Personality disorders, common mental disorders and receipt of disability benefits: evidence from the British National Survey of Psychiatric Morbidity

• Published in: Psychological medicine Vol. 42; no. 12; p. 2631
• Main Authors: Knudsen, A K, Skogen, J C, Harvey, S B, Stewart, R, Hotopf, M, Moran, P
• Format: Journal Article
• Language: English
• Published: England 01-12-2012
• Subjects: Adolescent; Adult; Chronic Disease; Comorbidity; Cross-Sectional Studies; Female; Health Surveys; Humans; Insurance, Disability - utilization; Male; Mass Screening - statistics & numerical data; Mental Disorders - diagnosis; Mental Disorders - epidemiology; Mental Disorders - rehabilitation; Middle Aged; Personality Disorders - diagnosis; Personality Disorders - epidemiology; Personality Disorders - rehabilitation; Rehabilitation, Vocational; Socioeconomic Factors; Substance-Related Disorders - diagnosis; Substance-Related Disorders - epidemiology; United Kingdom; Utilization Review; Young Adult
• ISSN: 1469-8978
• DOI: 10.1017/S0033291712000906

Common mental disorders (CMDs) are associated with occupational impairment and the receipt of disability benefits (DBs). Little is known about the relationship between personality disorders (PDs) and work disability, and whether the association between CMDs and work disability is affected by the presence of co-morbid PDs. The aim of this study was to examine the association between DB and individual categories of PDs, with special attention to the effect of co-morbid CMDs on this association.
The association between DB and PD was examined using data from the 2000 British National Survey of Psychiatric Morbidity. Probable PD caseness was identified using the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) screening questionnaire. The impact of CMDs, assessed with the revised version of the Clinical Interview Schedule (CIS-R), was examined as a covariate and in a stratified analysis of co-morbidity. Other covariates included sociodemographic factors, long-standing illnesses and substance use.
Probable PD was associated with DB, with the strongest associations found for borderline, dependent and schizotypal PD. Antisocial PD was not associated with DB. The relationship between PD and DB was strongly modified by CMD, reducing the association from an odds ratio (OR) of 2.84 to 1.34 [95% confidence interval (CI) 1.00-1.79)]. In the stratified analysis, co-morbid PD and CMD showed a stronger association with DB than PD without CMD but, when fully adjusted, this effect was not significantly different from the association between CMD without PD.
Individuals screening positive for PD are more likely to experience severe occupational outcomes, especially in the presence of co-morbid CMD.