Exploration of the Impact of Screening on the Outcomes of Bipolar Disorders: A Mixed Methods Study

Bipolar disorder (BPD) is a chronic mental health illness that impacts all aspects of an individual’s life and ability to function.  The World Health Organization ranks BPD as one of the top ten causes of disability in the world with an incidence as high as 5% in the U.S.  The 2000 National Depressive and Manic-Depressive Association Survey of individuals with BPD reported that 69% of patients received an initial misdiagnosis, and 33% had a delay in receiving a correct diagnosis of 10 years.  It is fatal when untreated in a high proportion of patients and marks BPD as a major unsolved public health problem.  BPDs are known to be missed, misdiagnosed or not treated appropriately in a majority of individuals.  Research has shown that screening for BPD in patients with known depression can identify BPD early, thereby reducing the long lag time to diagnosis and treatment.

The hypothesis of this study is that the long lag time to diagnosis and treatment of BPD could be reduced if Advanced Practice Registered Nurses (APRNs) screen patients with a diagnosis of depression using validated screening tools.  This mixed methods descriptive study is the first to explore APRN’s knowledge of BPD and their perceptions of facilitators and barriers to screening patients with known depression for BPD.  Triangulated data from the quantitative and qualitative studies generated a rich description of APRNs knowledge, experiences and perceptions of barriers and facilitators to screening for BPDs in their practice.  The results of the quantitative study (N=89) found  83.1% (n=74) of the APRNs  saw patients  with a diagnosis of depression, and 55.1% (n=49) did not screen  for BPDs. The focus group interviews supported the quantitative results; and highlight that nurses need more education on BPDs.  Implementing screening practices for all patients with a known diagnosis of depression can have a direct impact on reducing the morbidity and mortality of undiagnosed BPDs.  The results of this study can inform APRN practice, education,  research and policy.  This includes  advocating for full practice authority; policy changes at local, state, and national levels to include screening, research to determine the impact of screening, early treatment and referral; innovations to create and promote collaborative programs that connect individuals with BPD to PCPs and psychiatric care (PMH-NPs) and includes real-time screening at home or in PCP office waiting areas.