Impact of bipolar disorder on the family: Utilization and cost of health care resources

Objective: Our retrospective analysis compared costs and patterns of health care utilization by families that included a member with bipolar disorder ("bipolar families") and by families without serious psychiatric disease ("control families"). Methods: We used the MarketScan Commercial Claims and Encounters Database covering January 1998 through December 2002. International Classification of Diseases (ICD-9-CM) codes were used to identify individuals with bipolar disorder and link them to their family members. Bipolar families were matched in a ratio of 1:3 to families without a serious mental illness. We calculated and statistically compared the mean annual use of resources and health care costs for each group, including the individual with bipolar disorder. We used a multivariate model to test the effect of demographic and health care variables on the impact of total health care expenditures. Results: Families with a member with bipolar disorder (n = 43,448), compared with matched families (n = 122,769), made significantly more outpatient physician visits (24 vs. eight; P < 0.001), more inpatient hospital stays (1 vs. 0.3; P < 0.001), and more prescription medications (24 vs. 7.8; P < 0.001). Total annual health care costs were more than three-fold higher for bipolar families ($4,664), compared with matched families ($1,376) (P < 0.001). The multivariate model controlled for family size and comorbidities, indicating significantly higher total health care costs for families with one or more persons with bipolar disorder than for matched families without serious mental illness. Conclusion: These results indicate that bipolar disorder has a significant financial impact on families in addition to the individual with the diagnosis.