title: Predictors of natural and unnatural mortality among patients with personality disorder: evidence from a large UK case register.
abstract: BACKGROUND
  People with personality disorder have reduced life expectancy, yet, within this population, little is known about the clinical predictors of natural and unnatural deaths. We set out to investigate this, using a large cohort of secondary mental health patients with personality disorder.
  
  
  METHODS
  We identified patients with an ICD-10 diagnosis of personality disorder, aged ≥15 years in a large secondary mental healthcare case register. The case register was linked to national mortality tracing. Using Cox regression, we modelled the effect of a number of pre-specified clinical variables on all-cause, natural cause and unnatural cause mortality.
  
  
  RESULTS
  2,440 patients were identified. Eighty-five deaths (3.5% of cohort) occurred over a 5-year observation period, of which over 50% were from natural causes. All-cause mortality was associated with alcohol or drug use (adjusted Hazard Ratio [aHR] 2.3; 95% CI 1.3-4.1), physical illness (aHR 1.9; 95% CI 1.0-3.6), and functional impairment (aHR 1.9; 95% CI 1.0-3.6). Natural cause mortality was associated with mild problems of alcohol or drug use (aHR 3.4; 95% CI 1.5-7.4), and physical illness (aHR 2.4; 95% CI 1.0-5.6). Unnatural cause mortality was associated only with severe alcohol or drug use (aHR 3.1; 95% CI 1.3-7.3).
  
  
  CONCLUSIONS
  Alcohol and drug use, physical illness, and functional impairment are predictors of mortality in individuals with personality disorder. Clinicians should be aware of the existence of problems in these domains, even at mild levels, when assessing the needs of patients with personality disorder.
authors.affiliation: King's College London, King's Health Partners, Dept of Health Service and Population Research, Institute of Psychiatry, London, United Kingdom.
authors.forename: Marcella Lei-Yee
authors.initials: ML
authors.lastname: Fok
authors.affiliation: King's College London, King's Health Partners, Dept of Psychological Medicine, Institute of Psychiatry, London, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Stewart
authors.affiliation: King's College London, King's Health Partners, Dept of Psychological Medicine, Institute of Psychiatry, London, United Kingdom.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Hayes
authors.affiliation: King's College London, King's Health Partners, Dept of Health Service and Population Research, Institute of Psychiatry, London, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Moran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010554:Personality Disorders / Q000401:mortality*; D012042:Registries; D012044:Regression Analysis; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult