Abstract
BackgroundDepression and coronary heart disease (CHD) are frequently comorbid and portend higher morbidity, mortality and poorer quality of life. Prior systematic reviews of depression treatment randomized controlled trials (RCTs) in the population with CHD have not assessed the efficacy of collaborative care. This systematic review aims to bring together the contemporary research on the effectiveness of collaborative care interventions for depression in comorbid CHD populations.Methods/DesignElectronic databases (Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, PsycINFO and CINAHL) will be searched using a sensitive search strategy exploding the topics CHD, depression and RCT. Full text inspection and bibliography searching will be conducted, and authors of included studies will be contacted to identify unpublished studies. Eligibility criteria are: population, depression comorbid with CHD; intervention, RCT of collaborative care defined as a coordinated model of care involving multidisciplinary health care providers, including: (a) primary physician and at least one other health professional (e.g. nurse, psychiatrist, psychologist), (b) a structured patient management plan that delivers either pharmacological or non-pharmacological intervention, (c) scheduled patient follow-up and (d) enhanced inter-professional communication between the multiprofessional team; comparison, either usual care, enhanced usual care, wait-list control group or no further treatment; and outcome, major adverse cardiac events (MACE), standardized measure of depression, anxiety, quality of life, cost-effectiveness. Screening, data extraction and risk of bias assessment will be undertaken by two reviewers with disagreements resolved through discussion. Meta-analytic methods will be used to synthesize the data collected relating to the outcomes.DiscussionThis review will evaluate the effectiveness and cost-effectiveness of collaborative care for depression in populations primarily with CHD. The results will facilitate integration of evidence-based practice for this precarious population.Systematic review registrationPROSPERO CRD42014013653.
Highlights
Depression and coronary heart disease (CHD) are frequently comorbid and portend higher morbidity, mortality and poorer quality of life
We have considered the following to explain potential sources of heterogeneity between the included Randomized controlled trial (RCT) studies: (1) trials with a higher risk of bias will show larger effects than trials with lower risk of bias [30] and (2) trials comprised by a proportion of patients with diabetes will contain larger effect sizes than trials consisting of CHD patients only [14,33]
This systematic review may add to the extant literature by reporting the efficacy of collaborative care depression interventions in CHD populations with respect to major adverse cardiac events (MACE), depression, anxiety, quality of life and health care costs
Summary
This systematic review may add to the extant literature by reporting the efficacy of collaborative care depression interventions in CHD populations with respect to MACE, depression, anxiety, quality of life and health care costs. There are several limitations that will contextualize the findings and generalizability of the proposed review including the relative infancy of the collaborative care literature in the CHD population with depressive symptoms. Despite attempts to retrieve unpublished and non-significant studies, the proposed systematic review is likely to be limited by publication bias of only significant findings, given the infancy of the literature [36]. Given the emergence of collaborative care depression intervention evidence in chronic disease populations including CHD, and the absence of a systematic review, this review will help in summarizing the available evidence, both quantitatively and qualitatively. Authors’ contributions PJT and HB were involved in the concept and review design of the study and data analysis plan Both authors had major contributions to the write-up and editing of the manuscript.
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