Suicide risk in primary care patients diagnosed with a personality disorder: a nested case control study

BMC Family Practice

Research Article

Pearl L. H. Mok¹  Jenny Shaw¹  Louis Appleby¹  Kirsten Windfuhr¹  Roger T. Webb¹  David While¹  Michael Doyle²  Darren M. Ashcroft³  Carolyn A. Chew-Graham⁴  Evangelos Kontopantelis⁵ 

[1] Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England;Centre for Mental Health and Safety, Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, England;South West Yorkshire Partnership NHS Foundation Trust, Wakefield, England;Centre for Pharmacoepidemiology and Drug Safety, Manchester Pharmacy School, University of Manchester, Manchester, England;NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, England;Research Institute, Primary Care and Health Sciences, Keele University, Keele, England;West Midlands Collaboration for Leadership in Applied Health Research and Care (CLAHRC), Keele, England;The Farr Institute for Health Informatics Research, University of Manchester, Manchester, England;NIHR School for Primary Care Research, University of Manchester, Manchester, England;

关键词: Personality disorder;    Borderline personality disorder;    Suicide;    Alcohol misuse;    Mental illness;    Primary care;    General practitioners;    Clinical Practice Research Datalink;   

DOI  :  10.1186/s12875-016-0479-y

 received in 2015-11-17, accepted in 2016-07-12,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundPersonality disorder (PD) is associated with elevated suicide risk, but the level of risk in primary care settings is unknown. We assessed whether PD among primary care patients is linked with a greater elevation in risk as compared with other psychiatric diagnoses, and whether the association is modified by gender, age, type of PD, and comorbid alcohol misuse.MethodsUsing data from the UK Clinical Practice Research Datalink, 2384 suicides were matched to 46,899 living controls by gender, age, and registered practice. Prevalence of PD, other mental disorders, and alcohol misuse was calculated for cases and controls separately and conditional logistic regression models were used to estimate exposure odds ratios. We also fitted gender interaction terms and formally tested their significance, and estimated gender age-specific effects.ResultsWe found a 20-fold increase in suicide risk for patients with PD versus no recorded psychiatric disorder, and a four-fold increase versus all other psychiatric illnesses combined. Borderline PD and PD with comorbid alcohol misuse were associated with a 37- and 45-fold increased risk, respectively, compared with those with no psychiatric disorders. Relative risks were higher for female than for male patients with PD. Significant risks associated with PD diagnosis were identified across all age ranges, although the greatest elevations were in the younger age ranges, 16–39 years.ConclusionsThe large elevation in suicide risk among patients diagnosed with PD and comorbid alcohol misuse is a particular concern. GPs have a potentially key role to play in intervening with patients diagnosed with PD, particularly in the presence of comorbid alcohol misuse, which may help reduce suicide risk. This would mean working with specialist care, agreed clinical pathways and availability of services for comorbidities such as alcohol misuse, as well as opportunities for GPs to develop specific clinical skills.

【 授权许可】

CC BY   
© The Author(s). 2016