Ban, Ka-Young; (2022) Personality disorder: Prevalence, outcomes, and neighbourhood-level deprivation in mental health services. Doctoral thesis (Ph.D), UCL (University College London).

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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.

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