Meta-analysis and meta-regression analyses explaining heterogeneity in outcomes of chronic care management for depression: implications for person-centered mental healthcare

Main Article Content

Jolanda A.C. Meeuwissen
Lidwien C. Lemmens
Hanneke W. Drewes
Karin M.M. Lemmens
Lotte M.G. Steuten
Arianne M.J. Elissen
Hubertus J.M. Vrijhoef
Caroline A. Baan


Rationale, aims and objectives: Chronic care management programmes for depression show variation in effectiveness. This study aims to examine the clinical diversity and methodological heterogeneity related to the effectiveness of such programmes and to explain the heterogeneity in clinical outcomes. Objectives are to enable the understanding of and the decision-making about depression management programmes and to contribute to the implementation of chronic care management strategies for depression as part of advances in person-centered mental healthcare.Method: We performed a systematic review of reviews and empirical studies, including meta-analyses and meta-regression analyses on the most frequently reported outcomes. We explored to what extent the observed heterogeneity can be explained by study quality, length of follow-up, number of components of the Chronic Care Model (CCM) and patient characteristics.Results: Pooled effects of depression management programmes show significant improvement in treatment response (RR=1.38; p<0.05) and treatment adherence (RR=1.36; p<0.05). In meta-regression analysis, study quality and depression severity explain the substantial heterogeneity in respectively treatment response (36.6%; p=0.0352) and treatment adherence (88.7%; p=0.0083).Conclusions: The observed heterogeneity in depression outcomes cannot be explained by the number of intervention components and length of follow-up. Yet, the heterogeneity in treatment response can be explained partly by study quality, demonstrating the importance of good quality studies. Heterogeneity in treatment adherence can be explained partly by severity of the depression, indicating that taking account of depression severity contributes to maximising the effectiveness of chronic care management. Other potential sources of heterogeneity should be investigated to support informed decision-making on treating depression as a chronic condition as part of person-centered mental healthcare.

Article Details

Regular Articles
Author Biographies

Jolanda A.C. Meeuwissen, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Programme Innovation of Mental Health Care, Utrecht

Senior Resarch Associate

Lidwien C. Lemmens, National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven

Senior Researcher

Hanneke W. Drewes, Scientific Centre for Care and Welfare (Tranzo), Tilburg University, Tilburg; and National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven


Karin M.M. Lemmens, Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam

Senior Researcher

Lotte M.G. Steuten, Health Technology and Services Research, University of Twente, Enschede

Senior Researcher

Arianne M.J. Elissen, Department of Health Services Research; and CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht


Hubertus J.M. Vrijhoef, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre; and Scientific Centre for Care and Welfare (Tranzo), Tilburg University


Caroline A. Baan, National Institute for Public Health and the Environment, Centre for Prevention and Health Services Research, Bilthoven

Senior Researcher


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