Department of Psychiatry, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, the Netherlands.
Department of Clinical & Life Span Psychology, Vrije Universiteit Brussel, Brussels, Belgium.
BMC Psychiatry. 2022 Mar 24;22(1):214. doi: 10.1186/s12888-022-03857-8.
Although personality disorders are common and consequential, they are largely ignored in geriatric mental healthcare. We examined the relative contributions of different aspects of personality disorders and comorbid mental disorders to the impairment of mental wellbeing in older adults.
Baseline data were used of 138 patients who participated in a randomized controlled trial on schema therapy for geriatric mental health outpatients with a full or subthreshold cluster B or C personality disorder. Personality was assessed according to both the categorical and dimensional model of DSM-5. Aspects of mental wellbeing assessed were; psychological distress, positive mental health, subjective health, and life satisfaction. The current study uses baseline data of the RCT to examine the associations between different aspects of personality pathology and mental wellbeing by multivariate regression analysis, controlling for age, sex, level of education, and number of chronic somatic illnesses.
The vast majority of patients (79.0%) had one or more mental disorders in addition to personality disorder. Personality pathology was responsible for the core of the mental health burden experienced by patients, and negated the influence of co-occurring mental disorders when entered subsequently in multivariate analysis. Personality dimensions proved to be highly predictive of mental wellbeing, and this contrasted with absence of influence of personality disorder diagnosis. Although the personality functioning dimensions - and in particular Identity integration (large effect size with partial eta-squared = 0.36) - were the primary predictors of mental wellbeing, personality trait dimensions added significant predictive value to that (Disinhibition 0.25 and Negative affect 0.24).
Personality disorders seriously affect the mental wellbeing of patients, and this overshadows the impact of comorbid mental disorders. In particular personality functioning and pathological traits of the Alternative Model of Personality Disorders (AMPD) of DSM-5 contribute to this impact on mental wellbeing. Alertness for and treatment of personality disorders in geriatric mental healthcare seems warranted.
尽管人格障碍很常见且后果严重，但在老年精神保健中，它们在很大程度上被忽视了。我们研究了人格障碍的不同方面以及合并的精神障碍对老年人心理健康受损的相对贡献。
本研究使用了 138 名参加针对老年精神卫生门诊患者的图式治疗的随机对照试验的基线数据，这些患者患有全或亚阈值 B 组或 C 组人格障碍。人格根据 DSM-5 的分类和维度模型进行评估。评估的心理健康方面包括：心理困扰、积极的心理健康、主观健康和生活满意度。本研究使用 RCT 的基线数据，通过多元回归分析，控制年龄、性别、教育程度和慢性躯体疾病数量，来检查不同人格病理方面与心理健康之间的关系。
绝大多数患者（79.0%）除了人格障碍外，还有一种或多种精神障碍。人格病理是患者所经历的心理健康负担的核心，当随后在多元分析中纳入共病精神障碍时，它否定了其影响。人格维度被证明对心理健康有高度预测性，这与人格障碍诊断的缺乏影响形成对比。尽管人格功能维度——特别是身份整合（具有部分 eta 平方的大效应量=0.36）——是心理健康的主要预测因素，但人格特质维度也增加了显著的预测价值（抑制 0.25 和负性情绪 0.24）。
人格障碍严重影响患者的心理健康，这超过了共病精神障碍的影响。特别是 DSM-5 的替代人格障碍模型（AMPD）的人格功能和病理特征对此心理健康的影响有贡献。在老年精神保健中，对人格障碍的警惕和治疗似乎是必要的。
