Pharmacy and Therapeutics - January 2008 - (Page 28) Impact of Bipolar Disorder on the Family The study sample might have represented a high-functioning population of individuals with bipolar disorder. In our sample, 44% of individuals (19,768) with bipolar disorder were employees. This fact may suggest that the study population differs from bipolar individuals who would be covered by Medicaid or the mix of patients who would be seen in a general psychiatrist’s practice. Excluding families with other serious mental health diagnoses from the control group might have led to overestimating incremental costs. The reasoning behind this exclusion was the difficulty of diagnosing bipolar disorder; such a difficulty could have led to a large number of “undetected” cases in the control group. It has been reported that approximately onethird of patients diagnosed with unipolar depression also fit the diagnostic criteria for bipolar spectrum disorder. In addition, 34% of patients sometimes wait 10 years or more before they are given their first diagnosis of bipolar disorder.31 However, the control group did include subscribers to health plans and family members with other chronic diseases such as asthma, migraine, and gastroesophogeal reflux disease, which would have attenuated this problem. An additional limitation might be the lack of cost data for some services provided under capitated health plans. Our approach was to exclude these services, which could have resulted in an underestimation of total costs. In this study, the annual total direct medical cost for individuals with bipolar disorder ($2,909) was somewhat lower than that reported by Simon and Unutzer ($3,416).32 Their study benefited from a cost-accounting system that estimated the actual cost of producing services at health maintenance organization (HMO) facilities, and included the costs for capitated care.32 Despite these limitations, our study and the associated body of research raise important questions for health care providers, insurers, and P&T committees. Bipolar families appear to have unmet needs based on their higher utilization of health care resources, including prescriptions. More research is needed to determine whether effective drug and behavioral health treatment of bipolar patients can alleviate the burden on family members, thereby decreasing their health care utilization, or whether the effect persists. Future research should also focus on methods to address these unmet needs, such as family counseling and family-based disease management. psych.org/psych_pract/treatg/pg/prac_guide.cfm. Accessed December 3, 2007. 2. Kleinman LS, Lowin A, Flood E, et al. Costs of bipolar disorder. Pharmacoeconomics 21(9):601–622, 2003. 3. Begley CE, Annegers JF, Swann AC, et al. The lifetime cost of bipolar disorder in the U.S.: An estimate for new cases in 1998. Pharmacoeconomics 2001;19(5 Part 1):483–495. 4. Rice DP, Miller LS. The economic burden of affective disorders. Adv Health Econ Health Serv Res 1993;14:37–53. 5. Rice DP, Miller LS. Health economics and cost implications of anxiety and other mental health disorders in the United States. Br J Psychiatry 1998;173(Suppl 34):4–9. 6. Wyatt RJ, Henter I. An economic evaluation of manic-depressive illness, 1991. Soc Psychiatry Epidemiol 1995;30(5):213–219. 7. Wittmund B, Wilms HU, Mory C, et al. 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Maternal outcomes of a randomized controlled trial of a community-based support program for families of children with chronic illnesses. Arch Pediatr Adolesc Med 2001;155(7):771–777. 19. Hung JW, Wu YH, Yeh CH. Comparing stress levels of parents of children with cancer and parents of children with physical disabilities. Psycho-oncology 2004;13(12):898–903. 20. Tong HC, Kandala G, Haig AJ, et al. Physical functioning in female caregivers of children with physical disabilities compared with female caregivers of children with a chronic medical condition. Arch Pediatr Adolesc Med 2002;156(11):1138–1142. 21. Ory MG, Hoffman RR 3rd, Yee JL, et al. Prevalence and impact of caregiving: A detailed comparison between dementia and non-dementia caregivers. Gerontologist 1999;39(2):177–185. 22. Schulz R, O’Brien AT, Bookwala J, et al. Psychiatric and physical morbidity effects of dementia caregiving: Prevalence, correlates, and causes. Gerontologist 1995;35(6):771–791. 23. Solomon P, Draine J. Adaptive coping among family members of persons with serious mental illness. Psychiatr Serv 1995;46(11): 1156–1160. 24. Solomon P, Draine J. Subjective burden among family members of mentally ill adults: Relation to stress, coping, and adaptation. Am J Orthopsychiatry 1995;65(3):419–427. 25. Chumbler NR, Rittman M, Van Puymbroeck M, et al. The sense of coherence, burden, and depressive symptoms in informal caregivers during the first month after stroke. Int J Geriatr Psychiatry 2004;19(10):944–953. continued on page 34 CONCLUSION Our findings support the evidence that bipolar disorder has a significant financial impact on family members in addition to the individual with the diagnosis. Families containing a member with bipolar disorder incur far greater direct medical costs than families without a serious mental illness. Caring for or living with these individuals is associated with secondary medical consequences. Further research is needed to elucidate the factors that affect the health of and the health care costs for caregivers and family members of individuals with bipolar disorder as well as the impact of therapy for these families. REFERENCES 1. Work Group on Bipolar Disorder. Practice Guideline for the Treatment of Patients with Bipolar Disorder, 2nd ed. Washington, DC: American Psychiatric Association; 2002. Available at: www. 28 P&T® • January 2008 • Vol. 33 No. 1 http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm http://www.psych.org/psych_pract/treatg/pg/prac_guide.cfm
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