@phdthesis{discovery10153596,
           title = {Personality disorder: Prevalence, outcomes, and neighbourhood-level deprivation in mental health services},
          school = {UCL (University College London)},
           month = {August},
            year = {2022},
            note = {Copyright {\copyright} The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author's request.},
          author = {Ban, Ka-Young},
             url = {https://discovery.ucl.ac.uk/id/eprint/10153596/},
        abstract = {Introduction: Little is known about social-environmental factors at the neighbourhood-level in relation to
personality disorder prevalence and outcomes such as mortality and readmission. I investigated
personality disorder prevalence in secondary care records and whether neighbourhood-level
deprivation and population density were associated with both personality disorder prevalence and
its outcomes, including mortality and the first acute psychiatric admission, using data derived from
secondary mental health services in the UK. /

Methods: ? Study 1 - I systematically reviewed literature on the association between social deprivation
and frequency and prognosis of personality disorder.
? Study 2 - I examined comorbid personality disorder diagnosis prevalence and its association
with neighbourhood-level deprivation and population density within six early intervention in
psychosis (EIP) services in rural England (N=798) using logistic regression.
? Study 3 - I investigated prevalence of personality disorder and whether neighbourhood-level
deprivation and population density were associated with personality disorder diagnosis
prevalence and outcomes including mortality and first acute psychiatric admission after
personality disorder diagnosis using Clinical Record Interactive Search (CRIS) database in a
Camden and Islington NHS Foundation Trust (N=4,414). I used Poisson regression and Cox
regression.
? Study 4 - I replicated the study 3 using CRIS database from a different large inner city NHS
Foundation Trust (South London and Maudsley NHS Foundation Trust) (N=15,668). /

Results: ? Study 1 - The systematic review demonstrated that worse social deprivation was associated
with an increased risk of personality disorder and poorer prognosis in people with
personality disorder.
? Study 2 - The prevalence of comorbid personality disorder in EIP services was 9.5\% and I
found no association between neighbourhood-level deprivation and population density and
personality disorder prevalence.
? Study 3 - I found prevalence of personality disorder in clinical records (0.99\%; 95\% CI: 0.96-
1.02) was much lower than reported in community research-studies (4.4-13.4\%). People
from more deprived neighbourhoods were more likely to have personality disorder compared with those from more affluent neighbourhoods (RR: 1.29; 95\% CI: 1.20-1.39). I
found no association between neighbourhood-level deprivation and population density and
either mortality or the first acute psychiatric admission after personality disorder diagnosis.
? Study 4 - The prevalence of personality disorder diagnoses in secondary care (0.76\%; 95\%
CI: 0.74-0.78\%) was similar to study 3. Neighbourhood-level deprivation was associated with
this personality disorder prevalence (RR: 1.30; 95\% CI: 1.25-1.37), but there was no clear
association with population density. Again, there was no evidence of an association between
neighbourhood-level deprivation and population density and mortality or subsequent acute
psychiatric admission after personality disorder diagnosis. /

Conclusions: In this thesis, I found that the prevalence of personality disorder in secondary care is much lower
than in community samples and is associated with neighbourhood-level deprivation, but that
subsequent outcomes for these patients did not vary by neighbourhood-level deprivation or
population density. This extends our knowledge of the relationship between neighbourhood-level
deprivation and the development of personality disorder. It also suggests that neighbourhood-level
deprivation and population density have little effect on the prognosis of personality disorder once
people were diagnosed with personality disorder in this study conducted in very urban areas of
London. Further studies using data that cover neighbourhoods with different characteristics are
needed to examine the generalisability of my findings at a broader national level.}
}