Restricted accessResearch articleFirst published online 2022-1
Exploring the prevalence of personality disorder and the feasibility of using the SAPAS as a screening tool for personality disorder in an emergency department in India
Personality disorders (PD) lead to frequent emergency department (ED) visits. Existing studies have evaluated high-risk ED populations in Western settings. PD screening tools, such as the Standardized Assessment of Personality – Abbreviated Scale (SAPAS), have thus far only been validated in Western populations.
Aims
This study aimed to establish the screened prevalence of PD, and to evaluate the performance of the SAPAS as a screening tool within an ED setting in India.
Methods
The study took place in the ED of a private multi-speciality hospital in Kolkata, India. All attendees were approached during two days per week over three months, except those who were medically unfit to participate. The SAPAS and the International Personality Disorder Examination (IPDE) were translated into Bengali and then used as screening tools for PD and as the reference standard for PD diagnosis.
Results
Out of 120 ED attendees approached, 97 participated (48 men and 49 women), of whom 24% met the criteria for a diagnosis of PD. A cut-off score of 4 on the SAPAS provided the best trade-off between sensitivity and specificity for detecting PD.
Conclusion
The prevalence of PD was similar to Western samples, and the SAPAS showed promise for use in a non-Western setting.
TyrerPReedGMCrawfordMJ.Classification, assessment, prevalence and effect of personality disorder. Lancet2015;
385: 717–726.
2.
LenzenwegerMF.Epidemiology of personality disorders. Psychiatr Clin North Am2008;
31: 395–403.
3.
CoidJYangMTyrerP, et al.
Prevalence and correlates of personality disorder in Great Britain.Br J Psychiatry2006;
188: 423–431.
4.
TorgersenSKringlenECramerV.The prevalence of personality disorders in a community sample.Arch Gen Psychiatry2001;
58: 590–596.
5.
KeuroghlianASFrankenburgFRZanariniMC.The relationship of chronic medical illnesses, poor health-related lifestyle choices and health care utilization to recovery status in borderline patients over a decade of prospective follow-up. J Psychiatr Res2013;
47: 1499–1506.
6.
FokMLSeegobinSFrissaS, et al.
Validation of the Standardised Assessment of Personality – Abbreviated Scale in a general population sample. Personal Ment Health2015;
9: 250–257.
7.
FokMLHayesRDChangCK, et al.
Life expectancy at birth and all-cause mortality among people with personality disorder.J Psychosom Res2012;
73: 104–107.
8.
SkodolAEGundersonJGSheaMT, et al.
The collaborative longitudinal personality disorders study (CLPS): overview and implications.J Pers Disord2005;
19: 487–504.
9.
ZanariniMCFrankenburgFRHennenJ, et al.
The McLean Study of Adult Development (MSAD): overview and implications of the first six years of prospective follow-up.J Pers Disord2005;
19: 505–523.
10.
AnsellEBSanislowCAMcGlashanTH, et al.
Psychosocial impairment and treatment utilization by patients with borderline personality disorder, other personality disorders, mood and anxiety disorders, and a healthy comparison group.Compr Psychiatry2007;
48: 329–336.
11.
BlackDWBlumNPfohlB, et al.
Suicidal behavior in borderline personality disorder: prevalence, risk factors, prediction, and prevention.J Pers Disord2004;
18: 226–239.
12.
LewisKLFanaianMKotzeB, et al.
Mental health presentations to acute psychiatric services: 3-year study of prevalence and readmission risk for personality disorders compared with psychotic, affective, substance or other disorders.BJPsych Open2019;
5: e1.
13.
PenfoldSGrollDMauer-VakilD, et al.
A retrospective analysis of personality disorder presentations in a Canadian University-affiliated hospital’s emergency department.BJPsych Open2016;
2: 394–399.
14.
MoranPStewartRBrughaT, et al.
Personality disorder and cardiovascular disease: results from a national household survey. J Clin Psychiatry2007;
68: 69–74.
15.
Dixon-GordonKLWhalenDJLaydenBK, et al.
A systematic review of personality disorders and health outcomes.Can Psychol2015;
56: 168–190.
16.
TwomeyCDBaldwinDSHopfeM, et al.
A systematic review of the predictors of health service utilisation by adults with mental disorders in the UK.BMJ Open2015;
5: e007575.
17.
ChangGWeissAPOravEJ, et al.
Predictors of frequent emergency department use among patients with psychiatric illness. Gen Hosp Psychiatry2014;
36: 716–720.
18.
ByrneMMurphyAWPlunkettPK, et al.
Frequent attenders to an emergency department: a study of primary health care use, medical profile, and psychosocial characteristics.Ann Emerg Med2003;
41: 309–318.
19.
LucasRHSanfordSM.An analysis of frequent users of emergency care at an urban university hospital. Ann Emerg Med1998;
32: 563–568.
20.
AndoSTMatsumotoSKanataA, et al.
One-year follow up after admission to an emergency department for drug overdose in Japan.Psychiatry Clin Neurosci2013;
67: 441–450.
21.
Blasco-FontecillaHBaca-GarciaEDervicK, et al.
Specific features of suicidal behavior in patients with narcissistic personality disorder. J Clin Psychiatry2009;
70: 1583–1587.
22.
YamadaTKawanishiCHasegawaH, et al.
Psychiatric assessment of suicide attempters in Japan: a pilot study at a critical emergency unit in an urban area.BMC Psychiatry2007;
7: 64.
23.
BilénKOttossonCCastrénM, et al.
Deliberate self-harm patients in the emergency department: factors associated with repeated self-harm among 1524 patients.J Emerg Med2011;
28: 1019–1025.
24.
OlfsonMMarcusSCBridgeJA.Emergency department recognition of mental disorders and short-term outcome of deliberate self-harm.Am J Psychiatry2013;
170: 1442–1450.
25.
WagnerJAPietrzakRHPetryNM.Psychiatric disorders are associated with hospital care utilization in persons with hypertension: results from the National Epidemiologic Survey on alcohol and related conditions.Soc Psychiatry Psychiatr Epidemiol2008;
43: 878–888.
26.
RichmondTSHollanderJEAckersonTH, et al.
Psychiatric disorders in patients presenting to the emergency department for minor injury. Nurs Res2007;
56: 275.
27.
KoponenSTaiminenTHiekkanenH, et al.
Axis I and II psychiatric disorders in patients with traumatic brain injury: a 12-month follow-up study.Brain Inj2011;
25: 1029–1034.
28.
AndoSMatsumotoTKanataS, et al.
One‐year follow up after admission to an emergency department for drug overdose in Japan. Psychiatry Clin Neurosci2013;
67: 441–450.
29.
BerrinoAOhlendorfPDuriauxS, et al.
Crisis intervention at the general hospital: an appropriate treatment choice for acutely suicidal borderline patients.Psychiatry Res2011;
186: 287–292.
30.
HuNGlauertRALiJ, et al.
Risk factors for repetition of a deliberate self-harm episode within seven days in adolescents and young adults: a population-level record linkage study in Western Australia.Aust N Z J Psychiatry2016;
50: 154–166.
31.
McCullum-SmithCClarkBBlairC, et al.
Rapid follow-up for patients after psychiatric crisis.Community Ment Health J2015;
51: 139–144.
32.
OlfsonMMarcusSCBridgeJA.Emergency department recognition of mental disorders and short-term outcome of deliberate self-harm.Am J Psychiatry2013;
170: 1442–1450.
33.
SmithMWStocksCSantoraPB.Hospital readmission rates and emergency department visits for mental health and substance abuse conditions. Community Ment Health J2015;
51: 190–197.
34.
CollinsABarnicotKSenP.A systematic review and meta-analysis of personality disorder prevalence and patient outcomes in Emergency departments. J Pers Disord2020;
1: 1–24.
35.
HamiltonJEDesaiPVHootNR, et al.
Factors associated with the likelihood of hospitalization following emergency department visits for behavioral health conditions.Acad Emerg Med2016;
23: 1257–1266.
36.
ShaikhUQamarIJafryF, et al.
Patients with borderline personality disorder in emergency departments. Front Psychiatry2017;
8: 136.
37.
TyrerPCrawfordMMulderR, et al.
The rationale for the reclassification of personality disorder in the 11th revision of the International Classification of Diseases (ICD‐11). Pers Ment Health2011;
5: 246–259.
38.
TyrerPMulderRKimYR, et al.
The development of the ICD-11 classification of personality disorders: an amalgam of science, pragmatism, and politics.Annu Rev Clin Psychol2019;
15: 481–502.
39.
NathSPatraDKBiswasS, et al.
Comparative study of personality disorder associated with deliberate self harm in two different age groups (15–24 years and 45–74 years).Indian J Psychiatry2008;
50: 177.
40.
MenonPChaudhariBSaldanhaD, et al.
Childhood sexual abuse in adult patients with borderline personality disorder. Ind Psychiatry J2016;
25: 101–106.
41.
SarkarSPatraPMridhaK, et al.
Personality disorders and its association with anxiety and depression among patients of severe acne: a cross-sectional study from Eastern India.Indian J Psychiatry2016;
58: 378–382.
42.
SharanP.An overview of Indian research in personality disorders.Indian J Psychiatry2010;
52: S250.
43.
GuptaSMattooSK.Personality disorders: prevalence and demography at a psychiatric outpatient in North India.Int J Soc Psychiatry2012;
58: 146–152.
44.
SharanPKulharaPVermaSK, et al.
Reliability of the ICD-10 International Personality Disorder Examination (IPDE) (Hindi version): a preliminary study. Indian J Psychiatry2002;
44: 362.
45.
DahlAAAndreoliA.Problems in the field of personality disorders. In: LorangerAMJancaASartoriusN (eds) Assessment and diagnosis of personality disorders. The ICD-10 International Personality Disorder Examination (IPDE).
Cambridge:
Cambridge University Press, 1997, pp.3–9.
46.
MoranPLeeseMLeeT, et al.
Standardised Assessment of Personality – Abbreviated Scale (SAPAS): preliminary validation of a brief screen for personality disorder.Br J Psychiatry2003;
183: 228–232.
47.
InnocentSPodderPRamJR, et al.
Using the SAPAS to identify risk for personality disorders among psychiatric outpatients in India: a feasibility study.Pers Ment Health2018;
12: 15–24.
Hajian-TilakiK.Sample size estimation in diagnostic test studies of biomedical informatics.J Biomed Inform2014;
48: 193–204.
50.
GermansSVan HeckGLMoranP, et al.
The self-report Standardized Assessment of Personality – Abbreviated Scale: preliminary validation of a brief screening test for personality disorder. Pers Ment Health2008;
2: 70–76.
51.
GonzalezC.Screening for personality disorder in drug and alcohol dependence.Psychiatry Res2014;
217: 121–123.
52.
HesseMMoranP.Screening for personality disorder with the Standardised Assessment of Personality – Abbreviated Scale (SAPAS): further evidence of concurrent validity.BMC Psychiatry2010;
10: 10.
53.
HesseMRasmussenJPedersenMK.Standard uised Assessment of Personality – a study of validity and reliability in substance abusers.BMC Psychiatry2008;
8: 7.
54.
BukhJDBockCVinbergM, et al.
Clinical utility of Standardised Assessment of Personality – Abbreviated Scale (SAPAS) among patients with first episode depression.J Affect Dis2010;
127: 199–202.
55.
GorwoodPRouillonFEvenC, et al.
Treatment response in major depression: effects of personality dysfunction and prior depression.Br J Psychiatry2010;
196: 139–142.
56.
PluckGSirdifieldCBrookerC, et al.
Screening for personality disorder in probationers: validation of the Standardised Assessment of Personality – Abbreviated Scale (SAPAS). Pers Ment Health2012;
6: 61–68.
57.
KongerslevMMoranPBoS, et al.
Screening for personality disorder in incarcerated adolescent boys: preliminary validation of an adolescent version of the Standardised Assessment of Personality – Abbreviated Scale (SAPAS‐AV). BMC Psychiatry2012;
12: 94.
58.
LorangerAM.International Personality Disorder Examination (IPDE). In: LorangerAMJancaASartoriusN (eds) Assessment and diagnosis of personality disorders. The ICD-10 International Personality Disorder Examination (IPDE).
Cambridge:
Cambridge University Press, 1997, pp.43–51.
59.
MorseJQPilkonisPA.Screening for personality disorders.J Pers Disord2007;
21: 179–198.
60.
RansohoffDFFeinsteinAR.Problems of spectrum and bias in evaluating the efficacy of diagnostic tests.N Engl J Med1978;
299: 926–930.
61.
StewartSH.Alcoholics in acute medical settings have increased risk for other drug, mood, and personality disorders.Int J Psychiatry Med2007;
37: 59–67.
