Antisocial behavioral syndromes and 3-year quality-of-life outcomes in United States adults

Goldstein RB, Dawson DA, Smith SM, Grant BF. Antisocial behavioral syndromes and 3‐year quality‐of‐life outcomes in United States adults. Objective: To examine 3‐year quality‐of‐life (QOL) outcomes among United States adults with Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition (DSM‐IV) antisocial personality disorder (ASPD), syndromal adult antisocial behavior without conduct disorder (CD) before age 15 [adulthood antisocial behavioral syndrome (AABS), not a DSM‐IV diagnosis], or no antisocial behavioral syndrome at baseline. Method: Face‐to‐face interviews (n = 34 653). Psychiatric disorders were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule – DSM‐IV Version. Health‐related QOL was assessed using the Short‐Form 12‐Item Health Survey, version 2 (SF‐12v2). Other outcomes included past‐year Perceived Stress Scale‐4 (PSS‐4) scores, employment, receipt of Supplemental Security Income (SSI), welfare, and food stamps, and participation in social relationships. Results: Antisocial personality disorder and AABS predicted poorer employment, financial dependency, social relationship, and physical health outcomes. Relationships of antisociality to SSI and food stamp receipt and physical health scales were modified by baseline age. Both antisocial syndromes predicted higher PSS‐4, AABS predicted lower SF‐12v2 Vitality, and ASPD predicted lower SF‐12v2 Social Functioning scores in women. Conclusion: Similar prediction of QOL by ASPD and AABS suggests limited utility of requiring CD before age 15 to diagnose ASPD. Findings underscore the need to improve prevention and treatment of antisocial syndromes.