Defining severity of personality disorder using electronic health records: short report

Jonathan Monk-Cunliffe; Giouliana Kadra-Scalzo; Chloe Finamore; Oliver Dale; Mizanur Khondoker; Barbara Barrett; Hitesh Shetty; Richard d. Hayes; Paul Moran

doi:10.1192/bjo.2023.509

Defining severity of personality disorder using electronic health records: short report

Jonathan Monk-Cunliffe^*, Giouliana Kadra-Scalzo, Chloe Finamore, Oliver Dale, Mizanur Khondoker, Barbara Barrett, Hitesh Shetty, Richard d. Hayes, Paul Moran

^*Corresponding author for this work

Research output: Contribution to journal › Article (Academic Journal) › peer-review

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Abstract

Severity of personality disorder is an important determinant of future health. However, this key prognostic variable is not captured in routine clinical practice. Using a large clinical data-set, we explored the predictive validity of items from the Health of Nation Outcome Scales (HoNOS) as potential indicators of personality disorder severity. For 6912 patients with a personality disorder diagnosis, we examined associations between HoNOS items relating to core personality disorder symptoms (self-harm, difficulty in interpersonal relationships, performance of occupational and social roles, and agitation and aggression) and future health service use. Compared with those with no self-harm problem, the total healthcare cost was 2.74 times higher (95% CI 1.66–4.52; P < 0.001) for individuals with severe to very severe self-harm problems. Other HoNOS items did not demonstrate clear patterns of association with service costs. Self-harm may be a robust indicator of the severity of personality disorder, but further replication work is required.

Original language	English
Article number	e137
Journal	BJPsych Open
Volume	9
Issue number	5
Early online date	1 Aug 2023
DOIs	https://doi.org/10.1192/bjo.2023.509
Publication status	Published - 1 Sept 2023

Bibliographical note

Funding Information:
This paper represents independent research part funded by the NIHR Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. J.M.-C. is part funded by the University of Bristol. C.F. was part funded by the Robert Luff Foundation. R.D.H., G.K.-S. and H.S. receive salary support from the NIHR Biomedical Research Centre at SLaM and King's College London. P.M. is part-funded by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol and by the NIHR Applied Research Collaboration (ARC) West. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Publisher Copyright:
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

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title = "Defining severity of personality disorder using electronic health records: short report",

abstract = "Severity of personality disorder is an important determinant of future health. However, this key prognostic variable is not captured in routine clinical practice. Using a large clinical data-set, we explored the predictive validity of items from the Health of Nation Outcome Scales (HoNOS) as potential indicators of personality disorder severity. For 6912 patients with a personality disorder diagnosis, we examined associations between HoNOS items relating to core personality disorder symptoms (self-harm, difficulty in interpersonal relationships, performance of occupational and social roles, and agitation and aggression) and future health service use. Compared with those with no self-harm problem, the total healthcare cost was 2.74 times higher (95% CI 1.66–4.52; P < 0.001) for individuals with severe to very severe self-harm problems. Other HoNOS items did not demonstrate clear patterns of association with service costs. Self-harm may be a robust indicator of the severity of personality disorder, but further replication work is required.",

author = "Jonathan Monk-Cunliffe and Giouliana Kadra-Scalzo and Chloe Finamore and Oliver Dale and Mizanur Khondoker and Barbara Barrett and Hitesh Shetty and Hayes, {Richard d.} and Paul Moran",

note = "Funding Information: This paper represents independent research part funded by the NIHR Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. J.M.-C. is part funded by the University of Bristol. C.F. was part funded by the Robert Luff Foundation. R.D.H., G.K.-S. and H.S. receive salary support from the NIHR Biomedical Research Centre at SLaM and King's College London. P.M. is part-funded by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol and by the NIHR Applied Research Collaboration (ARC) West. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: Copyright {\textcopyright} The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.",

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AU - Shetty, Hitesh

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N1 - Funding Information: This paper represents independent research part funded by the NIHR Maudsley Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. J.M.-C. is part funded by the University of Bristol. C.F. was part funded by the Robert Luff Foundation. R.D.H., G.K.-S. and H.S. receive salary support from the NIHR Biomedical Research Centre at SLaM and King's College London. P.M. is part-funded by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol and by the NIHR Applied Research Collaboration (ARC) West. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

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AB - Severity of personality disorder is an important determinant of future health. However, this key prognostic variable is not captured in routine clinical practice. Using a large clinical data-set, we explored the predictive validity of items from the Health of Nation Outcome Scales (HoNOS) as potential indicators of personality disorder severity. For 6912 patients with a personality disorder diagnosis, we examined associations between HoNOS items relating to core personality disorder symptoms (self-harm, difficulty in interpersonal relationships, performance of occupational and social roles, and agitation and aggression) and future health service use. Compared with those with no self-harm problem, the total healthcare cost was 2.74 times higher (95% CI 1.66–4.52; P < 0.001) for individuals with severe to very severe self-harm problems. Other HoNOS items did not demonstrate clear patterns of association with service costs. Self-harm may be a robust indicator of the severity of personality disorder, but further replication work is required.

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Defining severity of personality disorder using electronic health records: short report

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