Roy‐Byrne 2005.

Methods	Study design: Randomised controlled trial
Participants	Setting: Primary care Diagnosis: Meeting Diagnostic and Statistical Manual (DSM‐IV) criteria for panic disorder with at least 1 panic attack in the prior week. The Composite International Diagnostic Interview (CIDI) used to determine eligibility. Inclusion criteria: Between 18 and 70 years of age, English speaking, access to a telephone, and willing to accept a combined treatment of anti‐anxiety medication and CBT. Exclusion criteria: Potentially life threatening co morbidities (i.e. suicidal ideation, terminal medical illness) or those expected to severely limit patient participation or adherence (e.g., psychosis, current substance abuse, dementia, pregnancy). Patients receiving psychiatric disability benefits or those already seeing a psychiatrist or cognitive‐behavioural therapist were excluded. Age: Mean 41.2 years Gender: 67% female Ethnicity: 66% white Country: United States Sample size (randomised): Total participants 232, intervention 119, control 113
Interventions	Intervention: CBT Contains the four elements of collaborative care: 1) a multi‐professional approach to patient care: Primary care physician (PCP), graduates (CM), psychiatrist (MH specialist) 2) a structured management plan: Patients received a video about panic disorder and a workbook including education on medication, its management and synergies with CBT. The medication algorithm involved dose titration of typically a Selective Serotonin Reuptake Inhibitor (SSRI) for at least 6 weeks or adjunctive medications (e.g., benzodiazepines). CMs coordinated care and delivered CBT, which targeted panic symptoms but also included modules to address depressive and social anxiety symptoms if required. Follow‐up calls monitored clinical status, reinforced medication use and CBT skills, and make further medication recommendations if necessary. 3) scheduled patient follow‐ups: CBT = 6 sessions in 3 months (3 face‐to‐face and then telephone if preferred) then 6 brief booster telephone calls at 6‐12 week intervals 4) enhanced inter‐professional communication: CMs relayed recommendations from MH specialist to PCP. CMs communicated with PCPs using rapid systems of 2‐way communication (i.e. telephone, fax, and e‐mail). CM received weekly supervision from MH specialist Control: Treatment as usual enhanced as PCPs were informed of diagnosis
Outcomes	Anxiety (Composite measure of high end state functioning): 3, 6, 9, 12 months Medication use: 3, 6, 9, 12 months Quality of Life (mental and physical health): 3, 6, 9, 12 months
Notes	CBT: cognitive behaviour therapy; CIDI: Composite International Diagnostic Interview; CM: case manager; MH: mental health; PCP: primary care provider
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Alternating assignment stratified by referred or screened
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 outcome (composite measure of high end state functioning ‐current MDD, CESD, SF MCS) was: overall 56/232 (24%), 32/119 (27%) intervention and 24/113 (21%) control. Reasons for loss to follow‐up provided, with similar reasons for missing data across groups. Intention‐to‐treat analysis reported, no description of methods to manage missing data
Selective reporting (reporting bias)	Low risk	Protocol available and all prespecified outcomes reported
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	Low risk	Assessor was not aware of treatment allocation