Linking Collaborative Care & Relapse Prevention for Depression

Research Paper Title

The role of relapse prevention for depression in collaborative care: A systematic review.

Background

Relapse (the re-emergence of depression symptoms before full recovery) is common in depression and relapse prevention strategies are not well researched in primary care settings.

Collaborative care is effective for treating acute phase depression but little is known about the use of relapse prevention strategies in collaborative care.

The researchers undertook a systematic review to identify and characterise relapse prevention strategies in the context of collaborative care.

Methods

The researchers searched for Randomised Controlled Trials (RCTs) of collaborative care for depression.

In addition to published material, they obtained provider and patient manuals from authors to provide more detail on intervention content.

They reported the extent to which collaborative care interventions addressed four relapse prevention components.

Results

93 RCTs were identified.

31 included a formal relapse prevention plan; 42 had proactive monitoring and follow-up after the acute phase; 39 reported strategies for optimising sustained medication adherence; and 20 of the trials reported psychological or psycho-educational treatments persisting beyond the acute phase or focussing on long-term health/relapse prevention.

30 (32.3%) did not report relapse prevention approaches.

The researchers did not receive trial materials for approximately half of the trials, which limited their ability to identify relevant features of intervention content.

Conclusions

Relapse is a significant risk amongst people treated for depression and interventions are needed that specifically address and minimise this risk.

Given the advantages of collaborative care as a delivery system for depression care, there is scope for more consistency and increased effort to implement and evaluate relapse prevention strategies.

Reference

Moriarty, A.S., Coventry, P.A., Hudson, J.L., Cook, N., Fenton, O.J., Bower, P., Lovell, K., Archer, J., Clarke, R., Richards, D.A., Dickens, C., Gask, L., Waheed, W., Huijbregts, K.M., van der Feltz-Cornelis, C., Ali, S., Gilbody, S. & McMillan, D. (2019) The role of relapse prevention for depression in collaborative care: A systematic review. Journal of Affective Disorders. pii: S0165-0327(19)30734-7. doi: 10.1016/j.jad.2019.11.105. [Epub ahead of print].

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