Authors' Responses to Peer Review of “Offenders With Personality Disorder Who Fail to Progress: A Case-Control Study Using Partial Least Squares Structural Equation Modeling Path Analysis”

Background People of minority ethnic backgrounds may be disproportionately affected by severe COVID-19. Whether this relates to increased infection risk, more severe disease progression, or worse in-hospital survival is unknown. The contribution of comorbidities or socioeconomic deprivation to ethnic patterning of outcomes is also unclear. Methods We conducted a case-control and a cohort study in an inner city primary and secondary care setting to examine whether ethnic background affects the risk of hospital admission with severe COVID-19 and/or in-hospital mortality. Inner city adult residents admitted to hospital with confirmed COVID-19 (n = 872 cases) were compared with 3,488 matched controls randomly sampled from a primary healthcare database comprising 344,083 people residing in the same region. For the cohort study, we studied 1827 adults consecutively admitted with COVID-19. The primary exposure variable was self-defined ethnicity. Analyses were adjusted for socio-demographic and clinical variables. Findings The 872 cases comprised 48.1% Black, 33.7% White, 12.6% Mixed/Other and 5.6% Asian patients. In conditional logistic regression analyses, Black and Mixed/Other ethnicity were associated with higher admission risk than white (OR 3.12 [95% CI 2.63–3.71] and 2.97 [2.30–3.85] respectively). Adjustment for comorbidities and deprivation modestly attenuated the association (OR 2.24 [1.83–2.74] for Black, 2.70 [2.03–3.59] for Mixed/Other). Asian ethnicity was not associated with higher admission risk (adjusted OR 1.01 [0.70–1.46]). In the cohort study of 1827 patients, 455 (28.9%) died over a median (IQR) of 8 (4–16) days. Age and male sex, but not Black (adjusted HR 1.06 [0.82–1.37]) or Mixed/Other ethnicity (adjusted HR 0.72 [0.47–1.10]), were associated with in-hospital mortality. Asian ethnicity was associated with higher in-hospital mortality but with a large confidence interval (adjusted HR 1.71 [1.15–2.56]). Interpretation Black and Mixed ethnicity are independently associated with greater admission risk with COVID-19 and may be risk factors for development of severe disease, but do not affect in-hospital mortality risk. Comorbidities and socioeconomic factors only partly account for this and additional ethnicity-related factors may play a large role. The impact of COVID-19 may be different in Asians. Funding British Heart Foundation; the National Institute for Health Research; Health Data Research UK.

It is a widely held belief that psychopathic individuals are extremely difficult to treat, if not immune to treatment. This therapeutic pessimism is pervasive and undermines motivation to search for effective modes of intervention for psychopathic individuals. A review of 42 treatment studies on psychopathy revealed that there is little scientific basis for the belief that psychopathy is an untreatable disorder. Three significant problems with regard to the research on the psychopathy-treatment relation cast doubt on strident conclusions that deem the disorder untreatable. First, there is considerable disagreement as to the defining characteristics of psychopathy. Second, the etiology of psychopathy is not well understood. Third, there are relatively few empirical investigations of the psychopathy-treatment relationship and even fewer efforts that follow up psychopathic individuals after treatment. Psychologists are encouraged to investigate the psychopathy-treatment relation from multiple perspectives as well as to conduct long-term follow-up studies to establish a modern view of the psychopathy-treatment relation.