Do people with bipolar disorders have access to psychosocial treatments? A survey in Italy

• Published in: International journal of social psychiatry Vol. 62; no. 4; pp. 334 - 344
• Main Authors: Barbato, Angelo, Vallarino, Martine, Rapisarda, Filippo, Lora, Antonio, Parabiaghi, Alberto, D’Avanzo, Barbara, Lesage, Alain
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.06.2016; Sage Publications Ltd
• Subjects: Adolescent; Adult; Aged; Bipolar disorder; Bipolar Disorder - epidemiology; Bipolar Disorder - therapy; Care delivery; Community health care; Community mental health services; Depressive Disorder - epidemiology; Depressive Disorder - therapy; Evidence-Based Practice; Family Therapy; Female; Health services; Health Services Accessibility - statistics & numerical data; Humans; Italy; Male; Mental depression; Mental health care; Mental Health Services - statistics & numerical data; Middle Aged; Psychiatric services; Psychosocial intervention; Psychosocial rehabilitation; Psychotherapy; Rehabilitation; Schizophrenia; Schizophrenia - epidemiology; Schizophrenia - therapy; Service provision; Surveys and Questionnaires; Young Adult; Italy; Bipolar disorder; psychosocial treatments; evidence-based practice; mental health services
• ISSN: 0020-7640; 1741-2854
• DOI: 10.1177/0020764016631368

Background: Several guidelines consider psychosocial treatments an essential component of clinical management of bipolar disorders in addition to drug therapy. However, to what extent such interventions are available in everyday practice to the average patient attending mental health services is not known. Aims: This study aims to investigate access of people with bipolar disorders to psychosocial treatments in a community-based care system. Method: Information on care delivery and service utilization were retrieved from the psychiatric database of Lombardy, Italy, covering a population of 9,743,000, for all adults who had at least one contact in 2009 with psychiatric services. Rates of patients with a diagnosis of bipolar disorder who had access to individual psychotherapy, couple/family therapy, group psychotherapy and family interventions were calculated and compared to patients with schizophrenia and depression. Results: A total of 8,899 subjects with bipolar disorder had been in contact with psychiatric services, corresponding to a treated annual prevalence rate of 1.1‰. More than 80% of patients were treated in community settings. Rates of patients receiving structured psychosocial treatments ranged from 0.7% for couple/family therapy to 6.1% for individual psychotherapy. No differences with patients with schizophrenia and depression were found. Patients with schizophrenia received more interventions labeled as rehabilitation. Conclusion: Few people with bipolar disorders had access to psychosocial treatments. Even in a well-developed system of community care, offer of psychosocial interventions for bipolar disorders is inadequate. This issue should be a target for future research on dissemination and implementation strategies.