Patients with personality disorders: functional status, health care utilization, and satisfaction with care.
BACKGROUND
Personality disorders are believed to occur in approximately 10% of the adult population, yet they are rarely diagnosed in primary care settings. This study compares the functional status, health care utilization, and satisfaction with care for patients who were at high risk for a personality disorder with those who were at low risk.


METHODS
Patients at high risk for personality disorders were identified using a standardized psychometric instrument, the Structured Clinical Inventory for DSM-III Axis II (SCID-II). After assigning patients to risk categories, responses were compared on the Medical Outcomes Study Short Form-36, the Beck Depression Inventory, the CAGE alcohol use questionnaire, and an adapted version of the RAND Patient Satisfaction Questionnaire.


RESULTS
Patients who were at high risk for any personality disorder had lower functional status, higher risk for depression or alcohol abuse, and lower levels of satisfaction with care. These differences could not be explained by demographic or socioeconomic differences between high- and low-risk patients. Being at high risk for specific personality disorders, such as borderline, schizoid, and dependent disorders, was associated with higher degrees of functional impairment and greater risk for depression and alcohol abuse. Patients at high risk for other disorders, such as obsessive-compulsive, narcissitic, and schizotypal, consistently showed no appreciable degree of impairment as compared with patients at low risk for any personality disorder. Medical care utilization was no higher when personality disorders were examined in aggregate, but a marked increase in utilization was noted among patients at high risk for histrionic and dependent disorders.


CONCLUSIONS
Among primary care patients, having a personality disorder is associated with lower functional status, lower satisfaction with health care, and higher risk for depression and alcohol abuse.
Hueston
W J
WJ
Department of Family Medicine/Eau Claire Family Practice Residency, University of Wisconsin-Madison, USA.
Mainous
A G
AG
Schilling
R
R
D000328:Adult; D000553:Ambulatory Care / Q000706:statistics & numerical data; D003863:Depression / Q000150:complications; D005194:Family Practice; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010554:Personality Disorders / Q000175:diagnosis / Q000523:psychology*; D011581:Psychological Tests; D012306:Risk; D014922:Wisconsin