Screening for Bipolar Disorder in the Primary Care Setting Using the Mood Disorder Questionnaire
View/ Open
Abstract
The majority of patients who have mental health needs are seen by their primary care provider (PCP) for treatment. In 2014, an estimated 6.6% of adults in the United States met diagnostic criteria for a major depressive episode during the past year. However, not all patients who present to their healthcare provider with symptoms of depression have a major depressive disorder. Some of these patients may have bipolar disorder, which in addition to symptoms of depression, include symptoms of mania or hypomania. This practice improvement project aimed to improve PCPs’ confidence in treating patients with depression and identifying patients with possible bipolar disorder. The project’s objectives were: 1) to implement clinic wide use of the Mood Disorder Questionnaire (MDQ), which screens for a lifetime history of mania or hypomania, to assist the PCPs in the diagnosis of depression and identifying patients with possible bipolar disorder and 2) improve PCPs’ confidence in treating patients with depression and identifying patients with possible bipolar disorder. The project took place at a family medicine residency clinic over a seven-month period. Four one-hour educational sessions were presented to the PCPs with pre-educational surveys and post-educational surveys administered at the beginning of the project and towards the end of the project. The surveys included seven statements assessing PCPs’ confidence in identifying, diagnosing, and managing patients with depression and bipolar disorder. A four-point Likert scale was used with 1 being very confident to 4 being not confident. During the seven-month project MDQs were offered to clinic patients presenting with mental health concerns. During the project, the MDQ was used 71 times with 23 of the 71 screens being positive. Eighteen PCPs completed the pre-education surveys and 15 PCPs completed the post-education surveys with confidence scores increasing pre-to post survey for all seven depression and bipolar disorder statements. Recommendations include continued use of the MDQ to screen for bipolar disorder in patients presenting with mental health concerns and offering educational sessions to increase PCP confidence in treating patients with depression and identifying patient with possible bipolar disorder.