Antisocial personality and risks of cause-specific mortality: results from the Epidemiologic Catchment Area study with 27 years of follow-up

Purpose: Little is known about the effect of antisocial personality disorder (ASPD) on the risks of cause-specific mortality in the community. This study aimed to close this gap by evaluating if ASPD increases risks of cause-specific mortality in population-based residential and institutionalized samples with 27 years of follow-up. Methods: Data were collected in four metropolitan sites as part of the Epidemiologic Catchment Area (ECA) study during 1979–1983. Records were linked to the National Death Index through the end of 2007. Cox proportional hazards models adjusted for propensity weights and sample weights were fitted to estimate the effect of ASPD on the hazard of dying. Results: 420 respondents with ASPD (median survival age 71.0 years) and 15,367 without ASPD (median survival age 84.6 years) were included in this study. Those with ASPD were more likely to die from all causes (HR = 4.46; 95% CI = 2.44–8.16), suicide (HR = 2.81; 95% CI = 1.03–7.65), malignant neoplasms (HR = 4.09; 95% CI = 2.66–6.28), chronic lower respiratory disease (HR = 5.67; 95% CI = 2.92–11.0), and human immunodeficiency virus infection (HR = 8.07; 95% CI = 2.03–32.1), but not from accidents (HR = 0.58; 95% CI = 0.17–1.93) or heart disease (HR = 1.09; 95% CI = 0.43–2.76). Conclusions: Our findings demonstrate that antisocial personality disorder is a strong predictor of all-cause mortality, and cause-specific mortality. Early identification, treatment, and prevention of ASPD are important public mental health initiatives that could reduce premature mortality among this vulnerable population.