Ell 2007.

Methods	Study design: Randomised controlled trial
Participants	Setting: Community Diagnosis: Screened positive for clinically significant depression Inclusion criteria: Home care, 65 and older Exclusion criteria: significant cognitive impairment, participation in another depression study Age:  =Mean 78.1 years Gender: 73% female Ethnicity: 72% white Country: United States Sample size (randomised): Total participants 311, intervention 155, control 156
Interventions	Treatment: Stepped care decision support Contains the four elements of collaborative care: 1) a multi‐professional approach to patient care: Primary care physician (PCP), existing staff ‐ nurses, social workers, psychiatric nurses, a telephone case manager and a psychologist (CM), existing staff ‐ psychiatrist, nurses, social workers (MH specialist) 2) a structured management plan: A stepped care algorithm (based on IMPACT) in which patients were offered a choice of PST or ADs prescribed by PCP, or combined treatment if indicated. Step 1 (8‐10 weeks) choice of AD or PST. Patients with full response go to maintenance treatment. Step 2 (4‐8 weeks): if AD in step 1 and partial response give different AD type or augment AD, if no response PST. If PST in step 1 and partial response add AD or different AD type, if no response give AD. CMs monitored medication and delivered structured PST 3) scheduled patient follow‐ups: PST = 6‐12 sessions, medication = as per stepped care algorithm 4) enhanced inter‐professional communication: CM communicated with PCP about medication or if a patient did not improve. Usual supervisory staff had the responsibility of monitoring and supportive supervision Control: Treatment as usual was enhanced by routine depression screening and staff training in depression care management for older adults. Patients PCP informed if a patient screened positive for probable major or minor depression
Outcomes	Depression (PHQ‐9): 4, 8, 12 months Medication use: during study period Quality of Life (mental and physical health): 4, 8, 12 months
Notes	AD: antidepressant; CM: case manager; MH: mental health; PCP: primary care provider; PHQ‐9: Patient Health Questionnaire–9; PST: problem solving therapy
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 50% reduction) was: overall 113/311 (36%), 58/156 (37%) intervention and 55/155 (35%) control. Reasons for loss to follow‐up not provided across groups. Intention‐to‐treat analysis reported using observed data
Selective reporting (reporting bias)	Unclear risk	Insufficient information available to assess
Other bias	Unclear risk	Insufficient information available to assess
Implementation Integrity	Low risk	Attempts were made to assess implementation integrity (e.g. direct observation or rating of tapes)
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