Samenvatting

This thesis provides a report on research aimed at enhancing treatment of patients with bipolar disorder. We describe various aspects of treatment of bipolar disorder. The central study reported in this thesis is an effect study of a multicomponent intervention, Collaborative Care.

Chapter 1 describes the study-protocol of the cluster-randomized controlled trial we conducted to study the effectiveness of CC for patients with bipolar disorder. The design of the intervention as well as the trial are described in detail, to enable readers to take note of the pre-defined measures and plans for analyses, once results of the trial are being published. Publishing protocols in advance allows for monitoring and enhancing quality in research.

Chapter 2 describes the main outcomes of the pragmatic trial, on severity of manic and depressive symptoms, as well as time spent with manic or depressive symptoms. This chapter provides an overview of the characteristics of the 138 patients who participated in the study, as well as the extent to which the intervention was implemented.

Chapter 3 contains the results of the trial on the two other main outcomes, i.e. psycho-social functioning and quality of life. We consider these outcomes to be essential for the thorough
evaluation of our intervention program, in addition to the symptomatic recovery of the patient’s mood disorder.

Chapter 4 explores the relationship between functional recovery and remission of symptoms. It was hypothesized that, in patients with mood disorders, the time since last mood episode occurred is negatively associated with functional impairment, in other words functional recovery is lagging behind remission of symptoms. This was studied in 3 groups of patients: patients with major depressive disorder (MDD) who have experienced a single depressive episode, patients with MDD with multiple episodes, and patients with bipolar disorder, which is by definition a recurrent disorder. This study is based on analyses of data from the Netherlands Study on Depression and Anxiety (NESDA).

Chapter 5 reports on patients’ experiences concerning helpful and obstructive elements of nursing care during a depressive episode. Patients participating in the experimental condition of the trial were interviewed, in line with the grounded theory method. This study resulted in a preliminary theory, that provides insight in the benefits of nursing interventions enhancing remission from a depressive episode, as experienced by patients.

Chapter 6 describes experiences of spouses of patients with bipolar disorder. Spouses who were a member of the Dutch Society of Manic Depressives and Relatives (VMDB) were invited to participate. These spouses were interviewed about perceived burden, coping and needs for support. The grounded theory method was applied, and resulted in a grounded theory explaining the experiences of the spouses.

Summary and general discussion.
This thesis ends with a summary of our main findings and general discussion on these findings.