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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
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.
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Baldwin, David
1beaa192-0ef1-4914-897a-3a49fc2ed15e
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.
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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), 336-349. (doi:10.1002/pmh.1484).

Record type: Article

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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Accepted/In Press date: 27 April 2020
e-pub ahead of print date: 19 May 2020

Identifiers

Local EPrints ID: 441084
URI: http://eprints.soton.ac.uk/id/eprint/441084
PURE UUID: 7569b6e2-aa9d-4ace-8460-5c29dc20e290
ORCID for David Baldwin: ORCID iD orcid.org/0000-0003-3343-0907

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Date deposited: 29 May 2020 16:31
Last modified: 10 Jan 2022 02:37

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Contributors

Author: David Baldwin ORCID iD
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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