Psychological Medicine

Randomized trial of a population-based care program for people with bipolar disorder

a1 Center for Health Studies, Group Health Cooperative, Seattle, WA, USA; UCLA Neuropsychiatric Institute, Los Angeles, CA, USA; Providence Veterans Affairs Medical Center and Brown University, Providence, RI, USA

Article author query
simon ge   [PubMed][Google Scholar] 
ludman ej   [PubMed][Google Scholar] 
unutzer j   [PubMed][Google Scholar] 
bauer ms   [PubMed][Google Scholar] 
operskalski b   [PubMed][Google Scholar] 
rutter c   [PubMed][Google Scholar] 


Background. Despite the availability of efficacious medications and psychotherapies, care of bipolar disorder in everyday practice is often deficient. This trial evaluated the effectiveness of a multi-component care management program in a population-based sample of people with bipolar disorder.

Method. Four hundred and forty-one patients treated for bipolar disorder during the prior year were randomly assigned to continued usual care or usual care plus a systematic care management program including: initial assessment and care planning, monthly telephone monitoring including brief symptom assessment and medication monitoring, feedback to and coordination with the mental health treatment team, and a structured group psychoeducational program – all provided by a nurse care manager. Blinded quarterly assessments generated week-by-week ratings of severity of depression and mania symptoms using the Longitudinal Interval Follow-Up Evaluation.

Results. Participants assigned to the intervention group had significantly lower mean mania ratings averaged across the 12-month follow-up period (Z=2·44, p=0·015) and approximately one-third less time in hypomanic or manic episode (2·59 weeks v. 1·69 weeks). Mean depression ratings across the entire follow-up period did not differ significantly between the two groups, but the intervention group showed a greater decline in depression ratings over time (Z statistic for group-by-time interaction=1·98, p=0·048).

Conclusions. A systematic care program for bipolar disorder significantly reduces risk of mania over 12 months. Preliminary results suggest a growing effect on depression over time, but longer follow-up will be needed.

c1 Dr Gregory Simon, Center for Health Studies, 1730 Minor Ave, #1600 Seattle, WA 98101, USA. (Email: