Psychiatric Care for Patients With Borderline Intellectual Disability

Study data published in the Journal of Psychiatric Research outline trends in the diagnosis and treatment of psychiatric disorders in patients with borderline intellectual impairment. While reported treatment access has increased over time, rates of psychiatric disorders have also increased, demonstrating a sustained need for mental health care in this population.

Borderline intellectual functioning (BIF) is a descriptive code, rather than a clinical diagnosis, and is characterized by an intelligence quotient (IQ) between 70 and 85. In the United Kingdom, patients with BIF often do not qualify for the specialist services offered to adults with intellectual disabilities. To assess trends in psychiatric diagnosis and treatment in this population, investigators extracted data from the Adult Psychiatric Morbidity Survey (APMS), a series of in-person surveys carried out in England at regular intervals. Data from the years 2000, 2007, and 2014 were included in the analyses.

At each time point, survey interviewers administered questions that captured data on demographics, mental illness, suicidal behavior, and utilization of mental health services. The National Adult Reading Test was used to assess intellectual functioning. Using survey results, logistic regression was used to assess the relative rates of psychiatric disorders and psychiatric care utilization in patients with BIF.

The final study cohort comprised 21,796 adults, among whom 2786 (12.8%) were considered to have BIF. The prevalence of BIF among survey respondents was consistent across years, ranging from 12.6% to 13.2%. Mean age and gender distribution were also similar across waves. Patients with BIF were more likely to meet the diagnostic criteria for multiple psychiatric disorders at all-time points, including depressive episodes, phobia, agoraphobia, and any neurotic disorder.

Higher prevalence rates of self-harm were also observed in the BIF cohort vs the general population for the years 2000 (3.7% vs 2.1%), 2007 (4.8% vs 2.9%), and 2014 (9.2% vs 5.1%). Patients with BIF were also more likely to report a prior suicide attempt. Notably, the prevalence of anxiety disorders, depressive disorders, psychosis, self-harm, and suicide attempts increased with each survey cycle.

Compared with the general population, patients with BIF were more likely to receive psychiatric treatment in the form of medication or therapy. Specifically, in 2014, patients with BIF were significantly more likely to receive antidepressants (odds ratio [OR], 1.47; 95% CI, 1.17-1.83), antipsychotics (OR, 3.18; 95% CI, 1.90-5.32), and therapy (OR, 1.58; 95% CI, 1.03-2.30) compared with the general population. Individuals with BIF were also significantly more likely to report admission to a psychiatric ward (OR, 3.31; 95% CI, 1.16-9.46), though contact frequency with formal psychologists and psychiatrists did not appear to be elevated.

Patients with BIF reported more visits with their general practitioners for mental health complaints. Treatment and health care access increased in the BIF cohort over time, with more patients reporting use of medication or a practitioner for mental health concerns in 2014 compared with 2000.

Results from this analysis suggest that while care access among patients with BIF has increased over time, so too has the prevalence of certain psychiatric disorders. The recognition of BIF as a distinct diagnostic category may allow better targeting of mental health resources to patients in need. Limitations of the present analysis include the cross-sectional design and the use of self-report to capture treatment use. Further research is necessary to investigate means of identifying and treating psychiatric symptoms in patients with BIF.

“Access to day-care, community care and health care services has increased over time for [patients with BIF] but not formal psychiatric care,” the authors wrote. “These changes over time underline some of the problems this population faces, emphasizing a need to recognize that this is a population often overlooked in research and clinical practice.”

Reference

Lim A, Totsika V, Ali A. Analysing trends of psychiatric disorders, treatment and service use across time in adults with borderline intellectual impairment: a cross-sectional study of private households. J Psychiatr Res. 2022;151:339-346. doi:10.1016/j.jpsychires.2022.04.026