The Economic Burden of Personality Disorders in Mental Health Care
J Clin Psychiatry 2008;69(2):259-265
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Some evidence suggests that personality disorders
are associated with a high economic burden due to, for example, a high demand
on psychiatric, health, and social care services. However, state-of-the-art
cost studies for the broad range of personality disorder diagnoses are lacking.
The present study examines the direct medical costs, as well as the indirect
costs, of patients seeking mental health treatment with DSM-IV personality
Method: The 1740 subjects included in this study were
recruited from March 2003 to March 2006 from 6 different mental health care
institutes in the Netherlands specializing in the psychotherapeutic treatment
of personality disorders. The direct and indirect costs were assessed using the
Trimbos and Institute for Medical Technology Assessment Questionnaire on Costs
Associated with Psychiatric Illness. Personality disorders were diagnosed using
the Structured Interview for DSM-IV Personality.
Results: The mean total costs of the personality disorder
group in the 12 months prior to treatment were 11,126 euros per patient. Two thirds
(66.5%) of these costs consisted of direct medical costs, while the remaining
costs were related to productivity losses. Borderline and obsessive-compulsive
personality disorders were uniquely associated with increased mean total costs.
Conclusions: Treatment-seeking patients with personality
disorders pose a high economic burden on society, a burden substantially higher
than that found in, for instance, depression or generalized anxiety disorder.
These high societal costs present a strong argument in favor of prioritizing
effective personality disorder treatments in reimbursement decisions.