Collaborative Chronic Care Models for Bipolar Disorder: A Meta-Analysis

Bipolar disorder is a chronic, complex mental health condition. Chronic Care Models were developed to treat chronic medical conditions in primary care. Several clinical trials have assessed their effects in treating individuals with bipolar disorder.

A systematic literature review identified randomized controlled trials that tested interventions utilizing at least three of the five Chronic Care Model clinical elements. Random effects meta-analysis assessed impact on six outcome domains: overall mental health, mania, depression, mental health-related quality of life, physical health-related quality of life, and treatment costs. Risk of bias for individual trials and confidence in the point estimate for outcome domains were determined following the Cochrane methodology.

Eight randomized controlled trials were identified, resulting in six meta-analyses of two to eight trials each. The single-blind methodology resulted in a high overall risk of bias for each trial. Statistically significant benefit was seen for overall mental health (standardized mean difference (SMD) = 0.28, 95% CI = 0.13-0.43, p < 0.01), mania (SMD = 0.16, 95% CI = 0.01-0.30, p = 0.03), and mental health-related quality of life (SMD = 0.24, 95% CI = 0.08-0.41, p < 0.01). No evidence of an effect was seen for depression, physical health-related quality of life, or costs. Confidence was moderate for overall mental health outcome, mania, depression, and mental health-related quality of life; low for physical health-related quality of life; and very low for costs.

Trials in diverse health care systems indicate that Chronic Care Model elements may improve mental health outcomes for bipolar disorder. This meta-analysis highlights the need for research to further explore the effectiveness and implementation of these models of care.