Increased Treatment Complexity for Major Depressive Disorder for Inpatients With Comorbid Personality Disorder

Wiegand, Hauke Felix; Godemann, F.

doi:10.1176/appi.ps.201600192

Cited by 12 publications

(12 citation statements)

References 11 publications

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“…Future research is needed to further elucidate the relationship and mechanism. According to our results and the previous evidence we reviewed, the presence of a personality disorder is not only associated with depression severity, but the comorbidity of a personality disorder can complicate treatment and worsen the prognosis of depression (Wiegand & Godemann, 2017;Zimmerman, Rothschild & Chelminski, 2005) and other unhealthy outcomes, including self-harming behaviors (Ayodeji et al, 2015). Therefore, understanding the relationship between personality disorders and depression has clinical importance for prognostic accuracy and individualized interventions for depression.…”

Section: Discussionsupporting

confidence: 54%

“…For example, compared to patients with major depression, patients with both borderline personality disorder and major depression have poor self-regulation ability, which affects their treatment (Kim et al, 2018). A comorbidity of a personality disorder makes the treatment of major depression more complex, and it is associated with higher rates of recurrent depression and hospital readmission, compared to patients who only have major depression (Wiegand & Godemann, 2017). Personality disorders are also associated with significantly greater severity of self-harm, overall psychopathology, and impairment (Ayodeji et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

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Insomnia partially mediates the relationship between pathological personality traits and depression: a case-control study

Chen

Lin

Pan

et al. 2021

PeerJ

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Background and Objective Personality disorders are frequently associated with insomnia and depression, but little is known about the inter-relationships among these variables. Therefore, this study examined these inter-relationships and the possible mediating effect of insomnia on the association between specific personality pathologies and depression severity. Methods There were 138 study participants, including 69 individuals with depression and 69 healthy controls. The main variables were measured by the Hamilton Depression Rating Scale-24 (HAMD-24), Athens Sleep Insomnia Scale (AIS), and the Personality Diagnostic Questionnaire (PDQ-4+). Multivariate linear regression and mediation analysis were conducted. Results With the exception of the antisocial personality score, all the PDQ-4+ scores and AIS scores were significantly higher in the depression group than in the healthy control group (p < 0.001). In the total sample, all personality pathology scores (p < 0.001), except the antisocial personality score, had significant positive correlations with the AIS scores and HAMD-24 scores, and the AIS scores and HAMD-24 scores were positively correlated (r = 0.620, p < 0.001). Regression analysis revealed that borderline personality, passive-aggressive personality, and insomnia positively predicted the severity of depression, after adjusting for sociodemographic covariates, and that insomnia partially mediated the associations of borderline personality and passive-aggressive personality with depression severity. Conclusions Borderline personality, passive-aggressive personality, and insomnia tend to increase the severity of depression, and the effect of borderline and passive-aggressive personality on depression severity may be partially mediated by insomnia. This is the first study to report these findings in a Chinese sample, and they may help researchers to understand the pathways from specific personality pathologies to the psychopathology of depression better, which should be useful for designing interventions to relieve depression severity, as the impact of specific personality pathology and insomnia should be considered.

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Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Insomnia partially mediates the relationship between pathological personality traits and depression: a case-control study

Chen

Lin

Pan

et al. 2021

PeerJ

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“…Looking at healthcare utilization, patients with PD had more psychiatric inpatient, outpatient, and pharmacological treatment than patients with MDD as a single diagnosis [ 22 ]. Additionally, patients with MDD and comorbid PD were more likely to have hospitalizations, higher rates of recurrent depressions, longer mean length of stay [ 23 ], and longer duration of depressive episodes than patients with MDD without comorbid PD [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

Real-World Treatment Costs and Care Utilization in Patients with Major Depressive Disorder With and Without Psychiatric Comorbidities in Specialist Mental Healthcare

et al. 2021

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Background The majority of patients with major depressive disorder (MDD) have comorbid mental conditions. Objectives Since most cost-of-illness studies correct for comorbidity, this study focuses on mental healthcare utilization and treatment costs in patients with MDD including psychiatric comorbidities in specialist mental healthcare, particularly patients with a comorbid personality disorder (PD). Methods The Psychiatric Case Register North Netherlands contains administrative data of specialist mental healthcare providers. Treatment episodes were identified from uninterrupted healthcare use. Costs were calculated by multiplying care utilization with unit prices (price level year: 2018). Using generalized linear models, cost drivers were investigated for the entire cohort. Results A total of 34,713 patients had MDD as a primary diagnosis over the period 2000-2012. The number of patients with psychiatric comorbidities was 24,888 (71.7%), including 13,798 with PD. Costs were highly skewed, with an average ± standard deviation cost per treatment episode of €21,186 ± 74,192 (median €2320). Major cost drivers were inpatient days and daycare days (50 and 28% of total costs), occurring in 12.7 and 12.5% of episodes, respectively. Compared with patients with MDD only (€11,612), costs of patients with additional PD and with or without other comorbidities were, respectively, 2.71 (p < .001) and 2.06 (p < .001) times higher and were 1.36 (p < .001) times higher in patients with MDD and comorbidities other than PD. Other cost drivers were age, calendar year, and first episodes. Conclusions Psychiatric comorbidities (especially PD) in addition to age and first episodes drive costs in patients with MDD. Knowledge of cost drivers may help in the development of future stratified disease management programs.

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“…In another study published in 2017, Wiegand et al evaluated a large set of data, including 58,913 cases from 75 hospitals using the German VIPP data set. The authors concluded that co-occurring PDs significantly increased the complexity of treating MDD, increased risk of recurrence of MDD, and led to nearly twice as many readmissions within 1 year [12]. This descriptive analysis of a large data set concluded that in this sample, PDs are a significant factor affecting the prognosis in MDD and require significantly increased resources to treat.…”

Section: Recent Evidence Regarding the Impact Of Pds On The Prognosis And Course Of Mddmentioning

confidence: 95%

Prognostic Significance of Personality Disorders in Patients with Major Depressive Disorder

Young

2020

Curr Treat Options Psych

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Purpose of Review Update the evidence regarding how co-occurring personality disorders influence treatment outcomes for major depressive disorder and update the evidence regarding treatment options for personality disorders that are co-occurring with major depressive disorder. Recent Findings There is evidence that personality disorders can be effectively treated through a variety of psychotherapeutic modalities. Given the substantial evidence that cooccurring personality disorders impede the recovery from major depressive disorder, comprehensively addressing any co-occurring personality disorders is an essential part of an effective treatment plan for patients with major depressive disorder. Personality disorders such as borderline personality disorder, which is commonly co-occurring with major depressive disorder, have several validated treatment options. Summary Since publication of past reviews on the topic, there have been multiple additional studies published to advance the discussion of the impact of personality disorders on treatment outcomes in major depression. There is now substantial evidence that personality disorders can negatively affect treatment outcomes in the setting of major depression, which is consistent with the clinical observation that co-occurring personality disorders need to be comprehensively addressed to achieve optimal outcomes for the individual. There also now exists substantial evidence that personality disorders can be effectively treated using several validated psychotherapeutic modalities. It is recommended that a comprehensive assessment, including assessment for co-occurring personality disorders, is implemented in all cases of major depressive disorder that have not been successfully treated. In those cases where a co-occurring personality disorder is identified, specific treatment for the personality disorder should be recommended.

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Increased Treatment Complexity for Major Depressive Disorder for Inpatients With Comorbid Personality Disorder

Abstract: Personality disorder comorbidity made MDD treatment more complex, and recurrence of MDD episodes and hospital readmission occurred more often than if patients had a sole MDD diagnosis.

Cited by 12 publications

References 11 publications

Insomnia partially mediates the relationship between pathological personality traits and depression: a case-control study

Insomnia partially mediates the relationship between pathological personality traits and depression: a case-control study

Real-World Treatment Costs and Care Utilization in Patients with Major Depressive Disorder With and Without Psychiatric Comorbidities in Specialist Mental Healthcare

Prognostic Significance of Personality Disorders in Patients with Major Depressive Disorder

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