Effectiveness of organisational models incorporating Clinical Psychology in Primary Care settings

Background

In recent years, Clinical Psychology (CP) has been progressively integrated into Primary Care (PC) in Spain, with regional differences in implementation and roles. However, there is no consensus on the most appropriate organisational model. This study evaluates the effectiveness of consultation-liaison, collaborative, and replacement models incorporating CP professionals into PC teams in improving mental health outcomes.

Methods

Three previous reviews were updated through searches in MEDLINE, EMBASE, Cochrane Library, APA PsycInfo and other databases (2012 to July 2025). Randomised and non-randomised studies evaluating organisational models involving CP professionals in some way compared with usual care or other models were included. Meta-analyses were conducted using random-effects models, with standardised mean differences (SMD) as effect sizes.

Results

Fifteen studies were included, primarily involving adult populations with depression and anxiety. The collaborative model was the most frequently evaluated. For depression, models incorporating CP professionals were associated with small reductions in symptoms compared with usual care at short term (SMD −0.31), significant only in collaborative and mixed models combining collaborative and replacement or referral features. These effects were maintained at medium and long term (SMD −0.26). For anxiety, small short-term effects were also observed (SMD −0.30), with more favourable outcomes in mixed models, although effects were smaller at medium and long term (SMD −0.19). Consultation-liaison models showed no consistent evidence of effect.

Conclusions

Integrating CP into PC is associated with small improvements in depression, anxiety and psychological well-being. Collaborative and mixed models appear most promising. However, high heterogeneity, regarding the exact role of the CP, and methodological limitations reduce certainty, and the clinical relevance of effects at the individual level may be limited.

Key messages

• Integrating Clinical Psychology into Primary Care is associated with small but consistent improvements in depression, anxiety and psychological well-being.

• Collaborative and mixed models appear most promising, although effects are modest and evidence is limited by heterogeneity and methodological constraints.