1
|
Thakur B, Pathak M, Strenth C, Wilmoth K, Arnold EM. The relationship between borderline personality disorder and self-injurious/suicidal behaviors in adolescents and young adults: A protocol for systematic review and meta-analysis. Health Sci Rep 2024; 7:e2143. [PMID: 38863733 PMCID: PMC11165399 DOI: 10.1002/hsr2.2143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/19/2024] [Accepted: 05/08/2024] [Indexed: 06/13/2024] Open
Abstract
Background & Aims Borderline personality disorder (BPD) is a common psychiatric disorder associated with a high risk of suicide attempts, death by suicide, and non-suicidal self-injury (NSSI). A systematic and comprehensive understanding of the link between BPD and suicide and self-injury in adolescents and young adults is crucial for effective public health prevention strategies. This protocol outlines our approach to summarize the evidence on the association between BPD diagnosis and self-injurious/suicidal behaviors including death by suicide, nonfatal suicide attempts, NSSI, and self-harm behavior through a systematic review and meta-analysis. Methods The protocol is registered (PROSPERO: CRD42022363329) and developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P)-2015 statement. We will conduct a comprehensive literature search using electronic databases including MEDLINE, EMBASE, SCOPUS, Web of Science, CINHAL, and PsycINFO. The review will include studies that meet the specific inclusion criteria and will be searched using multiple databases A meta-analysis will be conducted using a fixed-effects or random-effects approach based on the level of heterogeneity. Subgroup analysis and meta-regression will be performed if necessary. Conclusion This study is unique, as it is the first of its kind to systematically review and analyze the existing literature on this topic. The results of this study will provide important evidence on the magnitude of this relationship overall and in different subgroups, which can be used to inform the development of effective prevention and treatment strategies.
Collapse
Affiliation(s)
- Bhaskar Thakur
- Department of Family and Community MedicineUT Southwestern Medical CenterDallasTexasUSA
- Peter O'Donnell Jr. School of Public HealthUT Southwestern Medical CenterDallasTexasUSA
| | - Mona Pathak
- Department of PharmacotherapyUNT System College of PharmacyFort WorthTexasUSA
| | - Chance Strenth
- Department of Family and Community MedicineUT Southwestern Medical CenterDallasTexasUSA
| | - Kristin Wilmoth
- Departments of Psychiatry and Physical Medicine & RehabilitationUT Southwestern Medical CenterDallasTexasUSA
| | | |
Collapse
|
2
|
Oliogu E, Ruocco AC. DSM-5 suicidal behavior disorder: a systematic review of research on clinical utility, diagnostic boundaries, measures, pathophysiology and interventions. Front Psychiatry 2024; 15:1278230. [PMID: 38322141 PMCID: PMC10844467 DOI: 10.3389/fpsyt.2024.1278230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024] Open
Abstract
Background It has been a decade since Suicidal Behavior Disorder (SBD) was introduced in Section III of the DSM-5 under "Conditions for Further Study". SBD is chiefly characterized by a self-initiated sequence of behaviors believed at the time of initiation to cause one's own death and occurring in the last 24 months. Aims To systematically review empirical studies on SBD to identify primary research themes and promising future research directions. Method A search of empirical articles on SBD published between May 2013 and March 2023 was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Screening of 73 records by two independent raters yielded 14 eligible articles. The primary research themes identified from these articles included clinical utility of SBD to predict future suicide risk, association of SBD with closely related disorders, psychometric properties of SBD measures, pathophysiology of SBD, and the effectiveness of interventions for people with SBD. Conclusion Understanding of SBD has slowly progressed since its introduction a decade ago and has mainly been applied in research to define study groups displaying suicidal behavior. The clinical utility of SBD for predicting future suicide risk is low and more research is needed to understand measurement of the diagnosis and its distinctiveness from related disorders and other self-harming behaviors.
Collapse
Affiliation(s)
- Etinosa Oliogu
- Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada
| | - Anthony C. Ruocco
- Department of Psychological Clinical Science, University of Toronto, Toronto, ON, Canada
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada
| |
Collapse
|
3
|
McClelland H, Cleare S, O'Connor RC. Suicide Risk in Personality Disorders: A Systematic Review. Curr Psychiatry Rep 2023; 25:405-417. [PMID: 37642809 PMCID: PMC10506938 DOI: 10.1007/s11920-023-01440-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW This systematic review aimed to distil recent literature investigating psychosocial factors which may account for the association between personality disorder (PD) and suicide attempt or suicide death. RECENT FINDINGS Suicide risk is particularly elevated in people with PD compared to those with no, or many other, mental health diagnoses. Despite this, suicide prevention strategies for PD populations have not progressed markedly in recent years. It is critical, therefore, to identify additional factors associated with suicide in PD populations. Of the 34 studies included in this review, most identified a relationship between personality disorder and suicide attempt and/or death. Historical interpersonal factors (e.g., childhood trauma), drug and alcohol use, and ideation-to-enaction factors were commonly associated with suicide-related outcomes. Interventions that provide interpersonal support may reduce suicide attempts. Limitations of the review include the heterogeneity of studies and small sample sizes.
Collapse
Affiliation(s)
- Heather McClelland
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland.
| | - Seonaid Cleare
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, Institute of Health & Wellbeing, University of Glasgow, Glasgow, Scotland
| |
Collapse
|
4
|
Zhang L, Chen M, Yao B, Zhang Y. Aggression and Non-Suicidal Self-Injury among Depressed Youths: The Mediating Effect of Resilience. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:288-296. [PMID: 33747992 PMCID: PMC7956094 DOI: 10.18502/ijph.v50i2.5342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background The global spread of COVID-19 not only exerted an enormous impact on the public in different countries but also aggravated depression among youths. The aggressive tendencies of depressed individuals can harm their body and life and threaten those of others. The aggressive and non-suicidal self-injurious behaviors of depressed youths may seriously affect their physical and psychological health if not identified and mediated promptly. Method A total of 875 young respondents (including college students, community youths, migrant workers, and so on) from three provinces in China were surveyed in 2020 using a depression scale, non-suicidal self-injury scale, aggression scale, and resilience scale. Results Depression, non-suicidal self-injury, and aggression are significantly higher among the members of the depression group compared with the members of the healthy control group (P<0.001), and the resilience of the members of the former group is remarkably lower than that of the members of the latter group (P<0.001). Aggression among the depressed youths exhibits a significant positive correlation with non-suicidal self-injury (r= 0.43, P<0.01), whereas aggression (r= -0.18, P<0.05) and non-suicidal self-injury (r= -0.20, P<0.05) demonstrates significant negative correlations with resilience. The resilience of the youths in the depression group plays a partial mediating role in the relationship between aggression and non-suicidal self-injury. Conclusion The more aggressive the behaviors of the depressed youths, the more serious their non-suicidal self-injurious symptoms. Furthermore, resilience plays a partial mediating role in the relationship between aggression and non-suicidal self-injury.
Collapse
Affiliation(s)
- Ling Zhang
- Center for Mental Health, Shaoxing University, Shaoxing, China
| | - Meiai Chen
- School of Tourism and Health, Zhejiang A & F University, Hangzhou, China
| | - Benxian Yao
- College of Teacher Education, Hefei Normal University, Hefei, China
| | - Ying Zhang
- Center for Mental Health, Shaoxing University, Shaoxing, China
| |
Collapse
|
5
|
Theoretical models of suicidal behaviour: A systematic review and narrative synthesis. THE EUROPEAN JOURNAL OF PSYCHIATRY 2021. [DOI: 10.1016/j.ejpsy.2021.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
6
|
Borderline personality disorder: from understanding ontological addiction to psychotherapeutic revolution. Eur Arch Psychiatry Clin Neurosci 2020; 270:941-945. [PMID: 31165236 DOI: 10.1007/s00406-019-01029-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/30/2019] [Indexed: 12/25/2022]
Abstract
Bypassing a reductionist view of existing diagnostic categories, ontological addiction theory (OAT) is a new psychological model of human functioning. Borderline Personality Disorder (BPD), defined as "a pattern of instability in interpersonal relationships, self-image and affects, and marked impulsivity", is not only common (up to 20% of psychiatric inpatients), but also strongly associated with suicide attempts and death by suicide. Therefore, BPD constitutes a major public health concern. As a consequence of an underlying condition of ontological addiction, self-harming behaviors can be conceptualized as addictions, suicidal acts reflecting an experiential avoidance strategy against unbearable psychological pain. The present paper aims at: (1) understanding BPD daily life experiences from the perspective of OAT; (2) offering psychotherapeutic perspectives for this mental disorder. The diagnostic category of BDP may be understood as a simple label reflecting several extreme types of manifestations resulting from the Self-grasping ignorance that underpins ontological addiction. Therefore, development of psychotherapeutic interventions targeting ontological addiction appears to be a promising future direction.
Collapse
|
7
|
[Suicidal behavior in light of COVID-19 outbreak: Clinical challenges and treatment perspectives]. Encephale 2020; 46:S66-S72. [PMID: 32471707 PMCID: PMC7205618 DOI: 10.1016/j.encep.2020.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The COVID-19 pandemic affected today more than 3,000,000 worldwide, and more than half of humanity has been placed in quarantine. The scientific community and the political authorities fear an epidemic of suicide secondary to this crisis. The aim of this review is to analyze the impact of the COVID-19 pandemic on the dimensions of the suicidal process and its interaction with the various risk factors. We also propose innovative strategies to manage suicidal behavior in the context of pandemic. METHODS We carried out a narrative review of international publications dealing with major pandemics (COVID-19, SARS) and their influence on suicidal vulnerability. RESULTS Many factors are likely to increase the emergence of suicidal ideation and suicide attempts during this crisis. Social distancing and quarantine could increase the feeling of disconnection and the perception of social pain in vulnerable individuals. Some populations at high suicidal risk could be further impacted by the current pandemic: the elderly, medical staff and individuals exposed to economic insecurity. Several innovative tools adapted to the constraints of social distancing and quarantine may prevent suicide risk: e-health, VigilanS, buddhist-derived practices and art engagement. CONCLUSIONS This unprecedented crisis may interact with certain dimensions of the suicidal process. However, it is time to innovate. Several suicide prevention tools all have their place in new modes of care and should be tested on a large scale.
Collapse
|
8
|
Gentil L, Huỳnh C, Grenier G, Fleury MJ. Predictors of emergency department visits for suicidal ideation and suicide attempt. Psychiatry Res 2020; 285:112805. [PMID: 32035375 DOI: 10.1016/j.psychres.2020.112805] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/09/2020] [Accepted: 01/19/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study investigated predictors of emergency department (ED) visits for suicidal ideation and suicide attempt in 2014-15 among patients at six Quebec emergency departments (ED), using administrative data. METHODS Participants (n = 11,778) used ED for suicidal ideation (30.4%); suicide attempt (7.0%); or other reasons (61.7%). A multinomial logistic regression was performed using variables described by the Andersen Behavioral Model. RESULTS The odds of ED visits for suicidal ideation or suicide attempt was high for adjustment disorders, personality disorders, and prior ED consultations for mental health (MH) reasons, but lower for schizophrenia spectrum and other psychotic disorders, illness acuity levels 3-5 (low severity), and 3+ consultations with outpatient psychiatrists. The odds of visiting ED for suicidal ideation increased in depressive disorders, and in the 12-17 year age range, but decreased in association with 1-2 outpatient psychiatrist consultations. The odds of suicide attempt also increased with alcohol use disorders and drug-induced disorders, but decreased with specific MH interventions at local community health services centers. CONCLUSION increasing access to ambulatory care, and care continuity in outreach programs for acute MH disorders, including substance-related disorders, may reduce ED visits for suicidal ideation and suicide attempt, while improving overall service delivery.
Collapse
Affiliation(s)
- Lia Gentil
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Institut universitaire sur les dépendances, 950 Louvain East, Montréal, Québec H2M 2E8, Canada; Psychiatry Department, McGill University, Canada
| | - Christophe Huỳnh
- Institut universitaire sur les dépendances, 950 Louvain East, Montréal, Québec H2M 2E8, Canada; School of Psychoeducation, Université de Montréal, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Montréal, Québec H4H 1R3, Canada; Institut universitaire sur les dépendances, 950 Louvain East, Montréal, Québec H2M 2E8, Canada; Psychiatry Department, McGill University, Canada.
| |
Collapse
|
9
|
Porter C, Palmier-Claus J, Branitsky A, Mansell W, Warwick H, Varese F. Childhood adversity and borderline personality disorder: a meta-analysis. Acta Psychiatr Scand 2020; 141:6-20. [PMID: 31630389 DOI: 10.1111/acps.13118] [Citation(s) in RCA: 158] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The aim of this meta-analysis was to better understand the magnitude and consistency of the association between childhood adversity and borderline personality disorder (BPD) across case-control, epidemiological and prospective cohort studies. METHOD Following the review protocol (reference: CRD42017075179), search terms pertaining to adversity and BPD were entered into three search engines. Random-effects meta-analysis synthesised the size and consistency of the effects. RESULTS A total of 97 studies compared BPD to non-clinical (k = 40) and clinical (k = 70) controls. Meta-analysis of case-control studies indicated that individuals with BPD are 13.91 (95% CI 11.11-17.43) times more likely to report childhood adversity than non-clinical controls. This effect was smaller when considering retrospective cohort (OR: 2.59; 95% CI 0.93-7.30) and epidemiological (OR: 2.56, 95% CI 1.24-5.30) studies. Findings were significant across adversity subtypes with emotional abuse (OR: 38.11, 95% CI: 25.99-55.88) and neglect (OR: 17.73, 95% CI = 13.01-24.17) demonstrating the largest effects. Individuals with BPD were 3.15 (95% CI 2.62-3.79) times more likely to report childhood adversity than other psychiatric groups. CONCLUSIONS This meta-analysis corroborates theoretical proposals that exposure to adverse life experiences is associated with BPD. It highlights the importance of considering childhood adversity when treating people diagnosed with BPD.
Collapse
Affiliation(s)
- C Porter
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - J Palmier-Claus
- Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Lancaster, UK.,Lancashire Care NHS Foundation Trust, Lancashire, UK
| | - A Branitsky
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - W Mansell
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - H Warwick
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - F Varese
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
10
|
Timäus C, Meiser M, Bandelow B, Engel KR, Paschke AM, Wiltfang J, Wedekind D. Pharmacotherapy of borderline personality disorder: what has changed over two decades? A retrospective evaluation of clinical practice. BMC Psychiatry 2019; 19:393. [PMID: 31830934 PMCID: PMC6909459 DOI: 10.1186/s12888-019-2377-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess the pharmacological treatment strategies of inpatients with borderline personality disorder between 2008 and 2012. Additionally, we compared pharmacotherapy during this period to a previous one (1996 to 2004). METHODS Charts of 87 patients with the main diagnosis of borderline personality disorder receiving inpatient treatment in the University Medical Center of Goettingen, Germany, between 2008 and 2012 were evaluated retrospectively. For each inpatient treatment, psychotropic drug therapy including admission and discharge medication was documented. We compared the prescription rates of the interval 2008-2012 with the interval 1996-2004. RESULTS 94% of all inpatients of the interval 2008-2012 were treated with at least one psychotropic drug at time of discharge. All classes of psychotropic drugs were applied. We found high prescription rates of naltrexone (35.6%), quetiapine (19.5%), mirtazapine (18.4%), sertraline (12.6%), and escitalopram (11.5%). Compared to 1996-2004, rates of low-potency antipsychotics, tri-/tetracyclic antidepressants and mood stabilizers significantly decreased while usage of naltrexone significantly increased. CONCLUSIONS In inpatient settings, pharmacotherapy is still highly prevalent in the management of BPD. Prescription strategies changed between 1996 and 2012. Quetiapine was preferred, older antidepressants and low-potency antipsychotics were avoided. Opioid antagonists are increasingly used and should be considered for further investigation.
Collapse
Affiliation(s)
- Charles Timäus
- Department of Psychiatry and Psychotherapy, University Medical Centre, University of Goettingen, Von-Siebold-Straße 5, 37075, Goettingen, Germany.
| | - Miriam Meiser
- 0000 0001 2364 4210grid.7450.6Department of Psychiatry and Psychotherapy, University Medical Centre, University of Goettingen, Von-Siebold-Straße 5, 37075 Goettingen, Germany
| | - Borwin Bandelow
- 0000 0001 2364 4210grid.7450.6Department of Psychiatry and Psychotherapy, University Medical Centre, University of Goettingen, Von-Siebold-Straße 5, 37075 Goettingen, Germany
| | - Kirsten R. Engel
- 0000 0001 2364 4210grid.7450.6Department of Psychiatry and Psychotherapy, University Medical Centre, University of Goettingen, Von-Siebold-Straße 5, 37075 Goettingen, Germany
| | - Anne M. Paschke
- 0000 0001 2364 4210grid.7450.6Department of Psychiatry and Psychotherapy, University Medical Centre, University of Goettingen, Von-Siebold-Straße 5, 37075 Goettingen, Germany
| | - Jens Wiltfang
- 0000 0001 2364 4210grid.7450.6Department of Psychiatry and Psychotherapy, University Medical Centre, University of Goettingen, Von-Siebold-Straße 5, 37075 Goettingen, Germany ,0000 0004 0438 0426grid.424247.3German Center for Neurodegenerative Diseases, Goettingen, Germany ,0000000123236065grid.7311.4Institute for Research in Biomedicine, Medical Science Department, University of Aveiro, Aveiro, Portugal
| | - Dirk Wedekind
- 0000 0001 2364 4210grid.7450.6Department of Psychiatry and Psychotherapy, University Medical Centre, University of Goettingen, Von-Siebold-Straße 5, 37075 Goettingen, Germany
| |
Collapse
|