Mortality in women with personality disorders : Relationship to childbearing, ADHD and injuries treated in healthcare

Sammanfattning: Personality disorders (PDs) constitute a significant global health problem, with approximately 8% of the population fulfilling diagnostic criteria for one or more PDs. PDs influence various healthcare aspects of an affected person’s life, leading to impaired functioning, suffering, and a lower quality of life. Persons with one or more PDs die earlier than the background population of natural and unnatural causes. They also consume a proportionately large amount of healthcare services and suffer more often from comorbid conditions. Furthermore, persons with PDs are prone to different injuries, such as accidents, self-inflicted injuries, and abuse. Women with PDs have a higher frequency of perinatal complications and problems in child rearing than the background population. Borderline PD (BPD), one of the most frequently diagnosed PDs, is much more often diagnosed in women than men despite the similar prevalence rates in both sexes.This thesis aimed to elucidate the effect of parity, comorbidity with ADHD, and the accumulated number of injuries treated in healthcare on mortality in women diagnosed with PD, all based on data from high-quality Swedish healthcare registers.Study I is a validation study of the Swedish National Patient Register (NPR) on the accuracy of registered PD diagnoses by scrutinizing records for patients diagnosed with PD. It was concluded that the NPR has good validity for diagnosing PD.Study II investigates the effect of childbearing on all-cause mortality in women with any PD. The study demonstrated that women with PD who have given birth have a lower all-cause mortality than those who did not.Study III assesses the effect of comorbid ADHD on mortality in women with BPD. No significant effects were detected.Study IV reports a positive association between the number of injuries and intoxications that required inpatient care, on the one hand, and death due to natural and unnatural causes, on the other, in women with PD.This thesis shows that register data from the NPR can assess the consequences of having PD for diverse aspects of life. Specifically, it revealed the beneficial association between being parous for the risk of death, the indifferent association of having a comorbid ADHD, and the aggravating association between death risk and being prone to repeated injuries requiring inpatient healthcare.