title: Collaborative care for patients with bipolar disorder: Effects on functioning and quality of life.
abstract: BACKGROUND
  Functioning and quality of life are impaired in bipolar patients.
  
  
  METHODS
  Collaborative Care (CC) is a multi-component intervention, provided by a multidisciplinary team, in which a nurse-care manager plays a central role. Effects on functioning and quality of life were tested in a clinical trial. We also investigated the mediating role of depression severity on these outcome variables.
  
  
  RESULTS
  Patients randomized to CC showed more improvement in overall functioning compared to patients in the control group who obtained care as usual (CAU), with a small effect size (ES=0.3, z=-2.5, p=0.01). In the domains of autonomy and leisure time, a medium effect was found in favor of CC (autonomy: ES=0.5, z=-2.9, p=0.004; leisure-time: ES=0.4, z=-2.4, p=0.02). No differences between conditions were found in the other domains of functioning. Concerning quality of life, patients in CC improved more in the domain physical health (ES=0.4, z=2.5, p=0.01), if compared to CAU. No differences were found in overall quality of life. Half of the effects on functioning are mediated through the effects of CC on depression severity.
  
  
  CONCLUSIONS
  At baseline, differences on the main outcomes existed between conditions. Two teams stopped participation in the experimental condition after randomization. Sample size was limited.
  
  
  CONCLUSIONS
  Besides effects on depressive symptoms, CC seems to have direct beneficial effects on both level of functioning and aspects of quality of life.
authors.affiliation: VU University Medical Center, Department of Psychiatry, Amsterdam, The Netherlands; Inholland University of Applied Sciences, Department of Health, Sports & Welfare/Cluster Nursing, Research Group Mental Health Nursing, Amsterdam, The Netherlands. Electronic address: nienke.vandervoort2@inholland.nl.
authors.forename: Trijntje Y G
authors.initials: TY
authors.lastname: van der Voort
authors.affiliation: VU University Medical Center, Department of Psychiatry, Amsterdam, The Netherlands; Inholland University of Applied Sciences, Department of Health, Sports & Welfare/Cluster Nursing, Research Group Mental Health Nursing, Amsterdam, The Netherlands; Parnassia Psychiatric Institute, Parnassia Academy, The Hague, The Netherlands.
authors.forename: Berno
authors.initials: B
authors.lastname: van Meijel
authors.affiliation: VU University Medical Center, Department of Psychiatry, Amsterdam, The Netherlands.
authors.forename: Adriaan W
authors.initials: AW
authors.lastname: Hoogendoorn
authors.affiliation: Dimence Mental Health, Deventer, The Netherlands; Radboud University Medical Center, Nijmegen, The Netherlands; GGZVS, Institute for the Education of Clinical Nurse Specialists in Mental Health, Utrecht, The Netherlands.
authors.forename: Peter J J
authors.initials: PJ
authors.lastname: Goossens
authors.affiliation: VU University Medical Center, Department of Psychiatry, Amsterdam, The Netherlands.
authors.forename: Aartjan T F
authors.initials: AT
authors.lastname: Beekman
authors.affiliation: VU University Medical Center, Department of Psychiatry, Amsterdam, The Netherlands; Altrecht Mental Health, Utrecht, The Netherlands.
authors.forename: Ralph W
authors.initials: RW
authors.lastname: Kupka
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team / Q000458:organization & administration*; D026684:Personal Autonomy; D011788:Quality of Life
keywords: Bipolar disorder; Collaborative Care; Depression; Functioning; Quality of life