Social Psychiatry and Psychiatric Epidemiology

, Volume 54, Issue 1, pp 121–130 | Cite as

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 ChenEmail author
Original Paper



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.


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.


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.


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.


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



The authors thank Yin Chi Chen, BS, with the Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, for data management and help with the statistical analyses. Ms. Chen declares that she has no competing interests. The authors thank Formosa Medical Editors for assistance with manuscript preparation.

Author contributions

K and CCC conceived and designed the study. CCC acquired the data. K performed the statistical analysis. C provided administrative and material support. CCC, WYC, and K drafted the manuscript. T and PHC made critical revisions to the manuscript for important intellectual content, and K and CCC supervised the study.


This research was supported by grants from the Ministry of Science and Technology, Taiwan (NSC 102-2628-B-532-001-MY3 and MOST 105-2314-B-532-006-MY3) and Taipei City Hospital (10001-62-005, 10501-62-015, and 10601-62-002). The funding sources had no involvement in the study design, data collection, analysis, interpretation of data, writing of the report, or the decision to submit the paper for publication.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

127_2018_1587_MOESM1_ESM.doc (80 kb)
Supplementary material 1 (DOC 80 KB)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Chian-Jue Kuo
    • 1
    • 2
    • 3
    • 4
  • Wen-Yin Chen
    • 1
    • 5
  • Shang-Ying Tsai
    • 2
    • 3
  • Pao-Huan Chen
    • 3
  • Kai-Ting Ko
    • 6
  • Chiao-Chicy Chen
    • 2
    • 3
    • 4
    • 6
    Email author
  1. 1.Taipei City Psychiatric CenterTaipei City HospitalTaipeiTaiwan, Republic of China
  2. 2.Department of Psychiatry, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  3. 3.Psychiatric Research CenterTaipei Medical University HospitalTaipeiTaiwan
  4. 4.Department and Graduate Institute of Forensic MedicineNational Taiwan University School of MedicineTaipeiTaiwan
  5. 5.Graduate Institute of Epidemiology and Preventive MedicineNational Taiwan University College of Public HealthTaipeiTaiwan
  6. 6.Department of PsychiatryMackay Memorial Hospital and Taipei Medical UniversityTaipeiTaiwan

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