Collaborative Care for Individuals with Bipolar Disorder or Schizophrenia and Co-Occurring Physical Health Conditions: A Systematic Review

Background and Purpose:  Prevalence rates of chronic physical health conditions are increasing in the U.S.  Individuals with severe mental illness (SMI) are at particular risk for chronic physical health conditions, and a co-occurring diagnosis is associated with worse health care utilization, socioeconomic outcomes, and patient-reported health status.  Collaborative care models (CCM) that incorporate care coordination, and physical and mental health evaluation and treatment, have a growing presence in U.S. health care.  Prior research suggests CCM improve outcomes for persons with depression, but little is known about the effectiveness for persons with other SMI diagnoses, such as bipolar disorder and schizophrenia.  Using systematic review procedures, this study investigated whether CCM improve health for adults with bipolar disorder or schizophrenia, and co-occurring physical health conditions. 

Methods:  The systematic review included a comprehensive literature search of seven academic databases, forward/backward searches, grey literature search, and hand searching of a selected journal.  Studies of participants 18 years of age or older who were diagnosed with bipolar disorder or schizophrenia, and had a diagnosis of a chronic physical health condition or possessed a primary risk factor for developing such a condition were included in the review. Included studies had to test CCM as an intervention, and include a control or comparison group.  Studies included both objective and subjective physical and mental health outcomes.  The systematic review process was conducted simultaneously by both authors to enhance reliability.

Results: The initial search produced 249 unduplicated articles. The final sample consisted of six articles that met study inclusion criteria. Data extraction was completed for these articles using a rating form developed for the study, which included elements related to sample characteristics, methodology, outcomes, and validity/reliability. Inconsistent results were found regarding differences in quality of life measures between CCM and control groups.  Significant differences were found in three-year hospitalization rate for individuals in CCM versus the control group, however there were no differences in outpatient medical visits. The two studies that examined BMI and waist circumference found no significant differences between the groups, however blood pressure results were less consistent.  Most studies found no difference in manic or depressive symptoms between CCM and control groups, but some significant differences were found in other mental health outcomes.  No studies included participants with a schizophrenia diagnosis. 

Conclusion and Implications:  Social workers are employed in primary care clinics and community mental health centers where collaborative care models are present.  Medicaid health homes, created with the authorization of the Affordable Care Act, provide a new collaborative care delivery method for individuals with SMI, and provide the opportunity for greater access to collaborative care models.  The CCM identified through this review delivered mixed results regarding their effectiveness for improving quality of life, physical health, and mental health outcomes for persons with SMI.  These results are relevant for social workers practicing in collaborative care settings, and highlight the opportunities for social work researchers to address the many research and intervention gaps for this population.