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.
Eur Arch Psychiatry Clin Neurosci. 2024 Feb;274(1):139-149. doi: 10.1007/s00406-023-01655-1. Epub 2023 Aug 19.
Personality disorders (PDs) are associated with high levels of societal costs, regardless of whether a single PD or a broad range of PDs have been studied. However, research on the relative contribution of specific PD-types on societal costs is limited. The aim of this study was to explore the possible contributions of the individual DSM-5 categories of PDs on the level of societal costs and its components (health service costs and productivity loss), while controlling for the impact of comorbid mental health and substance use disorders on these outcomes. Participants (n = 798) 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 to treatment in the time-period 2017-2020. Costs were assessed using a structured interview covering the 6-month period prior to assessment. Diagnoses were determined by semi-structured diagnostic interviews (SCID-5-PD and M.I.N.I.). Statistics included multiple regression analyses. The main result was that no specific PD had a unique contribution to the high level of societal costs generally found among treatment-seeking patients with PDs. Borderline PD (BPD) was the only PD with significantly higher health service costs than the other PDs, while BPD, avoidant PD, and unspecified PD were independently associated with enhanced productivity loss. The differential cost-effects of specific PDs on the cost components were small. Several comorbid mental health and substance use disorders were significant contributors to costs, irrespective of PD status. The results underscore the importance of developing and implementing effective treatments for a broader range of PDs, to reduce the high levels of societal costs associated with all PDs.
人格障碍（PDs）与高额的社会成本相关，无论研究的是单一 PD 还是广泛 PD 范围。然而，关于特定 PD 类型对社会成本的相对贡献的研究有限。本研究旨在探讨 DSM-5 人格障碍分类个体类别对社会成本水平及其组成部分（医疗服务成本和生产力损失）的可能贡献，同时控制共病心理健康和物质使用障碍对这些结果的影响。参与者（n=798）来自挪威人格障碍网络的质量登记处-专业精神卫生服务中 PD 治疗单位的合作。这些患者在 2017-2020 年期间被转诊接受治疗。使用涵盖评估前 6 个月的结构化访谈评估成本。通过半结构化诊断访谈（SCID-5-PD 和 M.I.N.I.）确定诊断。统计学分析包括多元回归分析。主要结果是，没有特定的 PD 对寻求 PD 治疗的患者中普遍存在的高水平社会成本有独特的贡献。边缘型人格障碍（BPD）是唯一与医疗服务成本显著高于其他 PD 的 PD，而 BPD、回避型人格障碍和未指定型人格障碍与生产力损失增加独立相关。特定 PD 对成本组成部分的差异成本效应较小。几种共病心理健康和物质使用障碍是成本的重要贡献者，无论 PD 状态如何。研究结果强调了开发和实施更广泛 PD 有效治疗的重要性，以降低与所有 PD 相关的高额社会成本。
