Psychiatr Serv. 2013 Nov 1;64(11):1119-26. doi: 10.1176/appi.ps.201200479.
OBJECTIVE Bipolar disorder is a severe, chronic mental illness with a high incidence of medical and psychological comorbidities that make treatment and prevention of future episodes challenging. This study investigated the use of services among outpatients with bipolar disorder to further understanding of how to maximize and optimize personalization and accessibility of services for this difficult-to-treat population. METHODS The Lithium Treatment-Moderate Dose Use Study (LiTMUS) was a six-month multisite, comparative effectiveness trial that randomly assigned 283 individuals to receive lithium plus optimized care-defined as personalized, guideline-informed care-or optimized care without lithium. Relationships between treatment service utilization, captured by the Cornell Service Index, and demographic and illness characteristics were examined with generalized linear marginal models. RESULTS Analyses with complete data (week 12, N=246; week 24, N=236) showed that increased service utilization was related to more severe bipolar disorder symptoms, physical side effects, and psychiatric and general medical comorbidities. Middle-aged individuals and those living in the United States longer tended to use more services than younger individuals or recent immigrants, respectively. CONCLUSIONS These data suggest that not all individuals with bipolar disorder seek treatment services at the same rate. Instead, specific clinical or demographic features may affect the degree to which one seeks treatment, conveying clinical and public health implications and highlighting the need for specific approaches to correct such discrepancies. Future research is needed to elucidate potential moderators of service utilization in bipolar disorder to ensure that those most in need of additional services utilize them.
双相情感障碍是一种严重的慢性精神疾病，发病率高，伴有多种医学和心理共病，这使得治疗和预防未来发作具有挑战性。本研究调查了双相情感障碍门诊患者的服务利用情况，以进一步了解如何最大限度地提高和优化这一难以治疗人群的服务个性化和可及性。
锂治疗中剂量使用研究（LiTMUS）是一项为期六个月的多地点、比较有效性试验，将 283 名个体随机分配到锂加优化护理组（定义为个性化、基于指南的护理）或无锂的优化护理组。使用广义线性边缘模型，对以 Cornell 服务指数（Cornell Service Index）捕捉的治疗服务利用与人口统计学和疾病特征之间的关系进行了分析。
对完整数据（第 12 周，N=246；第 24 周，N=236）的分析显示，服务利用率的增加与更严重的双相情感障碍症状、身体副作用以及精神和一般医疗共病有关。中年个体和在美国居住时间较长的个体比年轻个体或新移民更倾向于使用更多的服务。
这些数据表明，并非所有双相情感障碍患者都以相同的速度寻求治疗服务。相反，特定的临床或人口统计学特征可能会影响一个人寻求治疗的程度，这传达了临床和公共卫生方面的意义，并强调需要针对这些差异采取具体方法。未来的研究需要阐明双相情感障碍服务利用的潜在调节因素，以确保那些最需要额外服务的人能够利用这些服务。
