Abstract：
BACKGROUND: Low- and middle-income countries (LMICs) face high burden of common mental disorders (CMDs). Most of the evidence for the Collaborative Care (CC) model effectiveness comes from high-income countries (HICs) and may not generalise to LMICs. A systematic review was conducted to assess effectiveness of CC for CMDs in LMICs.
METHODS: We searched eight-databases, two trial registries (2011-November 2023). Randomised controlled trials (RCTs) of adults (≥18 years) with depression/anxiety diagnosis, reporting remission/change in symptom severity were eligible. Random effects meta-analyses were conducted for: short-(0-6 months), medium-(7-12 months), long-(13-24 months), and very long-term (≥25 months) follow-up. Quality was assessed with Cochrane RoB2 tool. PROSPERO registration: CRD42022380407.
RESULTS: Searches identified 7494 studies, 12 trials involving 13,531 participants were included; nine had low-risk of bias. CC was more effective than usual care for depression: dichotomous outcomes (short-term, 7 studies, relative risk (RR) 1.39, 95%CI 1.31, 1.48; medium-term, 6 studies, RR 1.35, 95%CI 1.28, 1.43); and continuous outcomes (short-term, 8 studies, standardised mean difference (SMD) -0.51, 95%CI -0.80, -0.23; medium-term, 8 studies, SMD -0.59, 95%CI -1.00, -0.17). CC was found to be effective at long-term (one study), but not at very long-term. Improvement in anxiety outcomes with CC (2 studies, 340 participants) reported up to 12-months; improvements in quality-of-life were not statistically significant (3 studies, 796 participants, SMD 0.62, 95%CI -0.10, 1.34).
CONCLUSIONS: Pooled estimates showed high heterogeneity.
CONCLUSIONS: In LMICs, CC was more effective than usual care for improving depression outcomes at short and medium-term follow-up. A similar improvement was found for anxiety outcomes, but evidence is limited.
METHODS: We searched eight-databases, two trial registries (2011-November 2023). Randomised controlled trials (RCTs) of adults (≥18 years) with depression/anxiety diagnosis, reporting remission/change in symptom severity were eligible. Random effects meta-analyses were conducted for: short-(0-6 months), medium-(7-12 months), long-(13-24 months), and very long-term (≥25 months) follow-up. Quality was assessed with Cochrane RoB2 tool. PROSPERO registration: CRD42022380407.
RESULTS: Searches identified 7494 studies, 12 trials involving 13,531 participants were included; nine had low-risk of bias. CC was more effective than usual care for depression: dichotomous outcomes (short-term, 7 studies, relative risk (RR) 1.39, 95%CI 1.31, 1.48; medium-term, 6 studies, RR 1.35, 95%CI 1.28, 1.43); and continuous outcomes (short-term, 8 studies, standardised mean difference (SMD) -0.51, 95%CI -0.80, -0.23; medium-term, 8 studies, SMD -0.59, 95%CI -1.00, -0.17). CC was found to be effective at long-term (one study), but not at very long-term. Improvement in anxiety outcomes with CC (2 studies, 340 participants) reported up to 12-months; improvements in quality-of-life were not statistically significant (3 studies, 796 participants, SMD 0.62, 95%CI -0.10, 1.34).
CONCLUSIONS: Pooled estimates showed high heterogeneity.
CONCLUSIONS: In LMICs, CC was more effective than usual care for improving depression outcomes at short and medium-term follow-up. A similar improvement was found for anxiety outcomes, but evidence is limited.
摘要：
背景：低收入和中等收入国家（LMICs）面临着常见精神障碍（CMD）的高负担。协作护理（CC）模型有效性的大多数证据来自高收入国家（HIC），可能不会推广到LMIC。进行了系统评价，以评估CC对LMICsCMD的有效性。
方法：我们搜索了八个数据库，两个试验登记处(2011年至2023年11月)。成人（≥18岁）诊断为抑郁/焦虑的随机对照试验（RCT），报告缓解/症状严重程度的变化是合格的.进行了随机效应荟萃分析：短期（0-6个月），中期（7-12个月），长-（13-24个月），和非常长期（≥25个月）的随访。用CochraneRoB2工具评估质量。PROSPERO注册：CRD42022380407。
结果：搜索确定了7494项研究，纳入了12项试验，涉及13,531名参与者；9项有低偏倚风险。CC比常规治疗抑郁症更有效：二分法结果(短期，7研究,相对风险（RR）1.39，95CI1.31，1.48；中期，6研究,RR1.35，95CI1.28，1.43)；和连续结果(短期，8研究,标准化平均差（SMD）-0.51，95CI-0.80，-0.23；中期，8研究,SMD-0.59，95CI-1.00，-0.17）。CC被发现是有效的长期（一项研究），但不是很长期的。CC改善焦虑结果(2项研究，340名参与者)报告长达12个月；生活质量的改善没有统计学意义(3项研究，796名参与者，SMD0.62，95CI-0.10，1.34）。
结论：集合估计显示高度异质性。
结论：在LMIC中，在短期和中期随访中，CC在改善抑郁结果方面比常规治疗更有效。焦虑结果也有类似的改善，但证据有限.
方法：我们搜索了八个数据库，两个试验登记处(2011年至2023年11月)。成人（≥18岁）诊断为抑郁/焦虑的随机对照试验（RCT），报告缓解/症状严重程度的变化是合格的.进行了随机效应荟萃分析：短期（0-6个月），中期（7-12个月），长-（13-24个月），和非常长期（≥25个月）的随访。用CochraneRoB2工具评估质量。PROSPERO注册：CRD42022380407。
结果：搜索确定了7494项研究，纳入了12项试验，涉及13,531名参与者；9项有低偏倚风险。CC比常规治疗抑郁症更有效：二分法结果(短期，7研究,相对风险（RR）1.39，95CI1.31，1.48；中期，6研究,RR1.35，95CI1.28，1.43)；和连续结果(短期，8研究,标准化平均差（SMD）-0.51，95CI-0.80，-0.23；中期，8研究,SMD-0.59，95CI-1.00，-0.17）。CC被发现是有效的长期（一项研究），但不是很长期的。CC改善焦虑结果(2项研究，340名参与者)报告长达12个月；生活质量的改善没有统计学意义(3项研究，796名参与者，SMD0.62，95CI-0.10，1.34）。
结论：集合估计显示高度异质性。
结论：在LMIC中，在短期和中期随访中，CC在改善抑郁结果方面比常规治疗更有效。焦虑结果也有类似的改善，但证据有限.
