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Personality disorders and cause-specific mortality: a nationwide study of 2 million adolescents

Published online by Cambridge University Press:  14 October 2020

Shmuel Tiosano
Affiliation:
Department of Medicine ‘B’ and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Lucian Laur
Affiliation:
Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel
Amir Tirosh
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
Ariel Furer
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel
Arnon Afek
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel Central Management, Chaim Sheba Medical Center, Tel Hashomer, Israel
Noam Fink
Affiliation:
Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel
Estela Derazne
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel
Dorit Tzur
Affiliation:
Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel
Eyal Fruchter
Affiliation:
Department of psychiatry, Rambam Medical Center, Technion-Israel Institute of Technology, Haifa, Israel
Ariel Ben-Yehuda
Affiliation:
Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel
Tarif Bader
Affiliation:
Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel
Howard Amital
Affiliation:
Department of Medicine ‘B’ and Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
Moyses Szklo
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Mark Weiser
Affiliation:
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel Department of psychiatry, Sheba Medical Center, Tel-Hashomer, Israel
Gilad Twig*
Affiliation:
Surgeon General Headquarters, Israel Defense Forces, Ramat Gan, Israel and Department of Military Medicine, Hebrew University, Jerusalem, Israel Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
*
Author for correspondence: Gilad Twig, E-mail: Gilad.Twig@gmail.com

Abstract

Background

Personality disorders are prevalent in 6–10% of the population, but their risk for cause-specific mortality is unclear. The aim of the study was to assess the association between personality disorders diagnosed in late adolescence and all-cause as well as cause-specific (cardiovascular-related, external-related) mortality.

Methods

We performed a longitudinal study on a historical prospective cohort based on nationwide screening prior to recruitment to the Israeli army. The study participants were 16–19-year-old persons who attended the army screening (medical and cognitive, including screening for psychiatric disorders) between 1967 and 2006. Participants were followed from 1967 till 2011.

Results

The study included 2 051 606 subjects, of whom 1 229 252 (59.9%) were men and 822 354 (40.1%) were women, mean age 17.36 years. There were 55 508 (4.5%) men and 8237 (1.0%) women diagnosed with personality disorders. The adjusted hazard ratio (HRs) for coronary, stroke, cardiovascular, external-related causes and all-cause mortality among men with personality disorders were 1.34 (1.03–1.74), 1.82 (1.20–2.76), 1.45 (1.23–1.71), 1.41 (1.30–1.53) and 1.44 (1.36–1.51), respectively. The absolute rate difference for all-cause mortality was 56.07 and 13.19 per 105 person-years among men and women, respectively. Among women with personality disorders, the adjusted HRs for external-related causes and all-cause mortality were 2.74 (1.87–4.00) and 2.01 (1.56–2.58). Associations were already evident within 10 years of follow-up.

Conclusions

Personality disorder in late adolescence is associated with increased risk of cardiovascular, external- and all-cause mortality. Increased cardiovascular mortality is evident before the age of 40 years and may point to the importance of lifestyle education already in youth.

Type
Original Articles
Copyright
Copyright © The Author(s) 2020. Published by Cambridge University Press.

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