title: Quality of life among patients with bipolar disorder in primary care versus community mental health settings.
abstract: BACKGROUND
  Bipolar disorder is associated with functional impairment across a number of domains, including health-related quality of life (HRQOL). Many patients are treated exclusively in primary care (PC) settings, yet little is known how HRQOL outcomes compare between PC and community mental health (CMH) settings. This study aimed to explore the correlates of HRQOL across treatment settings using baseline data from a multisite, randomized controlled trial for adults with bipolar disorder.
  
  
  METHODS
  HRQOL was measured using the SF-12 physical (PCS) and mental (MCS) composite scale scores. Independent sample t-tests were calculated to compare differences in HRQOL between settings. Multivariate regression models then examined the effect of treatment setting on HRQOL, adjusting for covariate demographic factors, mood symptoms (Internal State Scale), hazardous drinking (AUDIT-C), and substance abuse.
  
  
  RESULTS
  A total of 384 enrolled participants completed baseline surveys. MCS and PCS scores reflected similar impairment in HRQOL across PC and CMH settings (p=0.98 and p=0.49, respectively). Depressive symptoms were associated with lower MCS scores (B=-0.68, p<0.001) while arthritis/chronic pain was strongly related to lower PCS scores (B=-5.23, p<0.001).
  
  
  CONCLUSIONS
  This study lacked a formal diagnostic interview, relied on cross-sectional self-report, and sampled from a small number of sites in two states.
  
  
  CONCLUSIONS
  Participants reported similar impairments in both mental and physical HRQOL in PC and CMH treatment settings, emphasizing the need for integrated care for patients with bipolar disorder regardless of where they present for treatment.
authors.affiliation: Center for Organization, Leadership, and Management Research, VA Boston Healthcare System, 150 S. Huntington Ave. 152M, Boston, MA 02130, United States. Christopher.Miller8@va.gov
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Miller
authors.forename: Kristen M
authors.initials: KM
authors.lastname: Abraham
authors.forename: Laura A
authors.initials: LA
authors.lastname: Bajor
authors.forename: Zongshan
authors.initials: Z
authors.lastname: Lai
authors.forename: Hyungjin Myra
authors.initials: HM
authors.lastname: Kim
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Nord
authors.forename: David E
authors.initials: DE
authors.lastname: Goodrich
authors.forename: Mark S
authors.initials: MS
authors.lastname: Bauer
authors.forename: Amy M
authors.initials: AM
authors.lastname: Kilbourne
mesh_terms: D000328:Adult; D001168:Arthritis; D001714:Bipolar Disorder / Q000523:psychology / Q000628:therapy*; D059350:Chronic Pain; D003155:Community Mental Health Centers; D003430:Cross-Sectional Studies; D003863:Depression; D005260:Female; D006302:Health Services Research; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D011788:Quality of Life; D016896:Treatment Outcome