Childbearing and mortality among women with personality disorders: nationwide registered-based cohort study

• Published in: BJPsych open 2020-09, Vol.6 (5), p.e95-e95, Article e95
• Main Authors: Kouppis, Efthymios, Björkenstam, Charlotte, Gerdin, Bengt, Ekselius, Lisa, Björkenstam, Emma
• Format: Article
• Language: English
• Subjects: Age; Child mortality; childbearing; Cohort analysis; Comorbidity; Education; Mortality; national registers; Personality disorder; Personality disorders; Population; Pregnancy; Socioeconomic factors; Suicides & suicide attempts; women; Womens health
• ISSN: 2056-4724; 2056-4724
• DOI: 10.1192/bjo.2020.77

BackgroundPeople with a personality disorder have a higher mortality and reduced life expectancy than the general population. Childbearing is thought to have a protective effect on morbidity and mortality. Yet, there are no studies on whether childbearing is related to a lower mortality among women with personality disorder.AimsThis study examined associations between childbearing and mortality among women with personality disorder. Our hypothesis was that parity would be associated with lower mortality.MethodThis register-based cohort study included 27 412 women treated for personality disorder in in-patient or specialised out-patient care between 1990 and 2015. We used nationwide population-based registers to obtain information on sociodemographics, child delivery, healthcare use and mortality. Mortality risk estimates were calculated as hazard ratios (HRs) with 95% CIs using Cox regression. Adjustments were made for year of birth, educational level, age at diagnosis, comorbidity and severity of personality disorder.ResultsNulliparous women had a nearly twofold increased mortality risk (adjusted HR = 1.78, 95% CI 1.50–2.12) compared with parous women and over twofold mortality risk (adjusted HR = 2.29, 95% CI 1.72–3.04) compared with those giving birth after their first personality disorder diagnosis. Those giving birth before their first personality disorder diagnosis had a 1.5-fold higher risk of mortality than those giving birth after their first personality disorder diagnosis (adjusted HR = 1.48, 95% CI 1.06–2.07). There was a threefold risk of suicide in nulliparous women compared with those giving birth after their first personality disorder diagnosis (adjusted HR = 2.90, 95% CI 1.97–4.26).ConclusionsChildbearing history should be an integral part of the clinical evaluation of women with personality disorder.