Further Considerations on Early Intervention for Borderline Personality Disorder

Migrant background and the impact of the COVID-19 pandemic on mental healthcare consultations among children and adolescents in Norway: a nationwide registry study

BACKGROUND

Despite concern about migrant children's mental health and their access to mental healthcare services during the COVID-19 pandemic, this topic has attracted little research attention. This study aimed to examine the impact of the COVID-19 pandemic on the use primary and specialist healthcare services for mental health problems among children and adolescents with migrant background.

METHODS

Using event study models, we investigated the impact of lockdown and subsequent COVID-19 infection control measures on children's health service use for mental health problems according to migrant background. Drawing on reimbursement data from Norwegian public healthcare providers we observe consultations in a pre-pandemic (2017-2019) and pandemic cohort (2019-2021) in primary and specialised care.

RESULTS

The pre-pandemic cohort included 77 324 migrants, 78 406 descendants of migrants and 746 917 non-migrants and the pandemic cohort included 76 830 migrants, 88 331 descendants and 732 609 non-migrants (age 6-19). The full cohorts were observed for mental healthcare use in primary care while a subsample (age 6-16) was observed for health care use in specialist care. Lockdown resulted in a dip in consultation volumes for mental disorders for all children, but this dip was relatively larger and more persistent for children with migrant background. After lockdown, consultation volumes rose more for non-migrant children than for children with migrant background. Consultations in primary healthcare peaked during January to April 2021 for non-migrants and descendants of migrants, but not for migrants (4%, 95% CI -4 to 11). In specialist care during the same period, consultations dropped by 11% for migrants (95% CI -21 to -1). By October 2021, all mental health consultations in specialist care were up with 8% for non-migrants (95% CI 0 to 15), and down with -18% for migrants and -2% for descendants (95% CIs -31 to -5 and -14 to 10). Migrant males experienced the largest reduction in consultations.

CONCLUSIONS

Changes in consultation volumes among children with migrant background after lockdown were not as pronounced as for non-migrants, and at times actually decreased. This suggests that an increase in barriers to care emerged during the pandemic for children with a migrant background.

Adolescent borderline personality disorder: Does early intervention 'bend the curve'?

OBJECTIVE

The Global Alliance for Prevention and Early Intervention for Borderline Personality Disorder (BPD) proposed a major change for youth mental health services. The Alliance recommended that early detection and specialised treatment for youth BPD becomes a major focus of their clinical activities. Since structured psychotherapies for BPD are complex and lengthy, this proposal has significant implications for youth policy, planning and resource allocation. Our commentary addresses whether BPD is diagnosable and treatable in youth, and whether early intervention results in longer-term benefits.

CONCLUSION

People diagnosed with BPD are highly heterogeneous and experience high levels of comorbidity. The low quality of the evidence for the treatment of BPD in adolescence limits our ability to develop evidence-based guidelines. Accordingly, there is no clear case for BPD early intervention as a major component of youth mental health services. The introduction of ICD-11 classification system may facilitate further empirical studies of personality disorders in adolescence and emerging adulthood.

A borderline personality assessment for adolescents: Validity and reliability of the Chinese languages borderline personality features scale (short form version) for adolescents/children

BACKGROUND

Borderline personality disorder (BPD) is characterized by behavioral patterns that promote suffering in many adolescents and their guardians. Currently, early diagnosis of BPD mainly depends on the effective assessment of pathological personality traits (i.e., borderline personality features) and using the indicated scales. The Borderline Personality Features Scale for Children-Short Form (BPFSC-SF) is widely used and the introduction of a Chinese version of the BPFSC-SF, can improve the diagnosis and prognosis of Chinese patients with BPD.

OBJECTIVE

The aim of the present study was to assess the validity and reliability of the Chinese version of the BPFSC-SF.

METHOD

120 adolescents with BPD were enrolled in the present study and completed the BPFSC-SF and the Personality Belief Questionnaire-Short Form (PBQ-SF) assessments. Confirmatory factor analysis (CFA) was used to test assessment validity. Test-retest correlations and the Cronbach's α coefficients were used to determine reliability.

RESULTS

CFA analysis identified primary factors of BPFSC, with each item ranging from 0.597~0.899. The Spearman rank correlation coefficient was 0.877 between CL-BFSFC-SF and the state vs. trait loneliness scale. The Cronbach's α of the scale was 0.854 in the clinical group. The test-retest reliability correlation coefficient (interclass correlation coefficients.ICC) was 0.937.

CONCLUSION

The Chinese version of BPFSC-SF is a valid and reliable tool for adolescent Chinese patients with BPD.