Access to weight loss counseling services among patients with bipolar disorder.
ABSTRACT Cardiovascular disease is the leading cause of mortality in persons with bipolar disorder but little is known about utilization of services for risk reduction. We assessed determinants of access to weight counseling in a sample of patients with bipolar disorder.
Patients enrolled in the Continuous Improvement for Veterans in Care: Mood Disorders (CIVIC-MD), a prospective study conducted from July 2004-July 2006. Patient data were obtained from a baseline questionnaire and chart review.
Out of 298 patients, 73% received some weight counseling, with utilization more likely for those with higher BMI (OR = 1.12, p < 0.001) or prescribed a second generation antipsychotic (SGA) (OR = 1.80, p = 0.05). About 41% received 2 > or = dietary consultations with consults more likely for those reporting illicit substance use (OR = 1.9, p < 0.05) or SGA treatment (OR = 2.4, p < 0.05). In approximately 25% of patients, increased BMI (OR = 1.06, p = 0.04) and SGA treatment (OR = 2.13, p = 0.04) were associated with greater likelihood of receiving > or = 2 exercise consultations. Zero-inflated Poisson regression found SGA treatment was associated with more diet consultations (beta = 35, p < 0.05) while SGA treatment (beta=29, p<0.05) and women (beta=76, p<0.001) were associated with more exercise consultations. Illicit substance use (beta = -0.36, p < 0.05), binge drinking (beta = 32, p < 0.05) and other ethnicity (beta = -0.57, p < 0.05) were associated with fewer exercise consults.
Single-site study and limited chart detail.
The majority of patients received some weight counseling, with obesity and SGA predicting service use over time. However, low utilization patterns underscore the need for research into determinants of long-term counseling utilization to improve patient health outcomes.
SourceAvailable from: Kristian Wahlbeck[Show abstract] [Hide abstract]
ABSTRACT: To estimate the cardiovascular mortality among persons with bipolar disorder in Sweden compared to the general population. Population register-based cohort study with a 20-year follow-up. Sweden. The entire population of Sweden (n=10.6 million) of whom 17 101 persons were diagnosed with bipolar disorder between 1987 and 2006. Mortality rate ratios (MRR), excess mortality (excess deaths), cardiovascular disorder (CVD) and specifically cerebrovascular disease, coronary heart disease, acute myocardial infarction, sudden cardiac deaths and hospital admission rate ratio (ARR). Persons with bipolar disorder died of CVD approximately 10 years earlier than the general population. One third (38%) of all deaths in persons with bipolar disorder were caused by CVD and almost half (44%) by other somatic diseases, whereas suicide and other external causes accounted for less than a fifth of all deaths (18%). Excess mortality of both CVD (n=824) and other somatic diseases (n=988) was higher than that of suicide and other external causes (n=675 deaths). MRRs for cerebrovascular disease, coronary heart disease and acute myocardial infarction were twice as high in persons with bipolar disorder compared to the general population. Despite the increased mortality of CVD, hospital admissions (ARR) for CVD treatment were only slightly increased in persons with bipolar disorder when compared to the general population. The increased cardiovascular mortality in persons with bipolar disorder calls for renewed efforts to prevent and treat somatic diseases in this group. Specifically, our findings further imply that it would be critical to ensure that persons with bipolar disorder receive the same quality care for CVD as persons without bipolar disorder.BMJ Open 04/2013; 3(4). DOI:10.1136/bmjopen-2012-002373 · 2.06 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: OBJECTIVE Bipolar disorder is a severe, chronic mental illness with a high incidence of medical and psychological comorbidities that make treatment and prevention of future episodes challenging. This study investigated the use of services among outpatients with bipolar disorder to further understanding of how to maximize and optimize personalization and accessibility of services for this difficult-to-treat population. METHODS The Lithium Treatment-Moderate Dose Use Study (LiTMUS) was a six-month multisite, comparative effectiveness trial that randomly assigned 283 individuals to receive lithium plus optimized care-defined as personalized, guideline-informed care-or optimized care without lithium. Relationships between treatment service utilization, captured by the Cornell Service Index, and demographic and illness characteristics were examined with generalized linear marginal models. RESULTS Analyses with complete data (week 12, N=246; week 24, N=236) showed that increased service utilization was related to more severe bipolar disorder symptoms, physical side effects, and psychiatric and general medical comorbidities. Middle-aged individuals and those living in the United States longer tended to use more services than younger individuals or recent immigrants, respectively. CONCLUSIONS These data suggest that not all individuals with bipolar disorder seek treatment services at the same rate. Instead, specific clinical or demographic features may affect the degree to which one seeks treatment, conveying clinical and public health implications and highlighting the need for specific approaches to correct such discrepancies. Future research is needed to elucidate potential moderators of service utilization in bipolar disorder to ensure that those most in need of additional services utilize them.Psychiatric services (Washington, D.C.) 08/2013; 64(11). DOI:10.1176/appi.ps.201200479 · 1.99 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: We examined the association between mood symptoms and 10-year CVD risk estimated by Framingham risk score in a cohort of patients with bipolar disorder. Veterans with bipolar disorder and CVD risk factors (N=118) were recruited from outpatient VA clinics. CVD risk factor data were collected from electronic medical records and patient surveys, and used to calculate patient Framingham Scores. The relationship between mood symptoms (depressive, manic) and Framingham scores was examined, as was the relationship between mental health symptoms and individual CVD risk factors (lipids, blood pressure, weight, smoking, and fasting glucose). Mean sample age was 53 years (SD=9.9), 17% were female, and 5% were African-American. Almost 70% were obese (BMI≥30), 84% had hyperlipidemia, 70% were hypertensive, and 25% had diabetes. Nineteen percent had a Framingham score of >20%, indicative of elevated 10-year risk of developing CVD. After adjusting for age, gender, diabetes diagnosis, smoking status, and mood symptoms, patients with clinically significant depressive symptoms had a 6-fold increased odds of having a Framingham score of >20% (OR=6.1, p=0.03) while clinically significant manic symptoms were not associated with the Framingham score (OR=0.6, p=0.36). Depressive symptoms were also associated with elevated BMI, fasting glucose, and blood pressure. Single-site study reliant on cross-sectional and self-reported mood measures. After controlling for physiologic correlates, depressive symptoms were associated with greater relative 10-year risk for CVD mortality among patients with bipolar disorder. Interventions that address self-management of depressive symptoms may help persons with bipolar disorder decrease CVD risk.Journal of Affective Disorders 02/2012; 138(3):405-8. DOI:10.1016/j.jad.2012.01.005 · 3.71 Impact Factor