The most effective components of disease management programs for depression

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However, it is unclear why or what exactly is effective in this bundle of measures for diagnosis, treatment, support, and patient empowerment. This is another reason why DMPs are not yet very widespread. "Our findings could help in the design of a DMP for depression in Germany," says lead author Hannah Schillok. Her study has now been published in the renowned journal "JAMA Psychiatry."

In Germany alone, nine and a half million people suffer from depression, half of them over a long period of time. Those affected often experience gaps in their treatment. Many services, from family doctors to psychotherapists, are not coordinated or are not even offered in some cases. The question currently being discussed in both psychiatry and general medicine is: How can patients be safely and successfully supported in their illness so that better relief can be achieved?

One option is disease management programs, in which the family doctor plays a leading role. DMPs are treatment programs for chronic diseases. Diagnosis and treatment are carried out in a coordinated manner, with all specialists working together with the patient and all important steps and tasks being carried out as part of a well-coordinated package. DMPs already exist in Germany for physical illnesses such as type 2 diabetes and asthma. Such a structured treatment program has not yet been established in Germany for depression, although it has "proven itself in studies" internationally, says scientist Schillok, "the data show that symptoms can be significantly improved."

However, such programs consist of many different components and are designed by many different people who work with the family doctor: medical assistants, supervising psychotherapists or psychiatrists, and even lay people such as the patient's family and friends. In order to make a disease management program for depression more attractive, the question arises: Which of the many components that make up such measures internationally are particularly effective?

The Munich researchers and their colleagues examined this question in a meta-analysis using individual patient data. The team examined 35 studies and more than 20,000 patients, comparing the effects of cooperative care—with a wide variety of components—and conventional care in adult patients with depression in primary care. They looked closely at how the DMP was designed: How many actors are involved? What tasks do the actors perform? Is the family involved? Is technology also used for patient contact? What psychotherapeutic interventions were used in practice? And so on.

According to the new study, two components stand out. First, and surprisingly for the experts, is the involvement of friends and family. This means educating the people who are close to the depressed patient. The aim is to enable them to deal with the patient better, support them outside the doctor's office, and motivate them to continue participating in the DMP. "And that," explains Schillok, "often works very well." Second: brief psychological interventions by the family doctor themselves. These usually last 20 to 40 minutes per session. Beforehand, the family doctor is instructed by a therapist and provided with various toolkits and manuals so that, according to Schillok, "they know exactly which exercises and steps to take in each session."

Efforts are currently underway in Germany to launch a new DMP for depression. "The findings of our study," says Hannah Schillok, "could help in the concrete design of the program."

The project was carried out as part of the DFG-funded Research Training Group "POKAL" (DFG-GRK 2621).

Publication:
Schillok H, Gensichen J, Panagioti M, et al. Effective Components of Collaborative Care for Depression in Primary Care: An Individual Participant Data Meta-Analysis. JAMA Psychiatry. Published online March 26, 2025.
doi: 10.1001/jamapsychiatry.2025.0183