Department of Child and Adolescent Psychiatry, Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway.
Network for Personality Disorder, Section for Personality Psychiatry and specialized treatments, Department for National and Regional Functions, Division of Mental health and Addiction, Oslo University Hospital, Oslo, Norway.
J Clin Psychol. 2023 Aug;79(8):1752-1769. doi: 10.1002/jclp.23504. Epub 2023 Mar 14.
There is a relatively small body of research on the cost-of-illness of personality disorders (PDs). Most studies only include borderline PD. The aim of this study was to investigate mean societal costs, including its components, (direct) health service costs and (indirect) productivity loss, among treatment-seeking patients with the broad range of all PDs according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
Cross-sectional data from 911 patients diagnosed with at least 1 PD were retrieved from the quality register of the Norwegian Network for Personality Disorders-a collaboration of PD treatment units within specialist mental health services. The patients were referred in the time period 2017-2020. Estimation of costs was based on a bottom-up approach, using information from a structured interview covering the 6-month period before assessment, whereas unit costs were retrieved from public reports, public records, or public agencies. The human capital approach was used to calculate productivity loss. Diagnoses were determined by semi-structured diagnostic interviews (Structured Clinical Interview for DSM-5-PD [SCID-5-PD]).
The mean societal costs were €20.260 during the 6-month period before specialized treatment. The largest cost component was productivity loss (65%), whereas health service costs constituted 35%. The main contributors to societal costs from the underlying health service cost components were inpatient treatment (20.5%) and individual outpatient treatment (10.5%).
Societal costs were substantial among treatment-seeking patients with the broad range of DSM-5 PDs, comparable to the societal costs of schizophrenia, and significantly higher than the societal costs of both depression and anxiety disorders. The cost estimates converged with recent, register-based cost-of-illness studies of different PDs but exceeded previous findings from other bottom-up studies. Furthermore, the results underscore the importance of implementing effective and specialized treatment for patients with a broad range of PDs, not only to alleviate individual suffering but also to reduce the level of societal costs. The emphasis on productivity loss as a main contributor to the overall societal costs is substantiated, hence underlining the relevance of interventions focusing on improving occupational functioning.
有关人格障碍（PD）疾病经济负担的研究相对较少。大多数研究仅包括边缘型 PD。本研究旨在根据《精神障碍诊断与统计手册》第五版（DSM-5），调查广泛 PD 患者的社会总成本，包括其组成部分（直接）卫生服务成本和（间接）生产力损失。
从挪威人格障碍网络的质量登记处检索到横断面数据，该网络是专家心理健康服务中 PD 治疗单位的合作组织，共纳入 911 名至少诊断为 1 种 PD 的患者。患者在 2017 年至 2020 年期间被转诊。成本估计基于自下而上的方法，使用从评估前 6 个月的结构化访谈中获取的信息，而单位成本则从公共报告、公共记录或公共机构中获取。使用人力资本法计算生产力损失。诊断由半结构化诊断访谈（DSM-5-PD 的结构性临床访谈 [SCID-5-PD]）确定。
在专门治疗前的 6 个月期间，社会总成本为 20260 欧元。最大的成本组成部分是生产力损失（65%），而卫生服务成本占 35%。对社会总成本有较大贡献的基础卫生服务成本组成部分是住院治疗（20.5%）和个体门诊治疗（10.5%）。
在寻求治疗的广泛 DSM-5 PD 患者中，社会成本相当高，与精神分裂症的社会成本相当，明显高于抑郁障碍和焦虑障碍的社会成本。成本估计与最近不同 PD 的基于登记的疾病经济负担研究一致，但超过了之前其他自下而上研究的发现。此外，研究结果强调了为广泛 PD 患者实施有效和专门治疗的重要性，不仅可以减轻个人痛苦，还可以降低社会成本水平。强调生产力损失是总体社会成本的主要贡献者是合理的，因此强调了关注改善职业功能的干预措施的相关性。
