Improving medical and psychiatric outcomes among individuals with bipolar disorder: a randomized controlled trial.
OBJECTIVE
Comorbid medical conditions, notably cardiovascular disease, occur disproportionately among persons with bipolar disorder; yet the quality and outcomes of medical care for these individuals are suboptimal. This pilot study examined a bipolar disorder medical care model (BCM) and determined whether, compared with usual care, individuals randomly assigned to receive BCM care had improved medical and psychiatric outcomes.


METHODS
Persons with bipolar disorder and cardiovascular disease-related risk factors were recruited from a large Department of Veterans Affairs mental health facility and randomly assigned to receive BCM or usual care. BCM care consisted of four self-management sessions on bipolar disorder symptom control strategies, education and behavioral change related to cardiovascular disease risk factors, and promotion of provider engagement. Primary outcomes were physical and mental health-related quality of life; secondary outcomes included functioning and bipolar symptoms.


RESULTS
Fifty-eight persons participated. Twenty-seven received BCM care, and 31 received usual care. The mean+/-SD age was 55+/-8 years, 9% were female, 90% were white, and 10% were African American. Repeated-measures analysis was used, and significant differences were observed between the two groups in change in scores from baseline to six months for the 12-Item Short-Form Health Survey (SF-12) subscale for physical health (t=2.01, df=173, p=.04), indicating that the usual care group experienced a decline in physical health over the study period. Change in SF-12 scores also indicated that compared with the usual care group, the BCM group showed improvements in mental health-related quality of life over the six-month study period; however, this finding was not significant.


CONCLUSIONS
Compared with usual care, BCM care may have slowed the decline in physical health-related quality of life. Further studies are needed to determine whether BCM care leads to long-term positive changes in physical and mental health-related quality of life and reduced risk of cardiovascular disease among persons with bipolar disorder.
Kilbourne
Amy M
AM
Serious Mental Illness Treatment Research and Evaluation Center, Health Services Research and Development, Department of Veterans Affairs Ann Arbor, Ann Arbor, MI 48105, USA. amykilbo@umich.edu
Post
Edward P
EP
Nossek
Agnes
A
Drill
Larry
L
Cooley
Susan
S
Bauer
Mark S
MS
D000328:Adult; D001714:Bipolar Disorder / Q000628:therapy*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006801:Humans; D008603:Mental Health; D008605:Mental Health Services; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012307:Risk Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology