Nurse-delivered collaborative care for depression and long-term physical conditions: A systematic review and meta-analysis

Background: Depression will be the second largest cause of disease burden by 2020. It is commonly associated with long term physical health conditions resulting in worsened clinical outcome and increased costs. Nurses would appear ideally placed to facilitate depression management in those people with long term health problems within health care clinics. This article reviews the evidence to support such a clinical approach. Method: A systematic review and meta-analysis of randomised trials of nurse led management of depression in patients with long term health problems. Databases were searched between December 2011 and May 2012, data were extracted and analysed using Comprehensive Meta Analysis software. Subgroup analysis and meta-regression were used to explore the impact of study level moderators of effect. Results: Nurse delivered collaborative care was compared to usual care in 14 studies including 4440 participants. The mean effect size at follow-up was d=0.43 95% CI 0.34 to 0.52 p<0.001 NNT 4.23, representing a moderate impact on depression severity. Results were consistent across studies and maintained at longer term follow up. Limitations: Data were only available on depression outcomes and with most studies being USA based generalizability is somewhat limited. To date only one study reported cost effectiveness outcomes. Conclusions: Based upon the research literature nurse led depression management provides effective treatment across a range of long term health conditions. Nurses are ideally placed to deliver such interventions and further research is required to examine the cost utility of the approach and its durability outside of the USA. (C) 2013 Elsevier By. All rights reserved.