Dr. Zeber is affiliated with the Veterans Affairs (VA) Health Services Research and Development Service (HSR&D), South Texas Veterans Health Care System, 7400 Merton Minter Blvd. (11C6), San Antonio, TX 78229 (e-mail: zeber@uthscsa.edu). Dr. McCarthy and Dr. Kilbourne are with the Serious Mental Illness Treatment, Evaluation, and Research Center, VA HSR&D, Ann Arbor, Michigan. Dr. Bauer is with the VA Medical Center, Providence, Rhode Island. Harold Alan Pincus, M.D., Terri L. Tanielian, M.A., and Dr. Kilbourne are editors of this column.

Bipolar disorder is a chronic mental illness associated with substantial functional impairment and increased mortality risks. Between 40% and 70% of treatment costs are attributable to high rates of co-occurring general medical disorders, including hypertension (35%), alcohol abuse (25%), hyperlipidemia (23%), and diabetes (17%) (1). Yet little research has explored whether these patients receive adequate care for general medical conditions. This study compared self-reported access barriers to general medical care and to mental health care among patients with bipolar disorder.

Participants were recruited from Continuous Improvement for Veterans in Care—Mood Disorders, a population-based, naturalistic study of patients with bipolar disorder receiving care at a large Veterans Health Administration mental health facility from 2004 to 2006 (2). Surveys gathered data on patient demographic characteristics, symptomatology, behavioral factors, ability to find appropriate treatment, and ability to receive urgent care appointments. Access barriers were solicited by the validated Cunningham instrument of perceived problems obtaining care (3).

The sample was representative of veterans diagnosed as having bipolar disorder nationally. Of the 435 veterans in the study, the mean±SD age was 49.4±11.0 years, 62 (14%) were women, 336 (77%) were white, 58 (13%) were African American, and 41 (9%) were from another racial or ethnic group. As shown in Figure 1, patients reported that mental health services were easier to access than medical care services.

Patients currently in treatment for bipolar disorder understandably achieved satisfactory access to psychiatric care. However, nearly a quarter reported significant barriers when seeking important general medical services. Recognizing how veterans with debilitating psychiatric conditions perceive medical care access may inform efforts to help balance "competing demands" as patients and providers jointly work toward a more holistic pursuit of recovery goals and better treatment retention.

This study was supported through funds provided by the VA HSR&D.

The authors report no competing interests.