Abstract
Objective: It is unclear whether collaborative care (CC) model is effective for people with comorbid depression and diabetes. We aimed to investigate whether CC could improve depression outcomes and HbA1c in patients with depressive symptoms and diabetes, and assess its effects on Quality of Life (QoL).
Methods: We searched Embase, Scopus, PubMed, Cochrane, PsycINFO and CINAHL to identify randomized controlled trials (RCTs) and cluster RCTs. Studies were required to assess CC in patients with depressive symptoms and diabetes. The primary outcomes were depression treatment response rate and HbA1c and secondary outcome was Quality of Life (QoL). Studies were independently screened by two reviewers and critically appraised using the Cochrane Risk of Bias tool. We conducted a systematic review and meta-analysis, and the fixed effects and random effects model were used to pool Relative Risks (RRs) and Standard Mean Differences (SMDs).
Results: Twelve RCTs were included. The total follow-up period ranged from 12 weeks to 24 months. At follow-up, depression treatment response rate had a significant increase (RR=1.31, 95% CI 1.23 to 1.39, I2=0%) in CC patients compared to controls. There was no statistically significant difference in HbA1c between CC group and the control group (SMD=0.15, 95% CI -0.35 to 0.65, I2=97.6%). Overall QoL at follow-up was greater (SMD=0.12, 95% CI 0.03 to 0.21, I2=54.2%) in CC patients compared to controls but the difference was minor.
Conclusions: This systematic review and meta-analysis supported the effectiveness of CC in reducing depression and improving QoL in people with comorbid depression and diabetes.