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

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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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Acknowledgements

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.

Funding

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.

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Authors and Affiliations

  1. Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan, Republic of China

    Chian-Jue Kuo & Wen-Yin Chen

  2. Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Chian-Jue Kuo, Shang-Ying Tsai & Chiao-Chicy Chen

  3. Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan

    Chian-Jue Kuo, Shang-Ying Tsai, Pao-Huan Chen & Chiao-Chicy Chen

  4. Department and Graduate Institute of Forensic Medicine, National Taiwan University School of Medicine, Taipei, Taiwan

    Chian-Jue Kuo & Chiao-Chicy Chen

  5. Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University College of Public Health, Taipei, Taiwan

    Wen-Yin Chen

  6. Department of Psychiatry, Mackay Memorial Hospital and Taipei Medical University, 92 Section II, Chung-Shang North Road, 104, Taipei, Taiwan

    Kai-Ting Ko & Chiao-Chicy Chen

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  1. Chian-Jue Kuo
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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.

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Correspondence to Chiao-Chicy Chen.

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Kuo, CJ., Chen, WY., Tsai, SY. et al. Excessive mortality and causes of death among patients with personality disorder with comorbid psychiatric disorders. Soc Psychiatry Psychiatr Epidemiol 54, 121–130 (2019). https://doi.org/10.1007/s00127-018-1587-x

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  • DOI: https://doi.org/10.1007/s00127-018-1587-x

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