Key result
Collaborative care targeting depression and CV health improves cardiovascular outcomes with low-certainty mortality benefits.
Why the study?
People with severe mental illness have reduced life expectancy largely from chronic somatic conditions like cardiovascular disorders, but whether integrated care in general practice reduces this excess mortality remained unclear.
Does collaborative care reduce all-cause mortality and improve cardiovascular health in patients with severe mental illness?
Systematic Review
Does collaborative care reduce all-cause mortality and improve cardiovascular health in patients with severe mental illness?
Collaborative care models addressing both mental and physical health may reduce mortality and improve cardiovascular outcomes in patients with depression, though evidence for other severe mental illnesses remains limited.
OBJECTIVE: People with severe mental illness (SMI) have a reduced life expectancy, primarily due to chronic somatic diseases like cardiovascular disorders. Integrated care in general practice addressing mental and physical health may reduce excess mortality in this population. This review assessed the effectiveness of collaborative care, general integrated care, and physical health interventions in reducing overall mortality in patients with SMI. Secondary outcomes included disease-specific mortality, cardiovascular health indicators, and health-related quality of life. METHODS: We searched PubMed, PsycINFO, Cochrane Library, and Embase for randomized controlled trials published before April 24, 2024. Eligible studies focused on integrated care interventions targeting somatic health in patients with SMI. Two reviewers independently conducted data extraction and risk of bias assessment. The study was registered with PROSPERO (CRD42022328464). RESULTS: Of 2904 identified publications, 17 were included (covering 13 studies). Seven studies reported mortality data, with one showing reduced mortality in patients with major depressive disorder receiving collaborative care. No studies examined disease-specific mortality. Nine studies assessed cardiovascular outcomes, with three reporting reduced cardiovascular risk in collaborative care interventions simultaneously targeting depression and cardiovascular factors. Seven studies reported on quality of life, with three finding improvements. Study quality was rated moderate to high. CONCLUSION: We found low-certainty evidence that collaborative care reduces mortality in depression. There was moderate evidence that collaborative care models, simultaneously addressing mental and cardiovascular health could potentially improve cardiovascular health in depression. The limited number of studies and their focus on depression limit the generalizability of these findings to other SMIs.
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Langkilde et al. (2025) conducted a systematic review in Severe mental illness. Collaborative care and integrated care interventions vs. Care as usual was evaluated on All-cause mortality. Collaborative care interventions provided low-certainty evidence for reducing mortality in depression and moderate evidence for improving cardiovascular health when targeting both conditions.
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