双相障碍与人格障碍共病在美国的流行情况：自杀率及物质滥用的影响。

Co-occurrence of bipolar disorder and personality disorders in the United States: Prevalence, suicidality, and the impact of substance abuse.

机构信息

Greater Manchester Mental Health National Health Service Foundation Trust, UK.

University of Ibadan, College of Medicine, Oyo State, Nigeria.

出版信息

J Affect Disord. 2024 Jan 15;345:1-7. doi: 10.1016/j.jad.2023.10.087. Epub 2023 Oct 15.

DOI:10.1016/j.jad.2023.10.087

PMID:37848089

Abstract

BACKGROUND

This study investigates prevalence rates of specific personality disorders (PDs) in individuals with bipolar disorder (BD) and their impact on substance abuse and suicidality, addressing existing gaps in the literature.

METHODS

Using Nationwide Inpatient Sample data (2016-2020), adult hospitalizations for BD with coexisting PDs were analyzed. Study variables were defined using ICD-10-CM codes. Prevalence of PD were reported as cases per 100,000 BD admissions. Regression models assessed the association between substance abuse and suicidality.

RESULTS

About 993,000 admissions for BD were analyzed. The cohort was predominantly Caucasian (70.5 %) with higher female representation (54.5 %). The mean age was 41 years. 89.4 % of individuals had a Charlson Comorbidity Index score ≤ 1. The most common diagnostic subtype was manic episode of BD with or without psychotic features (32.3 %). Coexisting PDs were observed in 12.2 % of the population, with borderline PD (8.2 %) and antisocial PD (2.6 %) being most prevalent. Substance abuse was common (44.8 %), with cannabis (23.8 %), alcohol (19.4 %), cocaine (10.5 %), and opioids (9.6 %) being most reported. Substance abuse was higher in individuals with BD and PD (50 %) compared to BD alone (44.1 %). 596 suicide attempts were recorded (60 per 100,000 BD admissions). Substance abuse and coexisting PD in bipolar individuals elevated the likelihood of attempts (P < 0.001).

LIMITATIONS

Use of administrative data (retrospective, inpatient); treatment not studied.

CONCLUSION

The study reveals a notable prevalence of PDs in individuals with BD, with increased likelihood of substance abuse and suicide attempts in those with coexisting BD and PD compared to BD alone.

摘要

背景

本研究调查了双相情感障碍（BD）患者中特定人格障碍（PD）的患病率及其对物质滥用和自杀的影响，填补了该领域文献的空白。

方法

使用全国住院患者样本数据（2016-2020 年），分析了同时患有 PD 的 BD 成人住院病例。使用 ICD-10-CM 代码定义研究变量。PD 的患病率以每 10 万例 BD 入院的病例数报告。回归模型评估了物质滥用和自杀之间的关联。

结果

共分析了约 99.3 万例 BD 入院病例。该队列以白种人为主（70.5%），女性比例较高（54.5%）。平均年龄为 41 岁。89.4%的患者Charlson 合并症指数评分≤1。最常见的诊断亚型是伴有或不伴有精神病特征的双相情感障碍躁狂发作（32.3%）。该人群中共有 12.2%存在共患 PD，其中边缘型 PD（8.2%）和反社会型 PD（2.6%）最为常见。物质滥用较为常见（44.8%），最常报告的物质包括大麻（23.8%）、酒精（19.4%）、可卡因（10.5%）和阿片类药物（9.6%）。与单纯 BD 患者（44.1%）相比，BD 合并 PD 患者的物质滥用率更高（50%）。共记录到 596 例自杀未遂（每 10 万例 BD 入院 60 例）。双相情感障碍患者中物质滥用和共患 PD 增加了自杀未遂的可能性（P<0.001）。