Bipolarity in a Collaborative Care Model Variation: Detection, Prevalence, and Outcomes

Area of Science:

• Psychiatry
• Primary Care Medicine
• Mental Health Services

Background:

• Assessing bipolar disorder prevalence in primary care is challenging.
• Collaborative Care Models (CoCM) offer a framework for integrated mental health services.
• Accurate diagnosis impacts treatment effectiveness for mood disorders.

Purpose of the Study:

• To evaluate the prevalence of bipolar disorder in a primary care setting using a CoCM.
• To examine the impact of bipolarity assessment on patient treatment outcomes.
• To determine the feasibility of universal bipolar disorder screening in CoCM.

Main Methods:

• Reviewed electronic records of 1,476 patients with depression in a CoCM.
• Utilized the Composite International Diagnostic Interview (CIDI) and consultant impressions for bipolarity assessment.
• Collected data on non-mania markers and Patient Health Questionnaire-9 (PHQ-9) scores.

Main Results:

• 97% of referred patients were screened for bipolar disorder.
• 21% were CIDI positive, and 35% had a positive consultant impression for bipolarity.
• All patient groups showed similar PHQ-9 score reductions post-consultation.

Conclusions:

• Universal bipolar disorder screening is feasible within CoCM programs.
• Dimensional interpretation of screening data is supported by score distributions.
• Treatment based on clinical impression, even with negative diagnostic interview results, did not lead to worse outcomes.