The Clinical Implications of DSM-IV Personality Disorder Comorbidity in Depressed Inpatients: A Replication Study in an Italian Setting

Abstract

In order to replicate, in a naturalistic Italian setting, prior studies about the clinical implications of Axis II comorbidity in depressed inpatients, 247 unipolar inpatients were divided into two diagnostic groups to examine the sociodemographic, clinical, and psychosocial correlates of patients with a concomitant personality disorder (PD). There were 155 depressed patients with a PD (63%) versus 92 (34%) patients with depression alone. Subjects were diagnosed on Axis I and II using the SCID-I and II. Self-ratings as well as expert ratings were used for assessment. Psychopathology and psychosocial functioning were measured by the Montgomery-Asberg Depression Rating Scale (MADRS), the Hamilton Rating Scale for Depression (HAM-D), the Symptom Checklist-90 (SCL-90), and the Social Adjustment Scale (SAS). By comparison with cases of depression alone, depressed patients with concomitant PD were younger and had been significantly younger at the onset of their affective illnesses, they reported more suicidal attempts, and they were more likely to have never been married. They revealed as having severe social impairment in overall social adjustment, and in the leisure, extended family, marital role, and financial status subareas in the comparison of SAS scores between groups. The baseline-to-discharge symptom changes were evaluated between the two groups. A significant group × time interaction was found in all scores, with the exception of the HAM-D and three SCL-90 subscales: the PD patients had more severe symptoms at baseline. Finally, both groups reported a favorable treatment outcome at discharge. Then, although the PD patients showed a more seriously affected social functioning and a more severe baseline symptomatology than depressed patients without PD, the personality pathology did not appear to worsen treatment response. The main findings are discussed.