Personality Disorder in the Elderly Depressed

Abstract

The objectives of this study were to examine the association of personality disorder with outcome of depression in older patients (age ≥ 60) treated in a psychiatric day hospital for depression and to compare the clinical diagnosis of personality disorder at admission with the results of a semi-structured interview at follow-up. Sixty-four patients were followed up for a mean interval of 30 (13–49) months after admission to the psychiatric day hospital and the semi-structured interview, Social Support Scale, Life Events Inventory, Hamilton Depression Rating Scale and Mini-Mental State Examination administered by a psychiatrist blind to the details of the index admission. Forty-nine informants (a close friend or relative) were also interviewed using the semi-structured interview. Axis II diagnoses at the time of admission were determined from patient records. Personality disorder diagnoses were analysed according to DSM-III-R clusters. Twenty-one (33%) patients fulfilled criteria for personality disorder at admission and 23 (36%) at follow-up. There was strong agreement (k = 0.78) between patient and informant semi-structured interview results and moderate agreement (k = 0.41) between diagnosis at admission and at follow-up. Presence of a personality disorder, and in particular a cluster B personality disorder diagnosis was associated with chronic outcome of depression and with impaired social support. Personality is a significant factor in the outcome of depression in the elderly. It remains unclear whether current methods of assessment tap enduring characteristics, or manifestations of affective state.