General Hospital Psychiatry
Volume 32, Issue 3 , Pages 246-254, May 2010

What is the role of consultation–liaison psychiatry in the management of depression in primary care? A systematic review and meta-analysis☆☆☆★

  • John Cape, Ph.D.

      Affiliations

    • Camden and Islington NHS Foundation Trust, London and Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
    • ,
  • Craig Whittington, Ph.D.

      Affiliations

    • Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
    • ,
  • Peter Bower, Ph.D.

      Affiliations

    • NIHR School for Primary Care Research, University of Manchester, M13 9PL, Manchester, UK
    • Corresponding Author InformationCorresponding author. Tel.: +0161 275 7638; fax: +0161 275 7600.

Received 7 December 2009; accepted 3 February 2010. published online 12 March 2010.

Abstract 

Objective

To assess the effectiveness of consultation–liaison services, involving mental health professionals working to advise and support primary care professionals in the management of depression.

Methods

Studies of consultation–liaison for depression in primary care were identified from a systematic search of electronic databases, augmented by identification of papers from reference lists, published reviews and from hand searching. Data on study quality, intervention characteristics and outcomes were extracted by two reviewers, and outcome data were meta-analyzed.

Results

Five studies met the criteria. There was no significant effect of consultation–liaison on antidepressant use (risk ratio 1.23, 95% CI 0.91 to 1.66) or depression outcomes in the short- (standardized mean difference −0.04, 95% CI −0.21 to 0.14) or long-term (standardized mean difference 0.06, 95% CI −0.13 to 0.26).

Conclusions

Evidence concerning consultation–liaison for depression in primary care remains limited, but the existing studies do not suggest it is more effective than usual care. Further research is required to explore the mechanisms by which consultation–liaison might be made more effective, including the potential role of consultation–liaison in combination with other models of care, and in other patient populations.

Keywords: Depression, Meta-analysis, Consultation–liaison, Primary care

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☆ Contributors: JC and CW designed the study. JC managed the literature search process, and all authors contributed to the extraction and analysis of data. PB wrote the initial manuscript draft and all authors contributed to the critical revisions and final approval of the manuscript.

☆☆ Conflict of interest: PB is a paid scientific consultant to the British Association of Counselling and Psychotherapy. All other authors declare that they have no conflicts of interest.

★ Role of the funding source: JC and CW thank Camden Primary Care Trust and Islington Primary Care Trust for funding the literature reviews. PB is funded by the Department of Health and the National Institute of Health Research. The study sponsors had no role in the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

PII: S0163-8343(10)00019-8

doi:10.1016/j.genhosppsych.2010.02.003

General Hospital Psychiatry
Volume 32, Issue 3 , Pages 246-254, May 2010

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