Rates of depressive and anxiety symptoms are high among patients with bipolar disorder who are treated in primary care, show the results of a US study of patients in this setting.
Despite this, only approximately a quarter of the cohort was referred to specialist mental health treatment, report the researchers.
“Successful treatment of bipolar disorder in primary care may require additional clinical interventions aimed at either further improving the care delivered to patients in primary care or through more effective referrals to community mental health centers”, remark Joseph Cerimele (University of Washington, Seattle) and co-workers in Psychiatric Services.
The team assessed the characteristics of 740 primary care patients with bipolar disorder who were receiving care via the Washington State Mental Health Integration Program.
The patients’ mean Patient Health Questionnaire-9 score was 18.1, indicating moderately severe depression, and 58% of patients reported endorsing suicidal ideation, report Cerimele et al. Furthermore, anxiety levels, measured by the Generalized Anxiety Disorder Scale, indicated that 88% of patients met the criteria for one of four anxiety disorders including panic disorder and social phobia.
Among 442 patients screened for Post Traumatic Disorder (PTSD), 91% scored over 45 on the PTSD Checklist, indicating a high likelihood of meeting the diagnostic criteria for this disorder.
“Although this result was from a subsample, it supports our finding that many of the patients had moderate to severe comorbid anxiety symptoms, such as symptoms that can occur with PTSD”, note the researchers.
Patients also reported frequent psychosocial as well as clinical concerns at baseline, including concerns about their housing situation, with 15% being homeless and 41% reporting staying with someone, in a shelter, car, motel or other, and 32% reporting a lack of dependable transportation.
Cerimele and colleagues found that the average time between initial assessment and referral to specialist mental health treatment was 17.2 weeks, with a 5.7-week wait between initial assessment and psychiatric assessment. However, just 26% of the cohort received a referral, which the team believes could result from a lack of community-based resources, as well as patients favouring treatment from their primary practitioner.
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