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Research article:
Suicide risk in primary care patients diagnosed with personality disorder: a nested case control study
Reference:
Michael Doyle; David While; Pearl L.H. Mok; Kirsten Windfuhr; Darren M. Ashcroft; Evangelos Kontopantelis; Carolyn Chew-Graham; Louis Appleby; Jenny Shaw; Roger T. Webb (2015) Suicide risk in primary care patients diagnosed with personality disorder: a nested case control study. BMC Family Practice, doi:
- Link to article
- Abstract
- Background: Personality disorder (PD) is associated with elevated suicide risk, but the level of risk in primary care settings is unknown. We assessed whether PD among primary care patients is linked with a greater elevation in risk as compared with other psychiatric diagnoses, and whether the association is modified by gender, age, type of PD, and comorbid alcohol misuse. Methods: Using data from the UK Clinical Practice Research Datalink, 2384 suicides were matched to 46,899 living controls by gender, age, and registered practice. Prevalence of PD, other mental disorders, and alcohol misuse was calculated for cases and controls separately and conditional logistic regression models were used to estimate exposure odds ratios. We also fitted gender interaction terms and formally tested their significance, and estimated gender age-specific effects. Results: We found a 20-fold increase in suicide risk for patients with PD versus no recorded mental disorder, and a four-fold increase versus all other psychiatric illnesses combined. Comorbid alcohol misuse and borderline PD were associated with a 45- and 37-fold increased risk, respectively, compared with those with no psychiatric disorders. Relative risks were higher for female than for male patients with PD. Significant risks associated with PD diagnosis were identified across all age ranges, although the greatest elevations were in the younger age ranges, 16-49 years. Conclusions: The large elevation in suicide risk among patients diagnosed with PD and comorbid alcohol misuse is a particular concern. Training in PD, alcohol misuse and suicide risk management for GPs and other primary care professionals may enhance the understanding of patients with PD and the interaction between PD traits, alcohol and suicidal behaviour. GPs have a potentially key role to play in intervening with patients diagnosed with PD, particularly in the presence of comorbid alcohol misuse, which may help reduce suicide risk.
- Author for correspondence
- Michael Doyle
- Email for correspondence
- michael.doyle@swyt.nhs.uk
Code list: res32: Personality Disorder
77 codes in list
| Code | Coding system | Description | Entity type | List name | |||
|---|---|---|---|---|---|---|---|
| E02y400 | Read | drug-induced personality disorder | diagnostic | res32: Personality Disorder | |||
| E21..00 | Read | personality disorders | diagnostic | res32: Personality Disorder | |||
| E210.00 | Read | paranoid personality disorder | diagnostic | res32: Personality Disorder | |||
| E211.00 | Read | affective personality disorder | diagnostic | res32: Personality Disorder | |||
| E211000 | Read | unspecified affective personality disorder | diagnostic | res32: Personality Disorder | |||
| E21..11 | Read | neurotic personality disorder | diagnostic | res32: Personality Disorder | |||
| E211100 | Read | hypomanic personality disorder | diagnostic | res32: Personality Disorder | |||
| E211200 | Read | depressive personality disorder | diagnostic | res32: Personality Disorder | |||
| E211300 | Read | cyclothymic personality disorder | diagnostic | res32: Personality Disorder | |||
| E211z00 | Read | affective personality disorder nos | diagnostic | res32: Personality Disorder | |||
| E212.00 | Read | schizoid personality disorder | diagnostic | res32: Personality Disorder | |||
| E212000 | Read | unspecified schizoid personality disorder | diagnostic | res32: Personality Disorder | |||
| E212z00 | Read | schizoid personality disorder nos | diagnostic | res32: Personality Disorder | |||
| E213.00 | Read | explosive personality disorder | diagnostic | res32: Personality Disorder | |||
| E214.00 | Read | compulsive personality disorders | diagnostic | res32: Personality Disorder | |||
| E214z00 | Read | compulsive personality disorder nos | diagnostic | res32: Personality Disorder | |||
| E215.00 | Read | histrionic personality disorders | diagnostic | res32: Personality Disorder | |||
| E215000 | Read | unspecified histrionic personality disorder | diagnostic | res32: Personality Disorder | |||
| E215.11 | Read | hysterical personality disorders | diagnostic | res32: Personality Disorder | |||
| E215z00 | Read | histrionic personality disorder nos | diagnostic | res32: Personality Disorder | |||
| E216.00 | Read | inadequate personality disorder | diagnostic | res32: Personality Disorder | |||
| E217.00 | Read | antisocial or sociopathic personality disorder | diagnostic | res32: Personality Disorder | |||
| E21y.00 | Read | other personality disorders | diagnostic | res32: Personality Disorder | |||
| E21y000 | Read | narcissistic personality disorder | diagnostic | res32: Personality Disorder | |||
| E21y100 | Read | avoidant personality disorder | diagnostic | res32: Personality Disorder | |||
| E21y200 | Read | borderline personality disorder | diagnostic | res32: Personality Disorder | |||
| E21y300 | Read | passive-aggressive personality disorder | diagnostic | res32: Personality Disorder | |||
| E21y400 | Read | eccentric personality disorder | diagnostic | res32: Personality Disorder | |||
| E21y500 | Read | immature personality disorder | diagnostic | res32: Personality Disorder | |||
| E21y600 | Read | masochistic personality disorder | diagnostic | res32: Personality Disorder | |||
| E21y700 | Read | psychoneurotic personality disorder | diagnostic | res32: Personality Disorder | |||
| E21yz00 | Read | other personality disorder nos | diagnostic | res32: Personality Disorder | |||
| E21z.00 | Read | personality disorder nos | diagnostic | res32: Personality Disorder | |||
| E21z.11 | Read | psychopathic personality | diagnostic | res32: Personality Disorder | |||
| Eu06000 | Read | [x]organic personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu06011 | Read | [x]organic pseudopsychopathic personality | diagnostic | res32: Personality Disorder | |||
| Eu21.17 | Read | [x]pseudopsychopathic schizophrenia | diagnostic | res32: Personality Disorder | |||
| Eu21.18 | Read | [x]schizotypal personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu34011 | Read | [x]affective personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu34112 | Read | [x]depressive personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60.00 | Read | [x]specific personality disorders | diagnostic | res32: Personality Disorder | |||
| Eu60000 | Read | [x]paranoid personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60013 | Read | [x]querulant personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60014 | Read | [x]sensitive paranoid personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60100 | Read | [x]schizoid personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60200 | Read | [x]dissocial personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60212 | Read | [x]antisocial personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60213 | Read | [x]asocial personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60214 | Read | [x]psychopathic personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60215 | Read | [x]sociopathic personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60300 | Read | [x]emotionally unstable personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60311 | Read | [x]aggressive personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60312 | Read | [x]borderline personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60313 | Read | [x]explosive personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60400 | Read | [x]histrionic personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60411 | Read | [x]hysterical personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60412 | Read | [x]psychoinfantile personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60500 | Read | [x]anankastic personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60511 | Read | [x]compulsive personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60512 | Read | [x]obsessional personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60513 | Read | [x]obsessive-compulsive personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60600 | Read | [x]anxious [avoidant] personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60700 | Read | [x]dependent personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60711 | Read | [x]asthenic personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60712 | Read | [x]inadequate personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60713 | Read | [x]passive personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60714 | Read | [x]self defeating personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60y00 | Read | [x]other specific personality disorders | diagnostic | res32: Personality Disorder | |||
| Eu60y11 | Read | [x]eccentric personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60y12 | Read | [x]haltlose type personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60y13 | Read | [x]immature personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60y14 | Read | [x]narcissistic personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60y16 | Read | [x]psychoneurotic personality disorder | diagnostic | res32: Personality Disorder | |||
| Eu60z00 | Read | [x]personality disorder, unspecified | diagnostic | res32: Personality Disorder | |||
| Eu61.00 | Read | [x]mixed and other personality disorders | diagnostic | res32: Personality Disorder | |||
| Eu84511 | Read | [x]autistic psychopathy | diagnostic | res32: Personality Disorder | |||
| Eu94211 | Read | [x]affectionless psychopathy | diagnostic | res32: Personality Disorder |
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