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Table 1 Characteristics of randomized controlled trials comparing collaborative care for anxiety disorders with care as usual

From: Collaborative care for anxiety disorders in primary care: a systematic review and meta-analysis

Study No. Authors/ year De-sign Recruit-ment Diagn instr. Int. Setting N(ITT) Collaborative care intervention Professionals involved Comparison intervention Outcomes FU Outcome CC vs CAU Outcome at 12 months [95 % CI]
1 Roy-Byrne et al. 2001 (Study 1) RCT Referral Screening (waiting room, PHQ-2 PD) PD CIDI CC vs CAU 3 primary care clinics (US) CC: 57 CAU: 58 Medication management by psychiatrist PCP, psychiatrist CAU by PCP, i.e. pharmacotherapy or referral to mental health professional ASI, PDSS 3,6,9,12 months -Improved anxiety outcome at 3,6 and 12 months -Improved panic outcome at 6 months -Anxiety/panic (ASI): T = 2.14, p = 0.035 ES 0.45 [0.03-0.87] -Panic (PDSS): statistics continuous outcome not reported
2 Roy-Byrne et al. 2005 (Study 2) RCT Referral Screening (waiting room, PHQ-2 PD) PD CIDI CC vs CAU University affiliated primary care clinics (US) CC: 119 CAU: 113 CBT and/or antidepressant medication PCP, CM, psychiatrist CAU by PCP, i.e. pharmacotherapy or referral to mental health professional ASI 3,6,9,12 months -Improved anxiety/panic outcome at all time points - Anxiety/panic (ASI): Dif −6.64 [−10.73 to −2.48] p <0.001; ES 0.48 [0.18-0.78]
3 Rollman et al. 2005 (Study 3) RCT Screening (waiting room, PHQ) PD/ GAD PRIME-MD CC vs CAU 4 university affiliated primary care practices (US) CC: 116 CC: 75 Guided selfhelp and/or antidepressant medication and/or referral to mental health specialist PCP, CM, psychiatrist/ Psycho-therapist CAU by PCP and patients received a diagnosis specific brochure SIGH-A, PDSS 2,4,8,12 months -Improved anxiety outcome at 12 months - Improved panic outcomes at 12 months -No sign. improvement in GAD outcomes -Anxiety (SIGH-A): Dif −3.6 [ −6.4 to −0.8] p = 0.01; ES 0.43 [0.10-0.77] -Panic (PDSS): Diff −3.3 [−5.5 to −1.1] p = 0.004; ES 0.58 [0.19-0.97] -GAD (SIGH-A): Diff −1.1 [−5.0 to 2.7] p = 0.57; ES 0.13 [−0.32 to 0.58]
4 Konig et al. 2009 (Study 4) Clus-ter RCT Screening (PHQ) PD/ GAD/ any AD PHQ CC vs CAU 46 primary care practices (GER) CC: 201 CAU: 188 Counselling (CBT) by the PCP PCP, psychiatrist/ Psycho-therapist CAU by PCP, including referral to mental health professional BAI 6,9 months - No difference in anxiety outcomes -Anxiety (BAI): CC: M 18.18 SD 12.17 CAU: M 16.72 SD 10.34, p = 0.35; ES −0.13 [−0.36-0.10]
5 Roy-Byrne et al. 2010 (Study 5) RCT Referral PD/ GAD/ SOP/ PTSD MINI CC vs CAU 17 primary care clinics (US) CC: 503 CAU: 501 CBT and/or antidepressant medication PCP, CM, psychiatrist CAU by PCP, i.e. medication, counseling or referral to mental health professional BSI, PDSS, GADSS, SPIN, PCL 6,12,18 months -Improved anxiety outcome at all time points -Improved panic outcome at 6 and 12 months -Improved GAD outcome at all time points -Improved SOP outcome at 6 and 12 months -No sign. improvement in PTSD outcomes -Anxiety (BSI): Diff −2.63 [ −3.73 to −1.54] p <0.001; ES 0.33 [0.19-0.47] -Panic (PDSS): Diff −2.71 [ −4.29 to −1.14] p = .003; ES 0.48 [0.20-0.76] -GAD (GADSS): Diff −2.34 [−3.22 to −1.45] p <0.001; ES 0.49 [0.30 to 0.68] -SOP (SPIN): Diff −5.71 [−10.74 to −0.68] p = 0.08; ES 0.43 [0.05 to 0.81] - PTSD (PCL-C): Diff −7.7 [−17.55 to 2.15] p = 0.49; ES 0.45 [−0.12 to 1.02]
6 Oosterbaan et al. 2013 (Study 6) Clus-ter RCT Referral PD/AGO/GAD/SOP/SP MINI CC vs CAU 22 primary care practices (NL) CC: 28 CAU: 27 Step 1) CBT based guided self-help with antidepressant medication for moderate disorder Step 2) CBT and medication in specialty care PCP, CM, psychiatrist, CBT therapist CAU by PCP, i.e. medication, counseling or referral to mental health professional CGI-I, CGI-S, HRS-A 4,8,12 months -Improved anxiety outcomes at 4 months -Anxiety (HRS-A) CC: M 6.14 SD 5.26 CAU M: 8.11 SD 7.83 p = 0.02 ES 0.29 [−0.29 to 0.87]
7 Muntingh et al. 2014 (Study 7) Clus-ter RCT Referral Screening (PHQ) PD/ GAD MINI CC vs CAU 43 primary care practices (NL) CC: 114 CAU: 66 Step 1) CBT based guided self-help Step 2) CBT Step 3) antidepressant medication PCP, CM, psychiatrist, CBT therapist CAU by PCP, i.e. medication, counseling or referral to mental health professional (including CM randomized to CAU) BAI -Improved anxiety outcome at all time points -Improved panic outcome at all time points -No sign. improvement in GAD outcomes -Anxiety (BAI) Diff −6.84 [ −10.13 to −3.55] p <0.001; ES 0.73 [0.37-1.09] - PD (BAI): Diff −9.29 [−12.99 to −5.59] ES 1.03 [0.60 to 1.46] - GAD (BAI): Diff −1.13 [−7.33 to 5.08] p = 0.72 ES 0.13 [−0.56 – 0.81]
  1. Abbreviations: AD anxiety disorder, ASI anxiety sensitivity index, BAI Beck Anxiety Inventory, CAU care as usual, CBT cognitive behavioral therapy, CC collaborative care, CI confidence interval, CIDI Composite International Diagnostic Interview, CM care manager, ES effect size, GAD generalized anxiety disorder, GADSS Generalized Anxiety Disorder Severity Scale, GER Germany, HRS-A Hamilton Rating Scale for Anxiety, ITT intention to treat, MINI Mini-International Neuropsychiatric Interview, NL Netherlands, PD Panic disorder, PCL-C PTSD Checklist–Civilian Version, PCP primary care physician, PDSS panic disorder severity scale, PHQ Patient Health Questionnaire, PRIME-MD Primary Care Evaluation of Mental Disorders, PTSD post traumatic stress disorder, SIGH-A Hamilton Anxiety Rating Scale, SOP social phobia, SP specific phobia, SPIN Social Phobia Inventory, US United States