---
title: "Modernized Collaborative Care for Depression: Symptom-Level Effects in the eIMPACT Trial"
id: "pubmed-42765385"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42765385"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42765385/"
doi: "10.1017/S0033291726105765"
published_at: "2026-09-21T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Modernized Collaborative Care for Depression: Symptom-Level Effects in the eIMPACT Trial
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42765385
- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42765385/)
- **DOI:** [10.1017/S0033291726105765](https://doi.org/10.1017%2FS0033291726105765)
- **Published At:** 2026-09-21T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The eIMPACT trial randomized 216 primary care patients to 12 months of **modernized collaborative care** (internet CBT, telephonic CBT, and/or selected antidepressants) versus usual care. - Participants were socioeconomically and racially diverse (mean age 59 years; 78% women; 50% Black; 46% with income < $10,000/year). - This secondary analysis examined item-level effects on depressive symptoms using the Hopkins Symptom Checklist-20 (**SCL-20**) and the Patient Health Questionnaire-9 (**PHQ-9**). - Two path analytic models estimated simultaneous effects on individual items rather than relying on total scores. - The intervention showed superiority over usual care on 15/20 SCL-20 items and 7/9 PHQ-9 items. - Seventeen symptoms including **hopelessness**, anxious distress, depressed mood, self-blame, worthlessness, disturbed sleep, and fatigue had moderate-to-large between-group improvements (β = -0.50 to -0.70). - Six additional symptoms had smaller but significant improvements (β = -0.35 to -0.49). - No significant treatment advantage was found for suicidality, loneliness, sexual dysfunction, appetite change, or psychomotor symptoms (β = -0.03 to -0.37). - Authors conclude that modernized collaborative care improves most depressive symptoms in diverse primary care patients, and that symptom-level analysis can reveal persistent domains that might need targeted adjunctive treatment. - Keywords emphasized: collaborative care, depression, digital health, primary care, symptom-level analysis, underserved population.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Department of Psychology, Indiana University Indianapolis, Indianapolis, USA. * 2 Department of Obstetrics and Gynecology, The University of Chicago, Chicago, USA. * 3 Outpatient Behavioral Health, Indiana University Health, Muncie, USA. * 4 Eskenazi Health, Indianapolis, USA. * 5 Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, USA. * 6 Department of Medicine, Indiana University School of Medicine, Indianapolis, USA. * 7 Department of Psychiatry and Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, USA. * PMID: **42765385** * DOI: [ 10.1017/S0033291726105765 ](https://doi.org/10.1017/s0033291726105765) Item in Clipboard Randomized Controlled Trial # Effect of modernized collaborative care for depression on individual depressive symptoms: A secondary analysis of the eIMPACT trial Christopher A Crawford et al. Psychol Med. 2026. Show details Display options Display options Format Abstract PubMed PMID Psychol Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Psychol+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Psychol+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42765385/) . 2026 Sep 21:56:e284. doi: 10.1017/S0033291726105765. ### Authors [Christopher A Crawford](https://pubmed.ncbi.nlm.nih.gov/?term=Crawford+CA&cauthor_id=42765385)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765385/#short-view-affiliation-1 "Department of Psychology, Indiana University Indianapolis, Indianapolis, USA."), [Michelle K Williams](https://pubmed.ncbi.nlm.nih.gov/?term=Williams+MK&cauthor_id=42765385)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42765385/#short-view-affiliation-2 "Department of Obstetrics and Gynecology, The University of Chicago, Chicago, USA."), [Aubrey L Shell](https://pubmed.ncbi.nlm.nih.gov/?term=Shell+AL&cauthor_id=42765385)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42765385/#short-view-affiliation-3 "Outpatient Behavioral Health, Indiana University Health, Muncie, USA."), [Zachary M Jones](https://pubmed.ncbi.nlm.nih.gov/?term=Jones+ZM&cauthor_id=42765385)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765385/#short-view-affiliation-1 "Department of Psychology, Indiana University Indianapolis, Indianapolis, USA."), [Jihee Yoon](https://pubmed.ncbi.nlm.nih.gov/?term=Yoon+J&cauthor_id=42765385)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765385/#short-view-affiliation-1 "Department of Psychology, Indiana University Indianapolis, Indianapolis, USA."), [Krysha L MacDonald](https://pubmed.ncbi.nlm.nih.gov/?term=MacDonald+KL&cauthor_id=42765385)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42765385/#short-view-affiliation-4 "Eskenazi Health, Indianapolis, USA."), [Christopher M Callahan](https://pubmed.ncbi.nlm.nih.gov/?term=Callahan+CM&cauthor_id=42765385)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42765385/#short-view-affiliation-5 "Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, USA.")[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42765385/#short-view-affiliation-6 "Department of Medicine, Indiana University School of Medicine, Indianapolis, USA."), [John I Nurnberger Jr](https://pubmed.ncbi.nlm.nih.gov/?term=Nurnberger+JI+Jr&cauthor_id=42765385)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42765385/#short-view-affiliation-7 "Department of Psychiatry and Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, USA."), [Jesse C Stewart](https://pubmed.ncbi.nlm.nih.gov/?term=Stewart+JC&cauthor_id=42765385)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42765385/#short-view-affiliation-1 "Department of Psychology, Indiana University Indianapolis, Indianapolis, USA.") ### Affiliations * 1 Department of Psychology, Indiana University Indianapolis, Indianapolis, USA. * 2 Department of Obstetrics and Gynecology, The University of Chicago, Chicago, USA. * 3 Outpatient Behavioral Health, Indiana University Health, Muncie, USA. * 4 Eskenazi Health, Indianapolis, USA. * 5 Sandra Eskenazi Center for Brain Care Innovation, Eskenazi Health, Indianapolis, USA. * 6 Department of Medicine, Indiana University School of Medicine, Indianapolis, USA. * 7 Department of Psychiatry and Stark Neurosciences Research Institute, Indiana University School of Medicine, Indianapolis, USA. * PMID: **42765385** * DOI: [ 10.1017/S0033291726105765 ](https://doi.org/10.1017/s0033291726105765) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## 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 (_β_ s = -0.50 to -0.70). Smaller but significant gains were observed for six other symptoms (_β_ s = -0.35 to -0.49). No significant advantage emerged for suicidality, loneliness, sexual dysfunction, appetite change, or psychomotor symptoms (_β_ s = -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. **Keywords:** collaborative care; depression; digital health; primary care; randomized controlled trial; symptom-level analysis; underserved population. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Similar articles * [ Longer-term effects of modernized collaborative care for depression on multiple mental health factors (eIMPACT): A randomized controlled trial. ](https://pubmed.ncbi.nlm.nih.gov/40930184/) Williams MK, Shell AL, Wu W, MacDonald KL, Callahan CM, Nurnberger JI Jr, Crawford CA, Schuiling MD, Stewart JC.Williams MK, et al.J Affect Disord. 2026 Jan 1;392:120272. doi: 10.1016/j.jad.2025.120272. Epub 2025 Sep 8.J Affect Disord. 2026.PMID: 40930184Free PMC article.Clinical Trial. * [ Effect of modernized collaborative care for depression on depressive symptoms and cardiovascular disease risk biomarkers: eIMPACT randomized controlled trial. ](https://pubmed.ncbi.nlm.nih.gov/37209779/) Stewart JC, Patel JS, Polanka BM, Gao S, Nurnberger JI, MacDonald KL, Gupta SK, Considine RV, Kovacs RJ, Vrany EA, Berntson J, Hsueh L, Shell AL, Rollman BL, Callahan CM.Stewart JC, et al.Brain Behav Immun. 2023 Aug;112:18-28. doi: 10.1016/j.bbi.2023.05.007. Epub 2023 May 18.Brain Behav Immun. 2023.PMID: 37209779Free PMC article.Clinical Trial. * [ Psychological therapies for treatment-resistant depression in adults. ](https://pubmed.ncbi.nlm.nih.gov/29761488/) Ijaz S, Davies P, Williams CJ, Kessler D, Lewis G, Wiles N.Ijaz S, et al.Cochrane Database Syst Rev. 2018 May 14;5(5):CD010558. doi: 10.1002/14651858.CD010558.pub2.Cochrane Database Syst Rev. 2018.PMID: 29761488Free PMC article. * [ Behavioural modification interventions for medically unexplained symptoms in primary care: systematic reviews and economic evaluation. ](https://pubmed.ncbi.nlm.nih.gov/32975190/) Leaviss J, Davis S, Ren S, Hamilton J, Scope A, Booth A, Sutton A, Parry G, Buszewicz M, Moss-Morris R, White P.Leaviss J, et al.Health Technol Assess. 2020 Sep;24(46):1-490. doi: 10.3310/hta24460.Health Technol Assess. 2020.PMID: 32975190Free PMC article. * [ Effect of modernized collaborative care for depression on brain-derived neurotrophic factor (BDNF) and depressive symptom clusters: Data from the eIMPACT trial. ](https://pubmed.ncbi.nlm.nih.gov/37931480/) Crawford CA, Williams MK, Shell AL, MacDonald KL, Considine RV, Wu W, Rand KL, Stewart JC.Crawford CA, et al.Psychiatry Res. 2023 Dec;330:115581. doi: 10.1016/j.psychres.2023.115581. Epub 2023 Oct 30.Psychiatry Res. 2023.PMID: 37931480Free PMC article.Clinical Trial. 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