Collaborative care works in depression with personality disorder

  • Solberg JJ & al.
  • J Prim Care Community Health

  • curated by Jim Kling
  • Clinical Essentials
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Takeaway

  • Compared with usual care, at 6 months, collaborative care management (CCM) produces a greater depression remission rate among patients with depression and comorbid personality disorder (PD).
  • Patients in both groups with comorbid PD fared worse than patients with depression alone.

Why this matters

  • PD and major depressive disorder (MDD) are often comorbid, and PD interferes with treatment of other mental disorders.
  • The increased contact with care providers in CCM may help patients with PD recognize maladaptive interpersonal patterns.

Study design

  • Retrospective cohort study included 9614 patients (CCM, n=5715; usual care, n=3899) with MDD.
  • Patient Health Questionnaire-9 was used to measure clinical outcomes at 6 months.
  • Funding: None.

Key results

  • 7.1% of patients with MDD were diagnosed with comorbid PD.
  • Among patients with MDD and PD, remission rates were better with CCM vs usual care (25.2% vs 11.5%; P=.002).
  • An increased rate of depressive symptoms was seen in patients with PD receiving usual care (67.7% vs 51.7%; P=.004).
  • Diagnosis of PD was associated with:
    • Decreased ORs for remission (OR, 0.369; 95% CI, 0.201-0.676); and
    • Increased ORs for PDs (OR, 2.123; 95% CI, 1.359-3.318).

Limitations

  • Potential underdiagnosis of PD within the cohort.

Coauthored with Chitra Ravi, MPharm

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