© 2009 The Royal College of Psychiatrists
DSM–IV personality disorders in the WHO World Mental Health Surveys
Institute of Mental Health, Peking University, Beijing, China
Stony Brook University, Stony Brook, New York, USA
IRCCS Centro S. Giovanni di Dio Fatebenefratelli, Brescia, Italy
Department of Psychology, University of Cagliari, Italy
Center for Public Mental Health, Gösing am Wagram, Austria
National Institute of Psychiatry, Mexico City, Mexico
University Hospital Gasthuisberg, Leuven, Belgium
Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands
Department of Psychiatry, University College Hospital, Ibadan, Nigeria
Department of Psychiatry and Clinical Psychology, Saint George Hospital University Medical Center, Department of Psychiatry and Clinical Psychology, Faculty of Medicine, Balamand University Medical School, and the Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Beirut, Lebanon
Department of Psychiatry, The Chinese University of Hong Kong, HKSAR, People’s Republic of China
INSERM U 705, CNRS UMR 7157, University Paris Diderot, Hôpital Lariboisière Fernand Widal, Assistance Publique Hôpitaux de Paris, France
Clinic of Psychiatry, University of Leipzig, Germany
Colegio Mayor de Cundinamarca University, Bogata, Colombia
MRC Anxiety Disorders Research Unit, Department of Psychiatry, University of Stellenbosch, South Africa
Health Services Research Unit, Institut Municipal d’Investigacio Medica (IMIM), CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA
Correspondence: Ronald C. Kessler, Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, Massachusetts 02115, USA. Email: kessler{at}hcp.med.harvard.edu
R.C.K has been a consultant for GlaxoSmithKline, Kaiser Permanente, Pfizer Inc, Sanofi-Aventis, Shire Pharmaceuticals and Wyeth-Ayerst. He has served on advisory boards for Eli Lilly & Company and Wyeth-Ayerst, and has had research support for his epidemiological studies from Bristol-Myers Squibb, Eli Lilly & Company, GlaxoSmithKline, Johnson & Johnson Pharmaceuticals, Ortho-McNeil Pharmaceuticals Inc, Pfizer Inc and Sanofi-Aventis.
This study was supported by the US National Institute of Mental Health (NIMH) (R01-MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864 and R01-DA016558), the Fogarty International Center (FIRCA R03-TW006481), the Pan American Health Organization, the Eli Lilly & Company Foundation, Ortho-McNeil Pharmaceutical Inc, GlaxoSmithKline and Bristol-Myers Squibb. A complete list of WMH publications can be found at www.hcp.med.harvard.edu/wmh/.
The Chinese World Mental Health Survey Initiative is supported by the Pfizer Foundation. The Colombian National Study of Mental Health (NSMH) is supported by the Ministry of Social Protection. The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP), and other local agencies and by an unrestricted educational grant from GlaxoSmithKline. The Lebanese National Mental Health Survey (LEBANON) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), Fogarty International, Act for Lebanon, anonymous private donations to IDRAAC, Lebanon, and unrestricted grants from Janssen Cilag, Eli Lilly, GlaxoSmithKline, Roche and Novartis. The Mexican National Comorbidity Survey (MNCS) is supported by the National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544-H), with supplemental support from the Pan American Health Organization (PAHO). The Nigerian Survey of Mental Health and Wellbeing (NSMHW) is supported by the WHO (Geneva), the WHO (Nigeria) and the Federal Ministry of Health, Abuja, Nigeria. The South Africa Stress and Health Study (SASH) is supported by the US NIMH (R01-MH059575) and National Institute of Drug Abuse (NIDA) with supplemental funding from the South African Department of Health and the University of Michigan. The US National Comorbidity Survey Replication (NCS–R) is supported by the NIMH (U01-MH60220) with supplemental support from NIDA, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Robert Wood Johnson Foundation (Grant 044708), and the John W. Alden Trust.
Background
Little is known about the cross-national population prevalence or correlates of personality disorders.
Aims
To estimate prevalence and correlates of DSM–IV personality disorder clusters in the World Health Organization World Mental Health (WMH) Surveys.
Method
International Personality Disorder Examination (IPDE) screening questions in 13 countries (n = 21 162) were calibrated to masked IPDE clinical diagnoses. Prevalence and correlates were estimated using multiple imputation.
Results
Prevalence estimates are 6.1% (s.e. = 0.3) for any personality disorder and 3.6% (s.e. = 0.3), 1.5% (s.e. = 0.1) and 2.7% (s.e. = 0.2) for Clusters A, B and C respectively. Personality disorders are significantly elevated among males, the previously married (Cluster C), unemployed (Cluster C), the young (Clusters A and B) and the poorly educated. Personality disorders are highly comorbid with Axis I disorders. Impairments associated with personality disorders are only partially explained by comorbidity.
Conclusions
Personality disorders are relatively common disorders that often co-occur with Axis I disorders and are associated with significant role impairments beyond those due to comorbidity.
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BJP 2009 195: A2.[Full Text]