Access to weight loss counseling services among patients with bipolar disorder
VA Ann Arbor Health Services Research and Development Center of Excellence, Ann Arbor, MI, USA. Journal of Affective Disorders
(Impact Factor: 3.38).
04/2010; 126(1-2):75-9. DOI: 10.1016/j.jad.2010.02.138
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.
Available from: David E Goodrich
- "Obesity is strongly associated with CVD risk (Whitlock et al., 2009) and current findings underscore the need for health promotion efforts for patients with bipolar disorder in order to reduce weight and the onset of CVD morbidity. For example, one prospective study of patients with bipolar disorder found obese patients prescribed psychotropic drugs associated with weight gain received more exercise counseling and/or dietary consultations, yet overweight patients were less likely to receive preventive counseling (Goodrich et al., 2010). "
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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.
Available from: Lung-Chang Chien
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ABSTRACT: Previous studies of clinical samples of adults with bipolar disorder (BD) suggest that there is increased prevalence of obesity and that obesity is associated with greater BD severity. We therefore examined this topic in a representative epidemiologic sample.
The 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions was used to determine whether the prevalence of obesity is elevated among subjects with lifetime BD, and whether obesity is associated with greater severity of BD.
The age-, race-, and sex-adjusted prevalence of obesity was significantly greater among subjects with BD versus controls [odds ratio (OR) = 1.65, 95% confidence interval (CI): 1.45-1.89, p < 0.001]. Obesity among subjects with BD was significantly positively associated with greater age, female sex, comorbid anxiety and medical conditions, and depression-related treatment utilization, and significantly negatively associated with past-year substance use disorder (SUD). In multivariable analyses, obesity among adults with BD was positively associated with age, comorbid anxiety disorders, duration of depressive episodes, and history of hospitalization for depression, and negatively associated with past-year SUD.
The increased prevalence of obesity in BD and its association with illness severity, particularly in relation to depression, cannot be attributed to biases inherent in treatment-seeking samples. Future studies are needed to examine the direction of the observed associations and to develop preventive and treatment strategies seeking to mitigate the burden of obesity in BD.
Available from: Kristian Wahlbeck
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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.
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.
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