, and prescriptions were filled at low or no cost 3) scheduled patient follow‐ups: CBT = once a week for 12 weeks, medication = about every 2 weeks initially and then at least monthly after that 4) enhanced inter‐professional communication: CMs shared AD follow‐up detail with PCPs. MH specialist conducted weekly supervision by phone and with both CMs at same time. Control: Treatment as usual enhanced as patients received a letter to take to PCP stating that they had screened positive for depression, an educational pamphlet, and a list of local mental health resources |
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| Outcomes | Depression (PHQ‐9): 4 months Medication use: 4 months |
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| Notes | AD: antidepressant; CBT: cognitive behaviour therapy; CM: case manager; MH: mental health; PCP: primary care provider; PHQ‐9: Patient Health Questionnaire–9 | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | Insufficient information available to assess |
| Allocation concealment (selection bias) | Unclear risk | Insufficient information available to assess |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | Short‐term loss to follow‐up based on primary depression outcome (PHQ‐9) was unclear. Reasons for loss to follow‐up not provided. Used intention‐to‐treat analysis |
| Selective reporting (reporting bias) | Unclear risk | Insufficient information available to assess |
| Other bias | Unclear risk | Insufficient information available to assess |
| Implementation Integrity | Unclear risk | Insufficient information available to assess |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Participants and personnel could not be blinded, outcome likely to be influenced by lack of blinding |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Insufficient information available to assess |