Effect of modernized collaborative care for depression on individual depressive symptoms: A secondary analysis of the eIMPACT trial
In brief
Collaborative care eases 15 of 20 depression symptoms, but not suicidality
In a trial of 216 racially and socioeconomically diverse primary-care patients, modernized collaborative care (internet or telephone CBT plus selected antidepressants) produced moderate-to-large improvements in 17 symptoms-including hopelessness, anxiety, sleep and fatigue-and modest gains in six others, outperforming usual care on most items. However, it did not significantly affect suicidality, loneliness, sexual dysfunction, appetite or psychomotor changes, suggesting those areas may need additional targeted treatment.
- Journal
- Psychological medicine (Q1)
- Published
- 21 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Christopher A Crawford, Michelle K Williams, Aubrey L Shell, Zachary M Jones, Jihee Yoon, Krysha L MacDonald, et al.
- PMID
- 42765385
- DOI
- 10.1017/S0033291726105765
Why clinicians should know about it
- Picked for Family Practice (paper of the day, 23 September 2026): Collaborative care improves depressive symptoms in primary care
Abstract
BACKGROUND: Depression affects over 400 million adults worldwide and is associated with substantial morbidity and mortality. Although symptoms vary in their responsiveness to treatment, clinical trials typically report total scores, obscuring symptom-level effects. Despite collaborative care's effectiveness for depression in primary care, its impact on individual depressive symptoms among racially and socioeconomically diverse patients remains unclear. METHODS: We conducted a secondary analysis of the eIMPACT trial of 216 primary care patients (Mage = 59 years; 78% women; 50% Black; 46% with income <$10,000/year). Participants were randomized to 12 months of modernized collaborative care (internet cognitive-behavioral therapy [CBT], telephonic CBT, and/or select antidepressants) or usual primary care. Two path analytic models estimated simultaneous item-level effects on the Hopkins Symptom Checklist-20 (SCL-20) and Patient Health Questionnaire-9 (PHQ-9). RESULTS: The intervention outperformed usual care on 15 of 20 SCL-20 items and 7 of 9 PHQ-9 items. Seventeen symptoms - including hopelessness, anxious distress, depressed mood, self-blame, worthlessness, disturbed sleep, and fatigue - showed moderate-to-large between-group improvement (βs = -0.50 to -0.70). Smaller but significant gains were observed for six other symptoms (βs = -0.35 to -0.49). No significant advantage emerged for suicidality, loneliness, sexual dysfunction, appetite change, or psychomotor symptoms (βs = -0.03 to -0.37). CONCLUSIONS: Modernized collaborative care improves most depressive symptoms in diverse primary care patients, though cross-measure persistent symptoms highlight clinically consequential domains that may be obscured by total scores. Symptom-level analyses may help identify persistent symptom domains requiring targeted adjunctive treatment to optimize recovery.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.