Personality disorder is a term used for a group of conditions that share similar symptoms, including difficulties with relationships and emotions. People diagnosed with a personality disorder often experience stigma from the public, and from healthcare professionals and services. This may further worsen the mental health of these patients and poorly affect the healthcare that they receive. People with a personality disorder are at higher risk of self-harm than the general population. Self-harm is similarly stigmatised, and those who self-harm also have poorer health outcomes. Therefore, we expect that patients with a diagnosis of a personality disorder who also self-harm will have less positive experiences than patients experiencing either on its own, due to additional stigma.
Our study aims to:
• Examine how often personality disorder and self-harm occur over time, including by age, sex, ethnicity, and deprivation.
• Explore general practice (GP) care of people diagnosed with a personality disorder and who self-harm, including the number of GP appointments, medication, and referrals to mental health services.
• Explore whether these groups have different rates of hospitalisation, suicide, homicide, and accidental death compared to members of the general population.
• Determine what may increase the likelihood of self-harm in those with a diagnosis of personality disorder.
This research will generate new knowledge that will inform initiatives to enhance care for patients with a personality disorder and who self-harm.
Aims:
1. Examine temporal trends in prevalence of personality disorder (PD) diagnosis, incidence of self-harm, and prevalence of a record of both in general practice records, and demographic characteristics of these groups.
2. Explore general practice management of those with a PD diagnosis and who have self-harmed, including pharmacological management, referrals to mental health services, consultation frequency, and continuity of care.
3. Examine rates of hospitalisation and of deaths from external causes in those with PD and who have self-harmed compared with the general population.
4. Estimate relative risks and risk factors for self-harm in those with a PD diagnosis.
Each aim represents a distinct phase of the study, which will use data from CPRD Aurum. Phases 1 and 2 will utilise a descriptive cohort design, while phases 3 and 4 will utilise matched cohorts to produce Cox’s Proportional Hazards models. Phase 4 will include a nested case-control study, to estimate the risks of self-harm. We propose utilisation of linked datasets: Hospital Episode Statistics (HES) Admitted Patient Care (APC) data, patient postcode deprivation measures, and the Office for National Statistics (ONS) death registration data.
Populations of interest: People with a PD diagnosis, people with PD-related codes, people with a record of self-harm, and people with both PD and self-harm recorded. The study will involve a sensitivity analysis of PD-related codes and PD diagnoses. The results of this analysis will inform the study population used in subsequent phases (i.e. whether those with PD-related codes are included in the PD population). If cells would contain
Phase 1 - Prevalence of personality disorder diagnoses; prevalence of personality disorder-related codes; incidence of self-harm; prevalence of personality disorder AND self-harm.
Phase 2 - Number of GP appointments; referral to mental health services (yes/no); quantity and type of prescriptions for psychotropic medication; Usual Provider of Care index; Bice-Boxerman index.
Phase 3 - Death from any external cause; death by suicide; death by homicide; accidental deaths; rate of hospitalisation.
Phase 4 - Risk of self-harm; risk factors for self-harm.
Sarah Steeg - Chief Investigator - University of Manchester
Jessica Hackney - Corresponding Applicant - University of Manchester
Darren Ashcroft - Collaborator - University of Manchester
Faraz Mughal - Collaborator - Keele University
Navneet Kapur - Collaborator - University of Manchester
Paul Moran - Collaborator - University of Bristol
Pearl Mok - Collaborator - University of Manchester
Roger Webb - Collaborator - University of Manchester
Rosa Parisi - Collaborator - University of Manchester
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;CPRD Aurum Ethnicity Record