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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

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 population.

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.