1 The Economic Burden of Personality Disorders  Djøra Soeteman, Jan J.V. Busschbach, Leona Hakkaart-van Roijen, Roel Verheul  Viersprong Institute for Studies on Personality Disorders (VISPD), The Netherlands;  Erasmus MC Rotterdam, Department of Medical Psychology and Psychotherapy;  Erasmus MC Rotterdam, Institute for Medical Technology Assessment (iMTA);  University of Amsterdam, Department of Clinical Psychology

2 Limited evidence on the economic burden  Evidence seems to indicate high costs  Health care resources  Prison services  Social care  Productivity losses  Borderline PD seems most expensive  Bender et al., 2001  State-of-the-art economic assessments are lacking  Should include both direct and indirect costs Medical and productivity losses  Standardized diagnoses

3 Patients recruitment  SCEPTRE  Study on the Cost-Effectiveness of Personality disorder TREatment  Six mental health care institutes  Offering outpatient, day hospital and/or inpatient psychotherapy for adult patients with personality pathology and/or personality disorders  Instruments part of the standard admission procedure  Thus all applicants were included

4 Inclusion / exclusion  2540 individuals registered as admissions  462 (18.2%) did not start  272 (10.7%) did not complete the admission procedure.  Of the remaining 1806 patients:  41 were excluded due to clear signs of unreliable data (2.3%)  5 due to serious intellectual impairment (0.3%)  The questionnaire for estimating costs (TiC-P) was missing for 20 patients (1.1%)  Leaving 1740 patients in current sample  96.3% of those who completed the formal assessment procedure

5 Instruments  Trimbos and iMTA questionnaire on Costs associated with Psychiatric illness (TiC-P)  Direct and indirect costs Number of visits to a general practitioner, psychiatrist, medical specialist, physiotherapist, and alternative health practitioner Day care/hospital lengths of stay Use of medication  All in the 4 weeks prior to filling out the questionnaire  Productivity losses  Two weeks prior to filling out the questionnaire  Friction costs valuation

6 Instruments  SIDP-IV  Structured Interview of DSM-IV Personality Disorders  11 formal DSM –IV-TR Axis II diagnoses e.g., schizoid personality disorder Including personality disorder not-otherwise-specified  2 DSM-IV-TR appendix diagnoses depressive and negativistic personality disorder  DSM-III-R self-defeating personality disorder  Trained interviewers  Booster sessions

7 Patient characteristics  Most frequently diagnosed  Depressive 31.8%  Avoidant 28.3%  Obsessive-compulsive 20.9%  Borderline 20.9%  Least frequent  Schizotypal 1.0%  Schizoid 1.1%  One-fifth no personality disorder diagnosis  68% without paying jobs because of health- related problems

8 Statistical analyses  Univariate regression  Comparison of each PD type vs the non-PD patients  Multiple regression  Main effect analysis measuring the unique contribution of the different diagnoses on the costs  Age, gender and education (socio-economic status) associated with health service use and were therefore entered into the multiple regression models  Number of diagnoses: 54.9% at least two diagnoses of PD

9 Direct medical costs

10 Productivity losses

11 PD types vs. non-PD patients

12 Results multivariate analysis  None of the specific diagnoses significantly predicted variations in costs  Categorical variables: yes/no diagnosis  P > 0.05  Differences accompanied by large variances  Total number of PD diagnoses no effect  R 2 = 1.3%

13 Diagnoses more continuous  Borderline, obsessive-compulsive and narcissistic (-) PD unique contribution on total costs  Ranked: none-trait-definite  P<0.05  Total number of PD diagnoses still no effect  Maximum variance explained by all variables: 3.6%

14 Conclusions  Personality disorders pose a substantial economic burden on society  Effective treatments are potentially also cost-effective  Especially if these treatments appear capable of reducing this economic burden  Considering PD in traits  In a treatment-seeking population  Borderline and obsessive-compulsive PD were found to be more costly to society  Narcissistic PD predicted lower costs

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