Impact of co‐morbid personality disorder on quality of inpatient mental health services for people with anxiety and depression

Article


Williams, R., Farquharson, L., Rhodes, E., Dang, M., Fitzpatrick, N., Quirk, A., Baldwin, D. S. and Crawford, M. J. 2020. Impact of co‐morbid personality disorder on quality of inpatient mental health services for people with anxiety and depression. Personality and Mental Health. 14 (4), pp. 336-349. https://doi.org/10.1002/pmh.1484
AuthorsWilliams, R., Farquharson, L., Rhodes, E., Dang, M., Fitzpatrick, N., Quirk, A., Baldwin, D. S. and Crawford, M. J.
Abstract

Introduction

Concerns have been raised about the quality of inpatient care received by patients with a diagnosis of personality disorder.

Objectives

The aim of this study was to examine the quality of care received by inpatients with an anxiety or depressive disorder, comparing subgroups with or without a co‐morbid personality disorder.

Method

We used a retrospective case‐note review of 3 795 patients admitted to inpatient psychiatric wards in England, utilizing data from the National Clinical Audit of Anxiety and Depression. Data were gathered on all acute admissions with an anxiety or depressive disorder over a 6‐month period, for a number of measures reflecting quality of care derived from national standards. Association of coexisting personality disorder with quality of care was investigated using multivariable regression analyses.

Results

Four hundred sixteen (11.0%) of the patients had a co‐co‐morbid diagnosis of personality disorder. Patients with personality disorder were less likely to have been asked about prior responses to treatment in their initial assessment (odds ratio (OR) = 0.67, 95% confidence interval (CI) 0.50 to 0.89, p = 0.007). They were less likely to receive adequate notice in advance of their discharge (OR = 0.87, 95% CI 0.65 to 0.98, p = 0.046). They were more likely to be prescribed medication at the point of discharge (OR = 1.52, 95% CI 1.02 to 2.09, p = 0.012) and less likely to have been provided with information about the medicines they were taking (OR = 0.86, 95% CI 0.69 to 0.94, p = 0.048). In addition, the carers of patients with co‐morbid personality disorder were less likely to have been provided with information about available support services (OR = 0.73, 95% CI 0.51 to 0.93, p = 0.045).

Conclusion

We found evidence of poorer quality of care for patients with co‐morbid personality disorder who were admitted to psychiatric hospital for treatment of anxiety or depressive disorders, highlighting the need for improved clinical care in this patient group.

JournalPersonality and Mental Health
Journal citation14 (4), pp. 336-349
ISSN1932-8621
Year2020
PublisherJohn Wiley & Sons, Ltd.
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Anyone
Digital Object Identifier (DOI)https://doi.org/10.1002/pmh.1484
Publication dates
Online19 May 2020
Publication process dates
Accepted27 Apr 2020
Deposited29 May 2020
FunderNational Institute for Health Research
Copyright holder© 2020 The Authors Personality and Mental Health
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