Excessive mortality and causes of death among patients with personality disorder with comorbid psychiatric disorders

Chian Jue Kuo, Wen Yin Chen, Shang Ying Tsai, Pao Huan Chen, Kai Ting Ko, Chiao Chicy Chen

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Purpose: Excessive mortality has been seen in patients with personality disorder (PD), but it has not been well-studied when patients also have other psychiatric comorbidities. This study investigated the mortality rates and causes of death in an Asian cohort with PD. Method: We enrolled patients ≥ 18 years of age with PD as defined by DSM-IV criteria (N = 1172), who had been admitted to a psychiatric service center in northern Taiwan between 1985 and 2008. By linking with the national mortality database (1985–2008), cases of mortality (n = 156, 13.3%) were obtained. We calculated the standardized mortality ratios (SMRs) to estimate the mortality gap between patients with PD and the general population. Stratified analyses of mortality rates by Axis I psychiatric comorbidity and sex were performed. Results: Borderline PD (n = 391, 33.4%) was the dominant disorder among the subjects. The SMRs for all-cause mortality of PD alone, PD comorbid with non-substance use disorder(non-SUD), and PD comorbid with SUD were 4.46 (95% CI 1.94–6.98), 7.42 (5.99–8.85), and 15.96 (11.07–20.85), respectively. Among the causes of death, the SMR for suicide was the highest (46.92, 95% CI 34.29–59.56). The SMR for suicide in PD patients with comorbid SUD was unusually high (74.23, 95% CI 33.88-114.58). Women had a significant increase in suicide with an SMR of 59.00 (95% CI 37.89–80.11). Men had significant increase in SMRs for cardiovascular disease and gastrointestinal disease. Conclusions: We found significant synergistic effects of PD and SUD on mortality risk. A personality assessment should be mandatory in all clinical settings to prevent premature death and detect SUD early.

Original languageEnglish
JournalSocial Psychiatry and Psychiatric Epidemiology
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

personality disorder
Personality Disorders
cause of death
Psychiatry
Cause of Death
mortality
Mortality
Suicide
suicide
comorbidity
Comorbidity
Personality Assessment
Disease
Borderline Personality Disorder
Premature Mortality
Gastrointestinal Diseases
Taiwan
Diagnostic and Statistical Manual of Mental Disorders
personality

Keywords

  • Cause of death
  • Comorbidity
  • Personality disorder
  • Standard mortality ratio
  • Substance use disorder

ASJC Scopus subject areas

  • Epidemiology
  • Health(social science)
  • Social Psychology
  • Psychiatry and Mental health

Cite this

Excessive mortality and causes of death among patients with personality disorder with comorbid psychiatric disorders. / Kuo, Chian Jue; Chen, Wen Yin; Tsai, Shang Ying; Chen, Pao Huan; Ko, Kai Ting; Chen, Chiao Chicy.

In: Social Psychiatry and Psychiatric Epidemiology, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Purpose: Excessive mortality has been seen in patients with personality disorder (PD), but it has not been well-studied when patients also have other psychiatric comorbidities. This study investigated the mortality rates and causes of death in an Asian cohort with PD. Method: We enrolled patients ≥ 18 years of age with PD as defined by DSM-IV criteria (N = 1172), who had been admitted to a psychiatric service center in northern Taiwan between 1985 and 2008. By linking with the national mortality database (1985–2008), cases of mortality (n = 156, 13.3{\%}) were obtained. We calculated the standardized mortality ratios (SMRs) to estimate the mortality gap between patients with PD and the general population. Stratified analyses of mortality rates by Axis I psychiatric comorbidity and sex were performed. Results: Borderline PD (n = 391, 33.4{\%}) was the dominant disorder among the subjects. The SMRs for all-cause mortality of PD alone, PD comorbid with non-substance use disorder(non-SUD), and PD comorbid with SUD were 4.46 (95{\%} CI 1.94–6.98), 7.42 (5.99–8.85), and 15.96 (11.07–20.85), respectively. Among the causes of death, the SMR for suicide was the highest (46.92, 95{\%} CI 34.29–59.56). The SMR for suicide in PD patients with comorbid SUD was unusually high (74.23, 95{\%} CI 33.88-114.58). Women had a significant increase in suicide with an SMR of 59.00 (95{\%} CI 37.89–80.11). Men had significant increase in SMRs for cardiovascular disease and gastrointestinal disease. Conclusions: We found significant synergistic effects of PD and SUD on mortality risk. A personality assessment should be mandatory in all clinical settings to prevent premature death and detect SUD early.",
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AU - Chen, Wen Yin

AU - Tsai, Shang Ying

AU - Chen, Pao Huan

AU - Ko, Kai Ting

AU - Chen, Chiao Chicy

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N2 - Purpose: Excessive mortality has been seen in patients with personality disorder (PD), but it has not been well-studied when patients also have other psychiatric comorbidities. This study investigated the mortality rates and causes of death in an Asian cohort with PD. Method: We enrolled patients ≥ 18 years of age with PD as defined by DSM-IV criteria (N = 1172), who had been admitted to a psychiatric service center in northern Taiwan between 1985 and 2008. By linking with the national mortality database (1985–2008), cases of mortality (n = 156, 13.3%) were obtained. We calculated the standardized mortality ratios (SMRs) to estimate the mortality gap between patients with PD and the general population. Stratified analyses of mortality rates by Axis I psychiatric comorbidity and sex were performed. Results: Borderline PD (n = 391, 33.4%) was the dominant disorder among the subjects. The SMRs for all-cause mortality of PD alone, PD comorbid with non-substance use disorder(non-SUD), and PD comorbid with SUD were 4.46 (95% CI 1.94–6.98), 7.42 (5.99–8.85), and 15.96 (11.07–20.85), respectively. Among the causes of death, the SMR for suicide was the highest (46.92, 95% CI 34.29–59.56). The SMR for suicide in PD patients with comorbid SUD was unusually high (74.23, 95% CI 33.88-114.58). Women had a significant increase in suicide with an SMR of 59.00 (95% CI 37.89–80.11). Men had significant increase in SMRs for cardiovascular disease and gastrointestinal disease. Conclusions: We found significant synergistic effects of PD and SUD on mortality risk. A personality assessment should be mandatory in all clinical settings to prevent premature death and detect SUD early.

AB - Purpose: Excessive mortality has been seen in patients with personality disorder (PD), but it has not been well-studied when patients also have other psychiatric comorbidities. This study investigated the mortality rates and causes of death in an Asian cohort with PD. Method: We enrolled patients ≥ 18 years of age with PD as defined by DSM-IV criteria (N = 1172), who had been admitted to a psychiatric service center in northern Taiwan between 1985 and 2008. By linking with the national mortality database (1985–2008), cases of mortality (n = 156, 13.3%) were obtained. We calculated the standardized mortality ratios (SMRs) to estimate the mortality gap between patients with PD and the general population. Stratified analyses of mortality rates by Axis I psychiatric comorbidity and sex were performed. Results: Borderline PD (n = 391, 33.4%) was the dominant disorder among the subjects. The SMRs for all-cause mortality of PD alone, PD comorbid with non-substance use disorder(non-SUD), and PD comorbid with SUD were 4.46 (95% CI 1.94–6.98), 7.42 (5.99–8.85), and 15.96 (11.07–20.85), respectively. Among the causes of death, the SMR for suicide was the highest (46.92, 95% CI 34.29–59.56). The SMR for suicide in PD patients with comorbid SUD was unusually high (74.23, 95% CI 33.88-114.58). Women had a significant increase in suicide with an SMR of 59.00 (95% CI 37.89–80.11). Men had significant increase in SMRs for cardiovascular disease and gastrointestinal disease. Conclusions: We found significant synergistic effects of PD and SUD on mortality risk. A personality assessment should be mandatory in all clinical settings to prevent premature death and detect SUD early.

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KW - Standard mortality ratio

KW - Substance use disorder

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