Psychological Medicine



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


GREGORY E. SIMON a1c1, EVETTE J. LUDMAN a1, JÜRGEN UNÜTZER a1, MARK S. BAUER a1, BELINDA OPERSKALSKI a1 and CAROLYN RUTTER a1
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] 

Abstract

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.


Correspondence:
c1 Dr Gregory Simon, Center for Health Studies, 1730 Minor Ave, #1600 Seattle, WA 98101, USA. (Email: simon.g@ghc.org)


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