%0 Thesis
%9 Doctoral
%A Ban, Ka-Young
%B Psychiatry
%D 2022
%F discovery:10153596
%I UCL (University College London)
%P 218
%T Personality disorder: Prevalence, outcomes, and neighbourhood-level deprivation in mental health services
%U https://discovery.ucl.ac.uk/id/eprint/10153596/
%X 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.
%Z 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.