Impact of co-morbid personality disorder on quality of inpatient mental health services for people with anxiety and depression
Impact of co-morbid personality disorder on quality of inpatient mental health services for people with anxiety and depression
Introduction: Concerns have been raised about the quality of inpatient care received by patients with a diagnosis of personality disorder. Objectives: The aim of this study was to examine the quality of care received by inpatients with an anxiety or depressive disorder, comparing subgroups with or without a co-morbid personality disorder. Method: We used a retrospective case-note review of 3 795 patients admitted to inpatient psychiatric wards in England, utilizing data from the National Clinical Audit of Anxiety and Depression. Data were gathered on all acute admissions with an anxiety or depressive disorder over a 6-month period, for a number of measures reflecting quality of care derived from national standards. Association of coexisting personality disorder with quality of care was investigated using multivariable regression analyses. Results: Four hundred sixteen (11.0%) of the patients had a co-co-morbid diagnosis of personality disorder. Patients with personality disorder were less likely to have been asked about prior responses to treatment in their initial assessment (odds ratio (OR) = 0.67, 95% confidence interval (CI) 0.50 to 0.89, p = 0.007). They were less likely to receive adequate notice in advance of their discharge (OR = 0.87, 95% CI 0.65 to 0.98, p = 0.046). They were more likely to be prescribed medication at the point of discharge (OR = 1.52, 95% CI 1.02 to 2.09, p = 0.012) and less likely to have been provided with information about the medicines they were taking (OR = 0.86, 95% CI 0.69 to 0.94, p = 0.048). In addition, the carers of patients with co-morbid personality disorder were less likely to have been provided with information about available support services (OR = 0.73, 95% CI 0.51 to 0.93, p = 0.045). Conclusion: We found evidence of poorer quality of care for patients with co-morbid personality disorder who were admitted to psychiatric hospital for treatment of anxiety or depressive disorders, highlighting the need for improved clinical care in this patient group.
336-349
Baldwin, David
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Quirk, Alan
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Farquharson, Lorna
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Williams, Ryan
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Rhodes, Ellen
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Dang, Mary
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Fitzpatrick, Naomi
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Crawford, Mike J.
1fafb17d-8c42-45c2-9f0a-bab7040566a6
1 November 2020
Baldwin, David
1beaa192-0ef1-4914-897a-3a49fc2ed15e
Quirk, Alan
68fbb952-64ad-4c2d-995b-881d4bc7a6be
Farquharson, Lorna
1a6b31bf-7959-4780-a40c-bc306b5badfa
Williams, Ryan
1d148019-2dad-4c6c-9009-b881ac934aa7
Rhodes, Ellen
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Dang, Mary
7dfd9a9a-b561-4c26-b1ae-5a9c5d560f9e
Fitzpatrick, Naomi
ba4e4ccb-b16e-4cb6-9c37-c5ef2460d605
Crawford, Mike J.
1fafb17d-8c42-45c2-9f0a-bab7040566a6
Baldwin, David, Quirk, Alan, Farquharson, Lorna, Williams, Ryan, Rhodes, Ellen, Dang, Mary, Fitzpatrick, Naomi and Crawford, Mike J.
(2020)
Impact of co-morbid personality disorder on quality of inpatient mental health services for people with anxiety and depression.
Personality and Mental Health, 14 (4), .
(doi:10.1002/pmh.1484).
Abstract
Introduction: Concerns have been raised about the quality of inpatient care received by patients with a diagnosis of personality disorder. Objectives: The aim of this study was to examine the quality of care received by inpatients with an anxiety or depressive disorder, comparing subgroups with or without a co-morbid personality disorder. Method: We used a retrospective case-note review of 3 795 patients admitted to inpatient psychiatric wards in England, utilizing data from the National Clinical Audit of Anxiety and Depression. Data were gathered on all acute admissions with an anxiety or depressive disorder over a 6-month period, for a number of measures reflecting quality of care derived from national standards. Association of coexisting personality disorder with quality of care was investigated using multivariable regression analyses. Results: Four hundred sixteen (11.0%) of the patients had a co-co-morbid diagnosis of personality disorder. Patients with personality disorder were less likely to have been asked about prior responses to treatment in their initial assessment (odds ratio (OR) = 0.67, 95% confidence interval (CI) 0.50 to 0.89, p = 0.007). They were less likely to receive adequate notice in advance of their discharge (OR = 0.87, 95% CI 0.65 to 0.98, p = 0.046). They were more likely to be prescribed medication at the point of discharge (OR = 1.52, 95% CI 1.02 to 2.09, p = 0.012) and less likely to have been provided with information about the medicines they were taking (OR = 0.86, 95% CI 0.69 to 0.94, p = 0.048). In addition, the carers of patients with co-morbid personality disorder were less likely to have been provided with information about available support services (OR = 0.73, 95% CI 0.51 to 0.93, p = 0.045). Conclusion: We found evidence of poorer quality of care for patients with co-morbid personality disorder who were admitted to psychiatric hospital for treatment of anxiety or depressive disorders, highlighting the need for improved clinical care in this patient group.
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Williams-NCAAD-PD-2020
- Accepted Manuscript
Text
Impact of co‐morbid personality disorder on quality of inpatient mental health services for people with anxiety and depression
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Accepted/In Press date: 27 April 2020
e-pub ahead of print date: 19 May 2020
Published date: 1 November 2020
Additional Information:
Funding Information:
R.?W. is supported by a UK National Institute for Health Research (NIHR) Academic Clinical Fellowship. The Imperial Biomedical Research Centre Facility, which is also funded by the NIHR, provided support for this project. The NCAAD was funded by the Royal College of Psychiatrists in conjunction with the McPin Foundation?an independent mental health research charity. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, RCPsych or the Department of Health. The authors would like to thank all members of the NCAAD team at the Royal College of Psychiatrists for their support with this study.
Publisher Copyright:
© 2020 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd
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Local EPrints ID: 441084
URI: http://eprints.soton.ac.uk/id/eprint/441084
PURE UUID: 7569b6e2-aa9d-4ace-8460-5c29dc20e290
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Date deposited: 29 May 2020 16:31
Last modified: 17 Mar 2024 02:41
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Author:
Alan Quirk
Author:
Lorna Farquharson
Author:
Ryan Williams
Author:
Ellen Rhodes
Author:
Mary Dang
Author:
Naomi Fitzpatrick
Author:
Mike J. Crawford
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