TY - JOUR
AU - J. H. Park
AU - S. A. Breitinger
AU - S. T. Savitz
AU - M. Gardea-Resendez
AU - B. Singh
AU - M. D. Williams
AU - M. A. Frye
A1 - 
AB - INTRODUCTION: While bipolar disorder is not uncommon in primary care, collaborative care models for bipolar depression treatment are underdeveloped. Our aim was to compare initial pharmacological treatment patterns for an episode of bipolar depression in different care models, namely primary care (PC), integrated behavioral health (IBH), and mood specialty clinic (SC). METHODS: A retrospective study of adults diagnosed with bipolar disorder who received outpatient care in 2020 was completed. Depressive episodes were captured based on DSM-5 criteria, ICD codes, or de novo emergent symptom burden (PHQ-9 ≥ 10). Pharmacological strategies were classified as 1) continuation of current regimen, 2) dose increase or 3) augmentation 4) switch to monotherapy or 5) a combination of more than two different strategies. Logistic regression was applied. RESULTS: A total of 217 encounters (PC = 32, IBH = 53, SC = 132) representing 186 unique patients were identified. PC was significantly more likely to continue the current regimen, while combination strategies were significantly more likely recommended in IBH and SC. Mood stabilizers were significantly more utilized in IBH and SC. There were no significant group differences in antidepressant use. LIMITATIONS: Retrospective study design at a single site. CONCLUSIONS: This study provides evidence of delays in depression care in bipolar disorder. This is the first study to compare treatment recommendations for bipolar depression in different clinical settings. Future studies are encouraged to better understand this gap and to guide future clinical practice, regardless of care model, emphasizing the potential benefits of decision support tools and collaborative care models tailored for bipolar depression.
AD - Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.; Department of Psychiatry, Universidad Autónoma de Nuevo León, Monterrey, Mexico.; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA. Electronic address: mfrye@mayo.edu.
AN - 39389118
BT - J Affect Disord
C5 - Healthcare Disparities
DA - Jan 15
DO - 10.1016/j.jad.2024.10.011
DP - NLM
ET - 20241009
JF - J Affect Disord
LA - eng
N2 - INTRODUCTION: While bipolar disorder is not uncommon in primary care, collaborative care models for bipolar depression treatment are underdeveloped. Our aim was to compare initial pharmacological treatment patterns for an episode of bipolar depression in different care models, namely primary care (PC), integrated behavioral health (IBH), and mood specialty clinic (SC). METHODS: A retrospective study of adults diagnosed with bipolar disorder who received outpatient care in 2020 was completed. Depressive episodes were captured based on DSM-5 criteria, ICD codes, or de novo emergent symptom burden (PHQ-9 ≥ 10). Pharmacological strategies were classified as 1) continuation of current regimen, 2) dose increase or 3) augmentation 4) switch to monotherapy or 5) a combination of more than two different strategies. Logistic regression was applied. RESULTS: A total of 217 encounters (PC = 32, IBH = 53, SC = 132) representing 186 unique patients were identified. PC was significantly more likely to continue the current regimen, while combination strategies were significantly more likely recommended in IBH and SC. Mood stabilizers were significantly more utilized in IBH and SC. There were no significant group differences in antidepressant use. LIMITATIONS: Retrospective study design at a single site. CONCLUSIONS: This study provides evidence of delays in depression care in bipolar disorder. This is the first study to compare treatment recommendations for bipolar depression in different clinical settings. Future studies are encouraged to better understand this gap and to guide future clinical practice, regardless of care model, emphasizing the potential benefits of decision support tools and collaborative care models tailored for bipolar depression.
PY - 2025
SN - 0165-0327
SP - 404
EP - 410+
ST - Delays in bipolar depression treatment in primary care vs. integrated behavioral health and specialty care
T1 - Delays in bipolar depression treatment in primary care vs. integrated behavioral health and specialty care
T2 - J Affect Disord
TI - Delays in bipolar depression treatment in primary care vs. integrated behavioral health and specialty care
U1 - Healthcare Disparities
U3 - 10.1016/j.jad.2024.10.011
VL - 369
VO - 0165-0327
Y1 - 2025
ER -