Welfare consequences of early-onset Borderline Personality Disorder: a nationwide register-based case-control study
Abstract
Information regarding welfare consequences of early onset of Borderline Personality Disorder (BPD) is limited. This nationwide study aimed to estimate the educational and employment outcome and health care costs of patients with early-onset BPD compared with matched controls. All patients (< 19 years) with first diagnosis of BPD in the Danish Patient Register (NPR) during the period 1983-2015 were included. Health care costs and socioeconomic variables were extracted from national registers. A total of 171 patients was compared with 677 controls. At the age of 20 years, BPD patients had reached a statistically significantly lower educational level (including lower primary school grades) and employment status compared with the controls. When adjusting for the parents' educational level, BPD patients were nearly 22 times more likely to be unemployed (OR = 21.7, 95% CI 11.9, 39.6), and nearly 15 times more likely to be on disability pension (OR = 14.8, 95% CI 5.0, 43.9) than controls. Furthermore, the total health care costs were more than 8 times higher in the BPD group. Early onset of BPD was associated with lower educational and vocational outcome and increased health care costs as early as at the age of 20 years. Even after controlling for parents' lower socioeconomic status, the patients have poorer outcome than the control group. This underlines that initiatives to support patients in finishing school and secondary education is highly needed. Future prevention and early intervention programs should target patients with early-onset BPD and their families.
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Negative outcomes such as educational challenges, unemployment, and increased health care utilization and costs are already prevalent during the transition from adolescence to young adulthood in persons with BPD.
“evidence consistently suggests that negative outcomes, such as educational challenges, unemployment, and increased health care utilization and costs, are already prevalent during the transition from adolescence to young adulthood in persons with BPD [11, 12].”
BPD during the transition to adulthood interferes extensively with development of adult role functioning.
“The abovementioned findings regarding long-term outcomes [e.g., (48)] strongly suggest that BPD during the transition to adulthood interferes extensively with development of adult role functioning.”
From The diagnosis that should speak its name: why it is ethically right to diagnose and treat personality disorder during adolescence (2023) · cites this paper as [48]
These poor outcomes are already established in the transition from adolescence to young adulthood in young persons with BPD.
“Evidence clearly suggests that these poor outcomes are already established in the transition from adolescence to young adulthood in young persons with BPD (31, 48).”
From The diagnosis that should speak its name: why it is ethically right to diagnose and treat personality disorder during adolescence (2023) · cites this paper as [48]
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- Authors
- Hastrup, L. H., Jennum, P., Ibsen, R., Kjellberg, J., & Simonsen, E.
- Affiliations
- Psychiatry Region Zealand (DK)
- Rigshospitalet (DK)
- VIVE - The Danish Center for Social Science Research (DK)
- University of Copenhagen (DK)
- Corresponding author
- Hastrup, Lene Halling
- Venue
- European Child & Adolescent Psychiatry
- Published
- 2020-11-24
- Volume
- 31
- Issue
- 2
- Pages
- 253-260
- ISSN
- 1018-8827 (ISSN-L)
- 1435-165X
- OpenAlex
- W3108992275
- Cited by
- 37
- References
- 62
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 11 · 2023: 10 · 2022: 2 · 2021: 1
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- welfare effects, educational attainment, employment status, unemployment, disability pension, health care costs, socioeconomic status, parental socioeconomic status, career outcomes, prevention and early intervention
- MeSH terms
- Adult, Borderline Personality Disorder, Educational Status, Employment, Humans, Case-Control Studies, Health Care Costs, Young Adult
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