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Personality disorders and cause-specific mortality: a nationwide study of 2 million adolescents

Published online by Cambridge University Press:  14 October 2020

Shmuel Tiosano Open the ORCID record for Shmuel Tiosano [Opens in a new window] ,
Lucian Laur ,
Amir Tirosh ,
Ariel Furer ,
Arnon Afek ,
Noam Fink ,
Estela Derazne ,
Dorit Tzur ,
Eyal Fruchter  and
Ariel Ben-Yehuda
...Show all authors
Shmuel Tiosano
Affiliation:
Department of Medicine ‘B’ and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Lucian Laur
Affiliation:
Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel
Amir Tirosh
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
Ariel Furer
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel
Arnon Afek
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel Central Management, Chaim Sheba Medical Center, Tel Hashomer, Israel
Noam Fink
Affiliation:
Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel
Estela Derazne
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel
Dorit Tzur
Affiliation:
Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel
Eyal Fruchter
Affiliation:
Department of psychiatry, Rambam Medical Center, Technion-Israel Institute of Technology, Haifa, Israel
Ariel Ben-Yehuda
Affiliation:
Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel
Tarif Bader
Affiliation:
Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel
Howard Amital
Affiliation:
Department of Medicine ‘B’ and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Moyses Szklo
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Mark Weiser
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel Department of psychiatry, Sheba Medical Center, Tel-Hashomer, Israel
Gilad Twig*
Affiliation:
Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
*
Author for correspondence: Gilad Twig, E-mail: [email protected]
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Abstract

Background

Personality disorders are prevalent in 6–10% of the population, but their risk for cause-specific mortality is unclear. The aim of the study was to assess the association between personality disorders diagnosed in late adolescence and all-cause as well as cause-specific (cardiovascular-related, external-related) mortality.

Methods

We performed a longitudinal study on a historical prospective cohort based on nationwide screening prior to recruitment to the Israeli army. The study participants were 16–19-year-old persons who attended the army screening (medical and cognitive, including screening for psychiatric disorders) between 1967 and 2006. Participants were followed from 1967 till 2011.

Results

The study included 2 051 606 subjects, of whom 1 229 252 (59.9%) were men and 822 354 (40.1%) were women, mean age 17.36 years. There were 55 508 (4.5%) men and 8237 (1.0%) women diagnosed with personality disorders. The adjusted hazard ratio (HRs) for coronary, stroke, cardiovascular, external-related causes and all-cause mortality among men with personality disorders were 1.34 (1.03–1.74), 1.82 (1.20–2.76), 1.45 (1.23–1.71), 1.41 (1.30–1.53) and 1.44 (1.36–1.51), respectively. The absolute rate difference for all-cause mortality was 56.07 and 13.19 per 105 person-years among men and women, respectively. Among women with personality disorders, the adjusted HRs for external-related causes and all-cause mortality were 2.74 (1.87–4.00) and 2.01 (1.56–2.58). Associations were already evident within 10 years of follow-up.

Conclusions

Personality disorder in late adolescence is associated with increased risk of cardiovascular, external- and all-cause mortality. Increased cardiovascular mortality is evident before the age of 40 years and may point to the importance of lifestyle education already in youth.

Keywords

Cardiovascular risk factorscohortpersonality disordersprognosissurvival
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 9 , July 2022 , pp. 1746 - 1754
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Copyright
Copyright © The Author(s) 2020. Published by Cambridge University Press.

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References

American Psychiatric Association (Eds.). (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington, DC: American Psychiatric Association.Google Scholar
Björkenstam, E., Björkenstam, C., Holm, H., Gerdin, B., & Ekselius, L. (2015). Excess cause-specific mortality in in-patient-treated individuals with personality disorder: 25-year nationwide population-based study. British Journal of Psychiatry, 207(04), 339–345. https://doi.org/10.1192/bjp.bp.114.149583.CrossRefGoogle ScholarPubMed
Black, D. W., Baumgard, C. H., Bell, S. E., & kao, C. (1996). Death rates in 71 men with antisocial personality disorder: A comparison with general population mortality. Psychosomatics, 37(2), 131–136. https://doi.org/10.1016/S0033-3182(96)71579-7.CrossRefGoogle ScholarPubMed
Black, D. W., Blum, N., Pfohl, B., & Hale, N. (2004). Suicidal behavior in borderline personality disorder: Prevalence, risk factors, prediction, and prevention. Journal of Personality Disorders, 18(3: Special issue), 226–239.CrossRefGoogle ScholarPubMed
Chabrol, H., Montovany, A., Chouicha, K., Callahan, S., & Mullet, E. (2001). Frequency of borderline personality disorder in a sample of French high school students. The Canadian Journal of Psychiatry, 46(9), 847–849. https://doi.org/10.1177/070674370104600909.CrossRefGoogle Scholar
Chen, H., Cohen, P., Crawford, T. N., Kasen, S., Guan, B., & Gorden, K. (2009). Impact of early adolescent psychiatric and personality disorder on long-term physical health: A 20-year longitudinal follow-up study. Psychological Medicine, 39(5), 865–874. https://doi.org/10.1017/S0033291708004182.CrossRefGoogle ScholarPubMed
Chen, L., Huang, Y., Kasen, S., Skodol, A., Cohen, P., & Chen, H. (2015). Impact of adolescent personality disorders on obesity 17 years later. Psychosomatic Medicine, 77(8), 921–926. https://doi.org/10.1097/PSY.0000000000000228.CrossRefGoogle ScholarPubMed
Chesney, E., Goodwin, G. M., & Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: A meta-review. World Psychiatry, 13(2), 153–160.CrossRefGoogle ScholarPubMed
Fok, M. L.-Y., Hayes, R. D., Chang, C.-K., Stewart, R., Callard, F. J., & Moran, P. (2012). Life expectancy at birth and all-cause mortality among people with personality disorder. Journal of Psychosomatic Research, 73(2), 104–107. https://doi.org/10.1016/j.jpsychores.2012.05.001.CrossRefGoogle ScholarPubMed
Fok, M. L.-Y., Stewart, R., Hayes, R. D., & Moran, P. (2014). Predictors of natural and unnatural mortality among patients with personality disorder: Evidence from a large UK case register. PLOS ONE, 9(7), e100979. https://doi.org/10.1371/journal.pone.0100979.CrossRefGoogle ScholarPubMed
Gal, R. (1986). The selection, classification and placement process. In Contributions in military studies: Vol. 52. A portrait of the Israeli soldier. New York: Greenwood Pr.Google Scholar
Goldstein, A., Haelyon, U., Krolik, E., & Sack, J. (2001). Comparison of body weight and height of Israeli schoolchildren with the Tanner and Centers for Disease Control and Prevention growth charts. Pediatrics, 108(6), E108.CrossRefGoogle ScholarPubMed
Gregg, E. W., Cheng, Y. J., Srinivasan, M., Lin, J., Geiss, L. S., Albright, A. L., & Imperatore, G. (2018). Trends in cause-specific mortality among adults with and without diagnosed diabetes in the USA: An epidemiological analysis of linked national survey and vital statistics data. The Lancet, 391(10138), 2430–2440. https://doi.org/10.1016/S0140-6736(18)30314-3.CrossRefGoogle ScholarPubMed
Hanley, J. A. (2003). Statistical analysis of correlated data using generalized estimating equations: An orientation. American Journal of Epidemiology, 157(4), 364–375. https://doi.org/10.1093/aje/kwf215.CrossRefGoogle Scholar
Henriksson, M., Nyberg, J., Schiöler, L., Hensing, G., Kuhn, G. H., Söderberg, M., … Åberg, M. (2018). Cause-specific mortality in Swedish males diagnosed with non-psychotic mental disorders in late adolescence: A prospective population-based study. Journal of Epidemiology and Community Health, 72(7), 582–588. https://doi.org/10.1136/jech-2018-210461.CrossRefGoogle ScholarPubMed
Holmstrand, C., Bogren, M., Mattisson, C., & Brådvik, L. (2015). Long-term suicide risk in no, one or more mental disorders: The Lundby Study 1947–1997. Acta Psychiatrica Scandinavica, 132(6), 459–469. https://doi.org/10.1111/acps.12506.CrossRefGoogle ScholarPubMed
Johnson, J. G., Cohen, P., Kasen, S., Skodol, A. E., & Oldham, J. M. (2008). Cumulative prevalence of personality disorders between adolescence and adulthood. Acta Psychiatrica Scandinavica, 118(5), 410–413. https://doi.org/10.1111/j.1600-0447.2008.01231.x.CrossRefGoogle ScholarPubMed
Johnson, J. G., Cohen, P., Skodol, A. E., Oldham, J. M., Kasen, S., & Brook, J. S. (1999). Personality disorders in adolescence and risk of major mental disorders and suicidality during adulthood. Archives of General Psychiatry, 56(9), 805–811. https://doi.org/10.1001/archpsyc.56.9.805.CrossRefGoogle ScholarPubMed
Jousilahti, P., Tuomilehto, J., Vartiainen, E., Eriksson, J., & Puska, P. (2000). Relation of adult height to cause-specific and total mortality: A prospective follow-up study of 31, 199 middle-aged men and women in Finland. American Journal of Epidemiology, 151(11), 1112–1120. https://doi.org/10.1093/oxfordjournals.aje.a010155.CrossRefGoogle ScholarPubMed
Kahl, K. G., Greggersen, W., Schweiger, U., Cordes, J., Correll, C. U., Frieling, H., … Moebus, S. (2013). Prevalence of the metabolic syndrome in patients with borderline personality disorder: Results from a cross-sectional study. European Archives of Psychiatry and Clinical Neuroscience, 263(3), 205–213. https://doi.org/10.1007/s00406-012-0339-2.CrossRefGoogle ScholarPubMed
Kuczmarski, R. J., Ogden, C. L., Guo, S. S., Grummer-Strawn, L. M., Flegal, K. M., Mei, Z., … Johnson, C. L. (2002). 2000 CDC Growth Charts for the United States: Methods and development. Vital and Health Statistics. Series 11, Data from the National Health Survey (246), 1–190. PMID: 12043359.Google ScholarPubMed
Newton-Howes, G., Clark, L. A., & Chanen, A. (2015). Personality disorder across the life course. The Lancet, 385(9969), 727–734.CrossRefGoogle ScholarPubMed
Nordentoft, M., Wahlbeck, K., Hällgren, J., Westman, J., Ösby, U., Alinaghizadeh, H., … Laursen, T. M. (2013). Excess mortality, causes of death and life expectancy in 270 770 patients with recent onset of mental disorders in Denmark, Finland and Sweden. PLOS ONE, 8(1), e55176. https://doi.org/10.1371/journal.pone.0055176.CrossRefGoogle ScholarPubMed
Olesen, J., Gustavsson, A., Svensson, M., Wittchen, H.-U., Jönsson, B., on behalf of the CDBE2010 study group, & the European Brain Council (2012). The economic cost of brain disorders in Europe: Economic cost of brain disorders in Europe. European Journal of Neurology, 19(1), 155–162. https://doi.org/10.1111/j.1468-1331.2011.03590.x.CrossRefGoogle ScholarPubMed
Pérez-Piñar, M., Mathur, R., Foguet, Q., Ayis, S., Robson, J., & Ayerbe, L. (2016). Cardiovascular risk factors among patients with schizophrenia, bipolar, depressive, anxiety, and personality disorders. European Psychiatry, 35, 8–15. https://doi.org/10.1016/j.eurpsy.2016.02.004.CrossRefGoogle ScholarPubMed
Rabinowitz, J., Bromet, E. J., Lavelle, J., Carlson, G., Kovasznay, B., & Schwartz, J. E. (1998). Prevalence and severity of substance use disorders and onset of psychosis in first-admission psychotic patients. Psychological Medicine, 28(6), 1411–1419.CrossRefGoogle ScholarPubMed
Samuels, J. (2011). Personality disorders: Epidemiology and public health issues. International Review of Psychiatry, 23(3), 223–233. https://doi.org/10.3109/09540261.2011.588200.CrossRefGoogle ScholarPubMed
Samuels, J., Eaton, W. W., Bienvenu, O. J., Brown, C. H., Costa, P. T., & Nestadt, G. (2002). Prevalence and correlates of personality disorders in a community sample. The British Journal of Psychiatry: The Journal of Mental Science, 180, 536–542.CrossRefGoogle Scholar
Statistical abstract of Israel. (2012). Retrieved from http://www.cbs.gov.il/shnaton63/st03_24.pdf.Google Scholar
Twig, G., Afek, A., Shamiss, A., Derazne, E., Landau Rabbi, M., Tzur, D., … Tirosh, A. (2014a). Adolescence BMI and trends in adulthood mortality: A study of 2.16 million adolescents. The Journal of Clinical Endocrinology and Metabolism, 99(6), 2095–2103. https://doi.org/10.1210/jc.2014-1213.CrossRefGoogle Scholar
Twig, G., Gluzman, I., Tirosh, A., Gerstein, H. C., Yaniv, G., Afek, A., … Cukierman-Yaffe, T. (2014b). Cognitive function and the risk for diabetes among young men. Diabetes Care, 37(11), 2982–2988. https://doi.org/10.2337/dc14-0715.CrossRefGoogle Scholar
Twig, G., Reichman, B., Afek, A., Derazne, E., Hamiel, U., Furer, A., … Pinhas-Hamiel, O. (2018a). Severe obesity and cardio-metabolic comorbidities: A nationwide study of 2.8 million adolescents. International Journal of Obesity, 43, 1391–1399. https://doi.org/10.1038/s41366-018-0213-z.CrossRefGoogle Scholar
Twig, G., Tirosh, A., Derazne, E., Haklai, Z., Goldberger, N., Afek, A., … Cukierman-Yaffe, T. (2018b). Cognitive function in adolescence and the risk for premature diabetes and cardiovascular mortality in adulthood. Cardiovascular Diabetology, 17(1), 154. https://doi.org/10.1186/s12933-018-0798-5.CrossRefGoogle Scholar
Twig, G., Yaniv, G., Levine, H., Leiba, A., Goldberger, N., Derazne, E., … Kark, J. D. (2016). Body-Mass Index in 2.3 million adolescents and cardiovascular death in adulthood. New England Journal of Medicine, 374(25), 2430–2440. https://doi.org/10.1056/NEJMoa1503840.CrossRefGoogle ScholarPubMed
Verheul, R. (2001). Co-morbidity of personality disorders in individuals with substance use disorders. European Psychiatry, 16(5), 274–282. https://doi.org/10.1016/S0924-9338(01)00578-8.CrossRefGoogle ScholarPubMed
Weiser, M., Reichenberg, A., Rabinowitz, J., Kaplan, Z., Mark, M., Bodner, E., … Davidson, M. (2001). Association between nonpsychotic psychiatric diagnoses in adolescent males and subsequent onset of schizophrenia. Archives of General Psychiatry, 58(10), 959–964.CrossRefGoogle ScholarPubMed
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