Bipolar patients show poor HRQoL regardless of treatment setting

Sep 21 2012

By Mark Cowen, Senior medwireNews Reporter

Patients with bipolar disorder (BD) who present for treatment in primary care (PC) settings and those who present at community mental health (CMH) clinics have equally poor health-related quality of life (HRQoL), US research shows.

Indeed, BD patients in PC and CMH settings showed similar deficits in both physical and mental HRQoL, the team reports in the Journal of Affective Disorders.

"Given the centrality of HRQoL as a measure of overall functioning, these findings suggest the importance of addressing both mental and physical health symptoms in this population, regardless of the setting in which patients seek treatment," comment Christopher Millar (Veterans Affairs Boston Healthcare System, Massachusetts) and colleagues.

Using the Short Form-36 Health Survey (SF-36), the team assessed HRQoL in 55 BD patients who presented for treatment in PC settings and 329 patients with the mood disorder who presented for treatment in CMH settings.

After accounting for age, gender, race, education, employment status, and other variables, the team found that there were no significant differences between PC and CMH patients regarding SF-36 Mental Composite Scale scores, both at 31.8, and Physical Composite Scale scores, at 37.2 and 36.4, respectively.

Higher depression scores, as assessed using the Internal State Scale, were associated with lower Mental Composite Scale (MCS) scores, and the presence of arthritis/chronic pain was associated with lower Physical Composite Scale scores, as was a greater number of other medical comorbidities.

Interestingly, hazardous drinking was associated with lower MCS scores in PC settings, but higher MCS scores in CMH settings. And while there was no association between hazardous drinking and Physical Composite Scale scores in PC settings, it was associated with higher scores in CMH settings.

Millar et al summarize: "Results from this cross-sectional study suggest that HRQoL is significantly impaired among people with BD presenting for treatment in PC or CMH settings."

The researchers add that recent efforts have been made to integrate mental health treatment into primary care, and say that more attention should be paid to addressing physical health issues in mental health settings.

They conclude that "further treatment development work in this area will allow clinicians to better address the mental and physical domains among patients with bipolar disorder, regardless of the particular setting in which they present for treatment."

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