Powers Abigail, Strube Michael J, Oltmanns Thomas F
Department of Psychiatry, Emory University, Atlanta, GA.
Department of Psychology, Washington University in St. Louis, St. Louis, MO.
Am J Geriatr Psychiatry. 2014 Dec;22(12):1478-86. doi: 10.1016/j.jagp.2013.10.009. Epub 2013 Oct 27.
Personality pathology is associated with many negative health outcomes in young adulthood, including overutilization of healthcare resources. It is unclear, however, what the relation between personality pathology and medical resource utilization is as individuals age and develop new physical health problems.
The present study examined whether personality disorder (PD) features were related to greater medical resource utilization in a sample of 1,630 community-dwelling participants, aged 55-64 years. PD features and health status were measured at baseline; medical resource utilization and new physical health problems were measured at four 6-month follow-up assessments. Multilevel modeling analyses tested associations between number of physical health problems and PD features in medical resource use over time.
Greater number of physical health problems significantly predicted higher medical resource utilization. The results also showed that many PD features were related to higher reported medical resource utilization independent of health status and sociodemographic variables. Schizoid and schizotypal PD features were associated with less reported medical resource utilization. When all PDs were included in the model together, dependent, antisocial, histrionic, and narcissistic PD features remained predictive of higher medical resource utilization.
Personality pathology remains a relevant predictor of greater medical resource utilization into later adulthood and should be considered an important risk factor when trying to determine ways to reduce costly overuse of healthcare resources among older adults.
人格病理学与青年期许多负面健康结果相关，包括医疗资源的过度使用。然而，随着个体年龄增长并出现新的身体健康问题，人格病理学与医疗资源利用之间的关系尚不清楚。
本研究在1630名年龄在55 - 64岁的社区居住参与者样本中，检验人格障碍（PD）特征是否与更多的医疗资源利用相关。在基线时测量PD特征和健康状况；在四次为期6个月的随访评估中测量医疗资源利用和新出现的身体健康问题。多层次建模分析测试了随着时间推移，身体健康问题数量与医疗资源使用中的PD特征之间的关联。
更多的身体健康问题显著预测了更高的医疗资源利用。结果还表明，许多PD特征与更高的报告医疗资源利用相关，且独立于健康状况和社会人口统计学变量。分裂样和分裂型PD特征与较少的报告医疗资源利用相关。当所有PD一起纳入模型时，依赖型、反社会型、表演型和自恋型PD特征仍然可预测更高的医疗资源利用。
人格病理学在成年后期仍然是更多医疗资源利用的相关预测因素，在试图确定减少老年人医疗资源昂贵的过度使用的方法时，应将其视为一个重要的风险因素。
