Antisocial Behavioral Syndromes and Past-Year Physical Health Among Adults in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions
J Clin Psychiatry 2008;69(3):368-380
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To describe associations of DSM-IV antisocial
personality disorder (ASPD), DSM-IV conduct disorder without progression to
ASPD (CD-only), and syndromal antisocial behavior in adulthood without conduct
disorder before age 15 years (AABS, not a DSM-IV diagnosis) with past-year
physical health status and hospital care utilization in the general U.S. adult
Method: This report is based on the 2001-2002 National
Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093, response
rate = 81%). Respondents were classified according to whether they met criteria
for ASPD, AABS, CD-only, or no antisocial syndrome. Associations of antisocial
syndromes with physical health status and care utilization were examined using
normal theory and logistic regression.
Results: ASPD and AABS were significantly but modestly
associated with total past-year medical conditions, coronary heart and
gastrointestinal diseases, and numbers of inpatient hospitalizations, inpatient
days, emergency department visits, and clinically significant injuries (all p <
.05). ASPD was also associated with liver disease, arthritis, and lower scores
on the Medical Outcomes Study 12-Item Short-Form Health Survey, version 2
(SF-12v2) physical component summary, role physical, and bodily pain scales
(all p < .05). AABS was associated with noncoronary heart disease, lower scores
on the SF-12v2 general health and vitality scales, and, among men, arthritis
(all p < .05). CD-only was associated with single but not multiple inpatient
hospitalizations, emergency department visits, and clinically significant
injuries (all p < .05).
Conclusions: Estimates of burden related to antisocial
behavioral syndromes need to consider associated physical health problems.
Prevention and treatment guidelines for injuries and common chronic diseases
may need to address comorbid antisociality, and interventions targeting
antisociality may need to consider general health status, including prevention
and management of injuries and chronic diseases.