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Riemann G, Chrispijn M, Kupka RW, Penninx BWJH, Giltay EJ. Borderline personality features in relationship to childhood trauma in unipolar depressive and bipolar disorders. J Affect Disord 2024; 363:358-364. [PMID: 39029699 DOI: 10.1016/j.jad.2024.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 06/09/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
BACKGROUND Childhood trauma, including emotional neglect, emotional abuse, physical abuse, and sexual abuse, may contribute to borderline personality features like affective instability, identity problems, negative relationships, and self-harm. This study aims to explore how different types of childhood trauma affect these features in bipolar versus unipolar depressive disorders. METHODS We included 839 participants of the Netherlands Study of Depression and Anxiety (NESDA) with a lifetime diagnosis of major depressive disorder single episode (MDDS; N = 443), recurrent major depressive disorder (MDD-R; N = 331), or bipolar disorder (BD; N = 65). Multivariate regression was used to analyze data from the Childhood Trauma Interview and borderline features (from the self-report Personality Assessment Inventory). RESULTS On average, participants were 48.6 years old (SD: 12.6), with 69.2 % being women, and 50.3 % of participants assessed positive for childhood trauma. Adjusted analyses revealed that participants diagnosed with BD, followed by MDD-R, exhibited the highest number of borderline personality features. Additionally, within the entire group, a strong association was found between childhood trauma, especially emotional neglect, and the presence of borderline personality features. CONCLUSION Given the high prevalence of childhood trauma and borderline personality features, screening for these factors in individuals with mood disorders is crucial. Identifying these elements can inform and enhance the management of the often fluctuating and complex nature of these comorbid conditions, leading to more effective and tailored treatment strategies.
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Affiliation(s)
- Georg Riemann
- Fontys, University of Applied Science, Emmasingel 28, 5611 AZ Eindhoven, the Netherlands.
| | - Melissa Chrispijn
- Dimence Mental Health, Center for Bipolar Disorders, Deventer, the Netherlands
| | - Ralph W Kupka
- Amsterdam UMC, VU University, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Brenda W J H Penninx
- Amsterdam UMC, VU University, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Erik J Giltay
- Leiden University Medical Center (LUMC), Department of Psychiatry, Leiden, the Netherlands; Health Campus The Hague, Department of Public Health and Primary Care, Leiden University Medical Centre, The Hague, the Netherlands
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2
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Zimmerman M, Becker L. The hidden borderline patient: patients with borderline personality disorder who do not engage in recurrent suicidal or self-injurious behavior. Psychol Med 2023; 53:5177-5184. [PMID: 35903008 DOI: 10.1017/s0033291722002197] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite the significant psychosocial morbidity associated with borderline personality disorder (BPD), its underrecognition is a significant clinical problem. BPD is likely underdiagnosed, in part, because patients with BPD usually present with chief complaints associated with mood, anxiety, and substance use disorders. When patients with BPD do not exhibit self-harm behavior, we suspect that BPD is less likely to recognized. An important question is whether the absence of this criterion, which might attenuate the likelihood of recognizing and diagnosing the disorder, identifies a subgroup of patients with BPD who are 'less borderline' than patients with BPD who do not manifest this criterion. METHODS Psychiatric outpatients were evaluated with a semi-structured diagnostic interview for DSM-IV BPD, 390 of whom were diagnosed with BPD. We compared the demographic and clinical characteristics of patients with BPD who do and do not engage in repeated suicidal and self-harm behavior. RESULTS Approximately half of the patients with BPD did not meet the suicidality/self-injury diagnostic criterion for the disorder. There were no differences between the patients who did and did not meet this criterion in occupational impairment, likelihood of receiving disability payments, impairment in social functioning, level of educational achievement, comorbid psychiatric disorders, history of childhood trauma, or severity of depression, anxiety, or anger upon presentation for treatment. CONCLUSIONS Repeated self-injurious and suicidal behavior is not synonymous with BPD. It is critical for clinicians to be aware that the absence of repeated self-injury and suicide threats/gestures or attempts does not rule out the diagnosis of BPD.
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Affiliation(s)
- Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
| | - Lena Becker
- Department of Psychiatry and Human Behavior, Brown Medical School, Rhode Island Hospital, Providence, RI, USA
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3
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Madigan A, Daly M. Socioeconomic status and depressive symptoms and suicidality: The role of subjective social status. J Affect Disord 2023; 326:36-43. [PMID: 36709827 DOI: 10.1016/j.jad.2023.01.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 01/11/2023] [Accepted: 01/21/2023] [Indexed: 01/28/2023]
Abstract
BACKGROUND Low socioeconomic status (SES) confers access to material resources and social standing and is an established risk factor of both depressive symptoms and suicidality. Subjective social status (SSS) assesses how people perceive their position within the social hierarchy and has been proposed to impact mental health. This study examined the relationship between SES and depressive symptoms and suicidality and tested whether SSS mediated these associations. METHODS This study drew on publicly available survey data from the US National Longitudinal Study of Adolescent to Adult Health (Add Health). Participants were surveyed at baseline in 2008 (N = 4948; aged 28.8 years) and at followed up in 2016-2018 (N = 3509; aged 37.8 years). SES was gauged using personal and household income, assets, education, and job prestige. SSS was assessed using the MacArthur Scale. Depressive symptoms were assessed using four-items from the Centre for Epidemiological Studies Scale of Depression (CESD) and participants reported suicidal ideation and suicide attempts in the past year. RESULTS Both low SES and SSS were associated with elevated levels of depressive symptoms, suicidal ideation, and suicide attempts in cross-sectional and prospective analyses. SSS explained 27 % of the association between SES and depressive symptoms, 51 % of the relationship between SES and suicidal ideation, and 37 % of the link between SES and suicide attempts on average. CONCLUSIONS These findings contribute to understanding the long-term effects of SSS and suggest that perceptions of status may be a key mechanism through which low SES forecasts the development of depressive symptoms and suicidality.
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Affiliation(s)
- Anna Madigan
- Department of Psychology, Maynooth University, Co. Kildare, Ireland
| | - Michael Daly
- Department of Psychology, Maynooth University, Co. Kildare, Ireland.
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Stoffers-Winterling JM, Storebø OJ, Pereira Ribeiro J, Kongerslev MT, Völlm BA, Mattivi JT, Faltinsen E, Todorovac A, Jørgensen MS, Callesen HE, Sales CP, Schaug JP, Simonsen E, Lieb K. Pharmacological interventions for people with borderline personality disorder. Cochrane Database Syst Rev 2022; 11:CD012956. [PMID: 36375174 PMCID: PMC9662763 DOI: 10.1002/14651858.cd012956.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Among people with a diagnosis of borderline personality disorder (BPD) who are engaged in clinical care, prescription rates of psychotropic medications are high, despite the fact that medication use is off-label as a treatment for BPD. Nevertheless, people with BPD often receive several psychotropic drugs at a time for sustained periods. OBJECTIVES To assess the effects of pharmacological treatment for people with BPD. SEARCH METHODS For this update, we searched CENTRAL, MEDLINE, Embase, 14 other databases and four trials registers up to February 2022. We contacted researchers working in the field to ask for additional data from published and unpublished trials, and handsearched relevant journals. We did not restrict the search by year of publication, language or type of publication. SELECTION CRITERIA Randomised controlled trials comparing pharmacological treatment to placebo, other pharmacologic treatments or a combination of pharmacologic treatments in people of all ages with a formal diagnosis of BPD. The primary outcomes were BPD symptom severity, self-harm, suicide-related outcomes, and psychosocial functioning. Secondary outcomes were individual BPD symptoms, depression, attrition and adverse events. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials, extracted data, assessed risk of bias using Cochrane's risk of bias tool and assessed the certainty of the evidence using the GRADE approach. We performed data analysis using Review Manager 5 and quantified the statistical reliability of the data using Trial Sequential Analysis. MAIN RESULTS We included 46 randomised controlled trials (2769 participants) in this review, 45 of which were eligible for quantitative analysis and comprised 2752 participants with BPD in total. This is 18 more trials than the 2010 review on this topic. Participants were predominantly female except for one trial that included men only. The mean age ranged from 16.2 to 39.7 years across the included trials. Twenty-nine different types of medications compared to placebo or other medications were included in the analyses. Seventeen trials were funded or partially funded by the pharmaceutical industry, 10 were funded by universities or research foundations, eight received no funding, and 11 had unclear funding. For all reported effect sizes, negative effect estimates indicate beneficial effects by active medication. Compared with placebo, no difference in effects were observed on any of the primary outcomes at the end of treatment for any medication. Compared with placebo, medication may have little to no effect on BPD symptom severity, although the evidence is of very low certainty (antipsychotics: SMD -0.18, 95% confidence interval (CI) -0.45 to 0.08; 8 trials, 951 participants; antidepressants: SMD -0.27, 95% CI -0.65 to 1.18; 2 trials, 87 participants; mood stabilisers: SMD -0.07, 95% CI -0.43 to 0.57; 4 trials, 265 participants). The evidence is very uncertain about the effect of medication compared with placebo on self-harm, indicating little to no effect (antipsychotics: RR 0.66, 95% CI 0.15 to 2.84; 2 trials, 76 participants; antidepressants: MD 0.45 points on the Overt Aggression Scale-Modified-Self-Injury item (0-5 points), 95% CI -10.55 to 11.45; 1 trial, 20 participants; mood stabilisers: RR 1.08, 95% CI 0.79 to 1.48; 1 trial, 276 participants). The evidence is also very uncertain about the effect of medication compared with placebo on suicide-related outcomes, with little to no effect (antipsychotics: SMD 0.05, 95 % CI -0.18 to 0.29; 7 trials, 854 participants; antidepressants: SMD -0.26, 95% CI -1.62 to 1.09; 2 trials, 45 participants; mood stabilisers: SMD -0.36, 95% CI -1.96 to 1.25; 2 trials, 44 participants). Very low-certainty evidence shows little to no difference between medication and placebo on psychosocial functioning (antipsychotics: SMD -0.16, 95% CI -0.33 to 0.00; 7 trials, 904 participants; antidepressants: SMD -0.25, 95% CI -0.57 to 0.06; 4 trials, 161 participants; mood stabilisers: SMD -0.01, 95% CI -0.28 to 0.26; 2 trials, 214 participants). Low-certainty evidence suggests that antipsychotics may slightly reduce interpersonal problems (SMD -0.21, 95% CI -0.34 to -0.08; 8 trials, 907 participants), and that mood stabilisers may result in a reduction in this outcome (SMD -0.58, 95% CI -1.14 to -0.02; 4 trials, 300 participants). Antidepressants may have little to no effect on interpersonal problems, but the corresponding evidence is very uncertain (SMD -0.07, 95% CI -0.69 to 0.55; 2 trials, 119 participants). The evidence is very uncertain about dropout rates compared with placebo by antipsychotics (RR 1.11, 95% CI 0.89 to 1.38; 13 trials, 1216 participants). Low-certainty evidence suggests there may be no difference in dropout rates between antidepressants (RR 1.07, 95% CI 0.65 to 1.76; 6 trials, 289 participants) and mood stabilisers (RR 0.89, 95% CI 0.69 to 1.15; 9 trials, 530 participants), compared to placebo. Reporting on adverse events was poor and mostly non-standardised. The available evidence on non-serious adverse events was of very low certainty for antipsychotics (RR 1.07, 95% CI 0.90 to 1.29; 5 trials, 814 participants) and mood stabilisers (RR 0.84, 95% CI 0.70 to 1.01; 1 trial, 276 participants). For antidepressants, no data on adverse events were identified. AUTHORS' CONCLUSIONS This review included 18 more trials than the 2010 version, so larger meta-analyses with more statistical power were feasible. We found mostly very low-certainty evidence that medication may result in no difference in any primary outcome. The rest of the secondary outcomes were inconclusive. Very limited data were available for serious adverse events. The review supports the continued understanding that no pharmacological therapy seems effective in specifically treating BPD pathology. More research is needed to understand the underlying pathophysiologic mechanisms of BPD better. Also, more trials including comorbidities such as trauma-related disorders, major depression, substance use disorders, or eating disorders are needed. Additionally, more focus should be put on male and adolescent samples.
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Affiliation(s)
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Child and Adolescent Psychiatric Department, Region Zealand, Roskilde, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Johanne Pereira Ribeiro
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Mickey T Kongerslev
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- District Psychiatric Services Roskilde, Region Zealand Mental Health Services, Roskilde, Denmark
| | - Birgit A Völlm
- Department of Forensic Psychiatry, Center for Neurology, University Rostock, Rostock, Germany
| | - Jessica T Mattivi
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Erlend Faltinsen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Adnan Todorovac
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | - Mie S Jørgensen
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
| | | | - Christian P Sales
- Duncan MacMillan House, Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, UK
- Institute of Mental Health, Department of Psychiatry & Applied Psychology, Nottingham, UK
| | - Julie Perrine Schaug
- Region Zealand Psychiatry, Center for Evidence Based Psychiatry, Slagelse, Denmark
| | - Erik Simonsen
- Research Unit, Mental Health Services, Copenhagen University Hospital, Psychiatry Region Zealand, Roskilde, Denmark
| | - Klaus Lieb
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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5
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Wu T, Hu J, Davydow D, Huang H, Spottswood M, Huang H. Demystifying borderline personality disorder in primary care. Front Med (Lausanne) 2022; 9:1024022. [PMID: 36405597 PMCID: PMC9668888 DOI: 10.3389/fmed.2022.1024022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Borderline personality disorder (BPD) is a common mental health diagnosis observed in the primary care population and is associated with a variety of psychological and physical symptoms. BPD is a challenging disorder to recognize due to the limitations of accurate diagnosis and identification in primary care settings. It is also difficult to treat due to its complexity (e.g., interpersonal difficulties and patterns of unsafe behaviors, perceived stigma) and healthcare professionals often feel overwhelmed when treating this population. The aim of this article is to describe the impact of BPD in primary care, review current state of knowledge, and provide practical, evidence-based treatment approaches for these patients within this setting. Due to the lack of evidence-based pharmacological treatments, emphasis is placed on describing the framework for treatment, identifying psychotherapeutic opportunities, and managing responses to difficult clinical scenarios. Furthermore, we discuss BPD treatment as it relates to populations of special interest, including individuals facing societal discrimination and adolescents. Through this review, we aim to highlight gaps in current knowledge around managing BPD in primary care and provide direction for future study.
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Affiliation(s)
- Tina Wu
- Warren Alpert Medical School, Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
- *Correspondence: Tina Wu,
| | - Jennifer Hu
- Duke University Hospital, Durham, NC, United States
- Jennifer Hu,
| | | | - Heather Huang
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Margaret Spottswood
- Community Health Centers of Burlington, Burlington, VT, United States
- Department of Psychiatry, University of Vermont College of Medicine, Burlington, VT, United States
| | - Hsiang Huang
- Cambridge Health Alliance, Cambridge, MA, United States
- Harvard Medical School, Boston, MA, United States
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6
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Yang F, Tong J, Zhang SF, Zhang J, Zhong BL. Prevalence and correlates of suicide attempts in Chinese individuals with borderline personality disorder. Front Psychiatry 2022; 13:942782. [PMID: 36104990 PMCID: PMC9464826 DOI: 10.3389/fpsyt.2022.942782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To date, few empirical studies have examined the clinical characteristics of suicide attempts (SA) in individuals with borderline personality disorder (BPD) in China. AIMS To examine the prevalence and factors associated with SA in Chinese individuals with BPD. METHODS In this cross-sectional study, 84 patients with BPD were recruited from a large public psychiatric hospital in Wuhan, China, between 2013 and 2015. Trained experienced psychiatrists interviewed participants to collect clinical data, including demographics, axis I and axis II diagnoses of mental disorders according to the DSM-IV-TR, number of hospitalizations, and history of SA. An interview outline was used to identify the existence of lifetime SA. In addition, the Beck Depression Inventory-II, Buss & Perry Aggression Questionnaire, Child Trauma Questionnaire-Short Form, and Beck Hopelessness Scale were administered to assess respondents' depressive symptoms, aggression, childhood traumatic experiences, and hopelessness. RESULTS Fifty-two (61.9%) patients reported attempting suicide during their lifetime. Univariate logistic regression analysis screened 7 factors associated with SA in individuals with BPD into Multiple logistic regression analysis: female sex, unemployment, major depressive disorder (MDD), hostility, self-aggression, depressive symptoms, and emotional neglect. Multiple logistic regression analysis identified 3 significant and independent correlates of SA: MDD [odds ratio (OR) = 26.773, 95% confidence interval (CI) = 3.914-183.132, P = 0.001], hostility (OR = 1.073, CI = 1.019-1.130, P = 0.007), and self-aggression (OR = 1.056, CI = 0.998-1.119, P = 0.060). CONCLUSION Chinese individuals with BPD have a high risk of suicide. Correlates of SA in this population differ to some extent from those in Western populations as reported in the literature. Paying attention to MDD and some types of aggression in Chinese individuals with BPD may help identify their risk of suicide. Future large-sample cohort study may improve the limitations of this study and further confirm the point of view above.
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Affiliation(s)
- Fan Yang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Jun Tong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Shu-Fang Zhang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Juan Zhang
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, China
| | - Bao-Liang Zhong
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China.,Department of Psychiatry, Wuhan Hospital for Psychotherapy, Wuhan, China
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7
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Chen SY, Cheng Y, Zhao WW, Zhang YH. Effects of dialectical behaviour therapy on reducing self-harming behaviours and negative emotions in patients with borderline personality disorder: A meta-analysis. J Psychiatr Ment Health Nurs 2021; 28:1128-1139. [PMID: 34519138 DOI: 10.1111/jpm.12797] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/26/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Dialectical behaviour therapy(DBT) has been widely used for borderline personality disorder(BPD). Existing studies are limited to behaviours such as self-harm, and the results for reducing self-harm were controversial. Few have systematically evaluated the effect of DBT on self-harming behaviours and negative emotions. AIM This study aims to evaluate the effects of DBT on self-harming behaviours and negative emotions in patients with BPD. METHODS RCTs on DBT for BPD were searched from PubMed, Embase, etc., and the results were performed by RevMan 5.3. RESULTS The meta-analysis demonstrated that DBT reduced self-harming behaviours, and alleviated depression, but had a negligible effect on suicidal ideation and anger. One subgroup revealed that standard DBT improved depression significantly, but DBT skills training improved poorly. Another subgroup revealed that there was a significant reduction in depression among patients receiving DBT for 4 months to 14 months, but not at 4 months. DISCUSSION AND IMPLICATIONS FOR PRACTICE Findings indicate that DBT can reduce self-harming behaviours and improve depression, but effects on suicidal ideation and anger are insignificant. Subgroup analysis suggests that standard DBT and DBT-ST lasting beyond 4 months benefits on BPD. Given the quality and quantity restrictions of RCTs, more high-quality RCTs need to verify these effects.
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Affiliation(s)
- Shu-Yan Chen
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yin Cheng
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Wei-Wei Zhao
- School of Nursing, Nanjing Medical University, Nanjing, China.,Department of Nursing, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Yan-Hong Zhang
- School of Nursing, Nanjing Medical University, Nanjing, China.,Department of Nursing, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
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8
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Rush K, Fok M, Moran P, Dorrington S, Shetty H, Stewart R, Chang CK. Risk of First General Hospital Admissions for Self-Harm Among People With Personality Disorder: A Retrospective Cohort Study. J Pers Disord 2021; 35:657-671. [PMID: 33107805 DOI: 10.1521/pedi_2020_34_489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
For individuals with a personality disorder (PD), it is unknown whether additional psychiatric conditions increase their risk of self-harm. The authors therefore conducted a retrospective cohort study, using data from secondary mental health care, to identify self-harm admissions. Adults with diagnosed PD, followed up over a 6-year period, were involved (N = 7,475). Cox regression was used to model the risk of self-harm admissions, with comorbid depression, substance use disorders (SUD), severe mental illness (SMI), anorexia nervosa (AN), and bulimia nervosa (BN) as primary exposures; sociodemographics were considered as confounders. In multivariable analyses, comorbid SUD (adjusted HR = 1.66; 95% CI [1.45, 1.90]), depressive disorder (1.25; [1.09, 1.44]), AN (1.63; [1.10, 2.39]), and BN (1.65; [1.09, 2.51]) were positively associated with increased risks of hospitalization due to self-harm. However, a negative association was found for comorbid SMI. The findings highlight the importance of assessing and treating comorbid psychiatric disorders in PD.
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Affiliation(s)
- Kelsey Rush
- Department of Psychological Medicine (King's College London), Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Marcella Fok
- Department of Psychological Medicine (King's College London), Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Paul Moran
- Centre for Academic Mental Health, Department of Population Health Sciences, University of Bristol, UK
| | - Sarah Dorrington
- Department of Psychological Medicine (King's College London), Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Robert Stewart
- Department of Psychological Medicine (King's College London), Institute of Psychiatry, Psychology, and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Chin-Kuo Chang
- Department of Psychological Medicine (King's College London), Institute of Psychiatry, Psychology, and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Global Health Program, College of Public Health, and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
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9
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Gonçalves Peter A, Lopez Molina M, de Azevedo Cardoso T, Campos Mondin T, Azevedo da Silva R, Jansen K, Dornellas de Barros MM, Nobre Dos Santos É, Rodrigues de Aguiar K, Dias de Mattos Souza L. Incidence and Risk Factors for Suicide Attempts in Patients Diagnosed with Major Depressive Disorder. Psychol Res Behav Manag 2020; 13:1147-1157. [PMID: 33299365 PMCID: PMC7721276 DOI: 10.2147/prbm.s274769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022] Open
Abstract
Objective This study seeks to investigate the cumulative incidence and risk factors of suicide attempts in an outpatient sample of adults diagnosed with major depressive disorder (MDD). Materials and Methods This is a longitudinal study with 377 patients aged between 18 and 60 years. Those were diagnosed with MDD with no history of suicide attempts when they sought care at the Mental Health Outpatient Clinic of the Catholic University of Pelotas and evaluated again 3 years after. Participants were evaluated with the Mini International Neuropsychiatric Interview (MINI Plus) and answered instruments of clinical investigation and a sociodemographic questionnaire. Results The cumulative incidence of suicide attempts in the sample was 10.1%. Youths aged up to 29 years (OR 2.23; 95% CI 1.13 to 4.64), with low schooling (OR 2.35; 95% CI 1.15 to 4.80), who suffered intense physical abuse during childhood (OR 2.77; 95% CI 1.31 to 5.84) and were at prior suicide risk (OR 3.39; 95% CI 1.56 to 7.37) were more likely to attempt suicide. Conclusion The findings of this study may help health professionals identify depressed patients at greater risk for a first suicide attempt, supporting clinical decision and therapeutic planning.
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Affiliation(s)
- Angélica Gonçalves Peter
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil.,Educational Development Center, Federal University of Pampa, Jaguarão, Brazil
| | - Mariane Lopez Molina
- Psychology Department, Anhanguera Educational College of Rio Grande, Rio Grande, Brazil
| | - Taiane de Azevedo Cardoso
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | | | - Ricardo Azevedo da Silva
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil
| | - Karen Jansen
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil
| | | | - Érico Nobre Dos Santos
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil
| | - Kyara Rodrigues de Aguiar
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas (UCPel), Pelotas, Brazil
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10
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Scheer V, Blanco C, Olfson M, Lemogne C, Airagnes G, Peyre H, Limosin F, Hoertel N. A comprehensive model of predictors of suicide attempt in individuals with panic disorder: Results from a national 3-year prospective study. Gen Hosp Psychiatry 2020; 67:127-135. [PMID: 33129137 DOI: 10.1016/j.genhosppsych.2020.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/20/2020] [Accepted: 09/28/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVE People with panic disorder are at increased risk of suicide. Multiple factors influence their risk suggesting a need to combine them into an integrative model to develop more effective suicide prevention strategies for this population. In this report, we sought to build a comprehensive model of the 3-year risk of suicide attempt in individuals with panic disorder using a longitudinal nationally representative study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; wave 1, 2001-2002; wave 2, 2004-2005). METHOD We used structural equation modeling to simultaneously examine effects of six broad groups of clinical factors previously identified as potential predictors of suicide attempt in adults with panic disorder: 1) severity of panic disorder, 2) severity of comorbidity, 3) prior history of suicide attempt, 4) family history of psychiatric disorders, 5) sociodemographic characteristics and 6) treatment-seeking behavior. RESULTS The 3-year prevalence rate of suicide attempt was 4.6%. A general psychopathology factor, lower physical health-related quality of life, prior suicide attempt and a greater number of stressful life events at baseline significantly and independently predicted suicide attempt between the two waves (p < .05). R-square of the models ranged from 0.47 to 0.50. CONCLUSION This model may help inform future research and identify high-risk individuals among adults with panic disorder.
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Affiliation(s)
- Valentin Scheer
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France.
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Mark Olfson
- Department of Psychiatry, New York State Psychiatric Institute / Columbia University, New York, NY 10032, USA
| | - Cédric Lemogne
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; Faculté de médecine Paris Descartes, Université de Paris, Paris, France; Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Guillaume Airagnes
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; UMS 011, Population-based Epidemiological Cohorts, Inserm, Villejuif, France
| | - Hugo Peyre
- Robert Debré Hospital, Child and Adolescent Psychiatry Department, Assistance Publique-Hôpitaux de Paris, Paris, France; Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, Paris, France
| | - Frédéric Limosin
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; Faculté de médecine Paris Descartes, Université de Paris, Paris, France; Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
| | - Nicolas Hoertel
- Service de Psychiatrie et d'Addictologie de l'adulte et du sujet âgé, DMU Psychiatrie et Addictologie, AP-HP.Centre-Université de Paris, France; Faculté de médecine Paris Descartes, Université de Paris, Paris, France; Inserm U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France
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11
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Soloff PH, Chiappetta L. Time, Age, and Predictors of Psychosocial Outcome in Borderline Personality Disorder. J Pers Disord 2020; 34:145-160. [PMID: 30179578 PMCID: PMC9233907 DOI: 10.1521/pedi_2018_32_386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In longitudinal studies, BPD symptoms diminish over time, though psychosocial functioning lags far behind. The effects of time and advancing age on BPD are poorly understood. We sought prospective predictors of psychosocial outcome and recovery in 150 BPD subjects followed 2 to 31 years (mean 9.94 years) using a multidimensional assessment method and biannual follow-ups. Time-in-study had no significant effect on achieving diagnostic remission in BPD, good psychosocial outcomes, meaningful interpersonal relationships, full employment, or total recovery; however, younger age was associated with social and vocational achievement independent of BPD remission. Significant contributions to psychosocial outcome were found for age, employment status, MDD, SUD, Any Anxiety Disorder, and Alcohol abuse/dependence (ALC). Remission from BPD was neither necessary or sufficient for good interpersonal relationships or full-time employment. Full-time employment and social and vocational adjustment (SAS-sr) predicted good psychosocial outcome. Axis I comorbidity with Any Anxiety Disorder, MDD, or SUD predicted poor outcome.
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Affiliation(s)
- Paul H. Soloff
- Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laurel Chiappetta
- Statistics Department, University of Pittsburgh, Pittsburgh, Pennsylvania
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12
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Flynn S, Graney J, Nyathi T, Raphael J, Abraham S, Singh-Dernevik S, Williams A, Kapur N, Appleby L, Shaw J. Clinical characteristics and care pathways of patients with personality disorder who died by suicide. BJPsych Open 2020; 6:e29. [PMID: 32183913 PMCID: PMC7176898 DOI: 10.1192/bjo.2020.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND It is estimated that 1 in 10 people have a personality disorder. People with emotionally unstable personality disorder are at high risk of suicide. Despite being frequent users of mental health services, there is often no clear pathway for patients to access effective treatments. AIMS To describe the characteristics of patients with personality disorder who died by suicide, examine clinical care pathways and explore whether the care adhered to National Institute for Health and Care Excellence guidance. METHOD National consecutive case series (1 January 2013 to 31 December 2013). The study examined the health records and serious incident reports of patients with personality disorder who died by suicide in the UK. RESULTS The majority had a diagnosis of borderline/emotionally unstable or antisocial personality disorder. A high proportion of patients had a history of self-harm (n = 146, 95%) and alcohol (n = 101, 66%) or drug misuse (n = 79, 52%). We found an extensive pattern of service contact in the year before death, with no clear pathway for patients. Care was inconsistent and there were gaps in service provision. In 99 (70%) of the 141 patients with data, the last episode of care followed a crisis. Access to specialised psychological therapies was limited; short-term in-patient admissions was adhered to; however, guidance on short-term prescribing for comorbid conditions was not followed for two-thirds of patients. CONCLUSIONS Continuity and stability of care is required to prevent, rather than respond to individuals in crisis. A comprehensive audit of services for people with personality disorder across the UK is recommended to assess the quality of care provided.
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Affiliation(s)
- Sandra Flynn
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
| | - Jane Graney
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
| | - Thabiso Nyathi
- Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Jessica Raphael
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
| | | | - Sandeep Singh-Dernevik
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
| | - Alyson Williams
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
| | - Nav Kapur
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
| | - Louis Appleby
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
| | - Jenny Shaw
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, University of Manchester, UK
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13
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Toward an animal model of borderline personality disorder. Psychopharmacology (Berl) 2019; 236:2485-2500. [PMID: 31201478 PMCID: PMC6697600 DOI: 10.1007/s00213-019-05289-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 05/30/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) is a pervasive psychiatric disorder characterized by emotion dysregulation, impulsivity, impaired self-perceptions, and interpersonal relationships and currently affects 1-3% of the US population as reported by Torgersen et al. (Arch Gen Psychiatry 58:590-596, Torgersen et al. 2001), Lenzenweger et al. (Biol Psychiatry 62:553-564, Lenzenweger et al. 2007), and Tomko et al. (J Personal Disord 28:734-750, Tomko et al. 2014). One major obstacle to our understanding of the neural underpinnings of BPD is a lack of valid animal models that translate the key known features of the disorder to a system that is amenable to study. OBJECTIVE To summarize the etiology, major symptoms, and symptom triggers of BPD and then propose a blueprint for building an animal model of BPD by choosing key components of the disorder that can be implemented in rodents. RESULTS We identify the role of early life stress and subsequent mild stress in adulthood as contributing etiological factors and the potential use of altered communication between frontal cortices and the amygdala in extinction and habituation, increased impulsivity, dysregulation of the hypothalamic pituitary axis (HPA), and increased neuroinflammation as biological markers of BPD. Building upon these features of BPD, we propose a two-hit animal model that uses maternal abandonment to alter maturation of the HPA axis and mild secondary adult stress to evoke behavioral symptoms such as increased impulsivity and impaired extinction, habituation, and social interactions. CONCLUSION Through exploration of the etiology, symptom presentation, and altered neurological function, we propose an animal model of BPD. We believe that a number of existing animal paradigms that model other mental health disorders should be combined in a unique way to reflect the etiology, symptom presentation, and altered neurological function that is evident in BPD. These model, when compared with available human data, will inform research and treatment in humans for better understanding of systems from the micro-molecular level to more global physiology underlying BPD.
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14
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Rodante DE, Grendas LN, Puppo S, Vidjen P, Portela A, Rojas SM, Chiapella LC, Daray FM. Predictors of short- and long-term recurrence of suicidal behavior in borderline personality disorder. Acta Psychiatr Scand 2019; 140:158-168. [PMID: 31155713 DOI: 10.1111/acps.13058] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the incidence of suicidal outcomes and risk factors for short- and long-term recurrence of suicidal behavior (SB) among high-risk borderline personality disorder (BPD) patients during a 24-month prospective follow-up period. METHODS A multicenter prospective cohort study was designed to compare data obtained from 136 patients admitted to the emergency department for current suicidal ideation (SI) or a recent suicide attempt (SA). Subjects were clinically evaluated and monitored for a new SA or suicide. RESULTS The incidence of a new SA was 25.63 events/100 persons-year, and one patient died by suicide. Child sexual abuse (CSA) was the only significant predictor throughout the complete follow-up period. The absence of prior psychiatric treatment predicts the recurrence of SB in the first 6 months of follow-up. Patient age, poor psychosocial functioning before hospitalization, age at first SA, and having multiple suicide attempts increased risk of SB recurrence at the long-term period (24th months). In addition, there was an interaction between CSA and poor psychosocial functioning that increased risk of SB. CONCLUSION The risk of recurrence was higher during the first 6 months. Risk factors at 6 and 24 months vary. These findings are important for implementing suicide strategies.
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Affiliation(s)
- D E Rodante
- School of Medicine, Institute of Pharmacology, University of Buenos Aires, Buenos Aires, Argentina.,Braulio A. Moyano Neuropsychiatric Hospital, Buenos Aires, Argentina
| | - L N Grendas
- School of Medicine, Institute of Pharmacology, University of Buenos Aires, Buenos Aires, Argentina.,Teodoro Alvarez Hospital, Buenos Aires, Argentina
| | - S Puppo
- School of Medicine, Institute of Pharmacology, University of Buenos Aires, Buenos Aires, Argentina.,Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - P Vidjen
- José Tiburcio Borda Hospital, Buenos Aires, Argentina
| | - A Portela
- José Tiburcio Borda Hospital, Buenos Aires, Argentina
| | - S M Rojas
- Department of Psychological Science, University of Arkansas, Fayetteville, AR, USA
| | - L C Chiapella
- Pharmacology Area, Faculty of Biochemical and Pharmaceutical Sciences, National University of Rosario, Rosario, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - F M Daray
- School of Medicine, Institute of Pharmacology, University of Buenos Aires, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
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15
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Andrewes HE, Hulbert C, Cotton SM, Betts J, Chanen AM. Relationships between the frequency and severity of non-suicidal self-injury and suicide attempts in youth with borderline personality disorder. Early Interv Psychiatry 2019; 13:194-201. [PMID: 28718985 DOI: 10.1111/eip.12461] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/24/2017] [Accepted: 05/14/2017] [Indexed: 11/27/2022]
Abstract
AIM Non-suicidal self-injury (NSSI) is a recognized indicator of suicide risk. Yet, the ubiquity of this behaviour in borderline personality disorder (BPD) limits its utility as a predictor of risk. Consequently, this study aimed to elucidate the relationship between other features of NSSI, including frequency and severity, and suicide attempts. METHOD Participants included 107 youth (15 to 25 year olds) with BPD who were assessed for BPD severity, depressive symptoms, 12-month frequency of NSSI and suicide attempts, as well as the levels of treatment sought following each self-harm event. RESULTS Three-quarters (75.7%) of youth with BPD reported NSSI and two-thirds (66.4%) reported a suicide attempt over the previous 12 months. The frequency of NSSI over the previous 12 months did not show a linear or quadratic relationship with the number of suicide attempts when adjusting for severity of depression, impulsivity and interpersonal problems. NSSI severity was not associated with more frequent suicide attempts. Only impulsivity and depression were uniquely predictive of suicide attempt frequency. A relative increase in the frequency and severity of NSSI occurred in the months prior to a suicide attempt. CONCLUSION The prevalence of NSSI and suicide attempts among youth presenting for their first treatment of BPD appear to be perilously high, considerably higher than rates reported by adults with BPD. Findings suggest that clinicians should give more weight to average levels of impulsivity and depression, rather than the absolute frequency and severity of NSSI, when assessing for risk of suicide attempts. Notwithstanding this, a relative increase in the frequency and severity of NSSI appears to be predictive of a forthcoming suicide attempt.
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Affiliation(s)
- Holly E Andrewes
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia
| | - Carol Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Australia
| | - Susan M Cotton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Australia
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16
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Abstract
Prospective predictors of suicide attempts were assessed in 118 subjects with borderline personality disorder (BPD) after 10 or more years of follow-up. Mean (SD) time to follow-up was 14.4 (4.7) years. Subjects were predominately female (78.8%), Caucasian (81.4%), and of lower socioeconomic status. Initial recruitment was evenly balanced between inpatient, outpatient, and non-patient (community) sources. In the 10-year interval, 55 subjects (46.6%) attempted suicide. Compared to baseline, suicidal ideation, number of attempts, and non-suicidal self-injury diminished markedly. Core symptoms of BPD, substance abuse, and alcohol use disorders decreased significantly; however, major depressive disorder (MDD) remained constant at 50%. Forty-four percent of subjects had poor psychosocial, vocational, and economic outcomes. Psychosocial outcome was independent of suicide history and any treatment. Increased risk was associated with interval hospitalization prior to any attempt (illness severity), as well as poor social, vocational, and psychosocial functioning at baseline.
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Affiliation(s)
- Paul H. Soloff
- Department of Psychiatry, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Laurel Chiappetta
- Statistics Department, University of Pittsburgh, Pittsburgh, Pennsylvania
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17
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18
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Álvarez-Tomás I, Ruiz J, Guilera G, Bados A. Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies. Eur Psychiatry 2018; 56:75-83. [DOI: 10.1016/j.eurpsy.2018.10.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 01/19/2023] Open
Abstract
AbstractBackground:This meta-analytic review is the first to synthesise findings from prospective research on the long-term course of borderline personality disorder in adult clinical populations.Methods:Systematic searches were conducted in Medline, PsycINFO, PsycArticles, PubMed and Scopus within the period 1990-2017. Inclusion criteria were: (1) adult BPD sample diagnosed by a validated, semi-structured interview; (2) at least two prospective assessments of outcomes; and (3) follow-up period ≥ 5 years. Quality of evidence was rated with the Systematic Assessment of Quality in Observational Research (SAQOR). Four outcomes were meta-analysed using mixed-effect methods: remission from BPD diagnosis, completed suicide, depressive symptoms, and functioning. Potential moderators regarding the natural course and the initial treatment received were studied.Results:Eleven studies met the inclusion criteria, with 837 participants from nine countries being followed. Between 50% and 70% of the BPD patients achieved remission in the long-term. Significant reductions in depression and functional impairment were also found. Mean suicide rate ranged from 2% to 5%. Younger age was associated with higher likelihood for remission. Being female was correlated with lower functional improvement. Despite some positive trends, there were no significant associations between treatment moderators and the long-term outcome.Conclusions:Findings suggest that the course of BPD is characterised by symptomatic amelioration and a slight functional improvement in the long-term. Age and gender modulate the long-term prognosis and should be considered to adapt treatment resources. Further research is required to draw robust conclusions on the long-term effects of psychotherapeutic interventions.
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19
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di Giacomo E, Arntz A, Fotiadou M, Aguglia E, Barone L, Bellino S, Carpiniello B, Colmegna F, Lazzari M, Lorettu L, Pinna F, Sicaro A, Signorelli MS, Clerici M. The Italian Version of the Borderline Personality Disorder Severity Index IV: Psychometric Properties, Clinical Usefulness, and Possible Diagnostic Implications. J Pers Disord 2018; 32:207-219. [PMID: 28604275 DOI: 10.1521/pedi_2017_31_294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) has a core embodied in affective and behavioral dysregulations, impulsivity, and relational disturbance. Clinical presentation might be heterogeneous due to a combination of different symptoms listed in the DSM-5. Clinical diagnosis and assessment of the severity of manifestations might be improved through the administration of structured interviews such as the Borderline Personality Disorder Severity Index, 4th edition (BPDSI-IV). The psychometric properties of the Italian version of the BPDSI-IV were examined for the first time in 248 patients affected by BPD and 113 patients affected by bipolar disorder, proving to be a valid and accurate instrument with good internal consistency and high accuracy. The Italian version also demonstrates significant validity in the discrimination between these clinical groups (p < 5001).
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Affiliation(s)
- Ester di Giacomo
- School of Medicine and Surgery, University of Milan, Bicocca, Italy.,Psychiatric, Department, S. Gerardo Health Care Trust, Monza, Italy.,PhD Program, in Neuroscience, Doctorate School, University of Milan, Bicocca
| | - Arnoud Arntz
- Department of Clinical, Psychology, University of Amsterdam, the Netherlands
| | - Maria Fotiadou
- Female Medium Secure Forensic Service, South London, and the Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Eugenio Aguglia
- Department of Clinical and Molecular Biomedicine, University of Catania, Italy
| | - Lavinia Barone
- Psychology, Section, Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
| | - Silvio Bellino
- Center for, Personality Disorders, Psychiatric Clinic, Department of Neuroscience, University of Turin, Italy
| | - Bernardo Carpiniello
- Department of Public Health, Clinical and Molecular Medicine, Psychiatric Unit, University of Cagliari, Italy
| | | | - Marina Lazzari
- Psychiatric, Department, S. Gerardo Health Care Trust, Monza, Italy
| | - Liliana Lorettu
- Psychiatric Clinic, Department of Biomedical Science, University of Sassari, Italy
| | - Federica Pinna
- Department of Public Health, Clinical and Molecular Medicine, Psychiatric Unit, University of Cagliari, Italy
| | - Aldo Sicaro
- Psychiatric, Department, S. Gerardo Health Care Trust, Monza, Italy
| | | | | | - Massimo Clerici
- School of Medicine and Surgery, University of Milan, Bicocca, Italy.,Psychiatric, Department, S. Gerardo Health Care Trust, Monza, Italy
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20
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Schilling L, Moritz S, Kriston L, Krieger M, Nagel M. Efficacy of metacognitive training for patients with borderline personality disorder: Preliminary results. Psychiatry Res 2018; 262:459-464. [PMID: 28927866 DOI: 10.1016/j.psychres.2017.09.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 07/31/2017] [Accepted: 09/10/2017] [Indexed: 11/25/2022]
Abstract
'Metacognitive training for borderline personality disorder' (B-MCT) represents a complementary group intervention. It aims at raising awareness for cognitive biases that may play an important role in the development and maintenance of borderline symptomatology. For the present study, we evaluated the effectiveness of this new approach against a control condition. Seventy-four inpatients with borderline personality disorder (BPD) were randomly assigned to metacognitive training for BPD or progressive muscle relaxation training as an add-on intervention to treatment as usual. Severity of symptomatology was assessed at baseline, four weeks after beginning and six months after completion of the intervention. The per-protocol and intention-to-treat analyses revealed that patients in the metacognitive training group showed significantly greater reductions on the primary outcome (Borderline Symptom List-23) after six months. Progressive muscle relaxation was superior in alleviating depressive symptoms (secondary outcome: Beck Depression Inventory) at the long-term follow-up. Findings provide preliminary evidence that metacognitive training for BPD yields surplus effects to standard treatment.
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Affiliation(s)
- Lisa Schilling
- Department of Psychiatry and Psychotherapy, Asklepios Clinic Nord, Horner Landstraße 302-304, 22111 Hamburg, Germany; Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Maria Krieger
- Department of Psychiatry and Psychotherapy, Asklepios Clinic Nord, Horner Landstraße 302-304, 22111 Hamburg, Germany; Refugio Stuttgart e.V., Weißenburgstraße 15, 70180 Stuttgart, Germany
| | - Matthias Nagel
- Department of Psychiatry and Psychotherapy, Asklepios Clinic Nord, Horner Landstraße 302-304, 22111 Hamburg, Germany; Department of Psychiatry and Psychotherapy, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany
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21
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Flink N, Honkalampi K, Lehto SM, Leppänen V, Viinamäki H, Lindeman S. Comparison of early maladaptive schemas between borderline personality disorder and chronic depression. Clin Psychol Psychother 2018; 25:532-539. [PMID: 29542265 DOI: 10.1002/cpp.2188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/30/2018] [Accepted: 02/04/2018] [Indexed: 11/06/2022]
Abstract
Borderline personality disorder (BPD) and chronic depression (CD) are common and challenging mental disorders. Maladaptive cognitive schemas have been proposed to increase vulnerability to both disorders. In order to elucidate the role of maladaptive cognitive schemas in BPD and CD, this study compared psychiatric outpatients with BPD (N = 30) and CD (N = 30) in terms of early maladaptive schemas (EMSs). The groups were compared using the Young Schema Questionnaire short form-extended (YSQ-S2-extended) and the 15D health status questionnaire. BPD patients showed higher endorsement on the majority of EMSs, poorer social functioning, and greater concurrent distress than CD patients. However, after controlling for concurrent effects of psychological distress, the groups did not differ in 14 out of the 18 EMSs. These findings point to significant similarities in maladaptive beliefs between the 2 disorders and do not support broad, specific patterns of EMSs associated with either disorder. The results highlight the need for further study of the role of maladaptive schemas in the development and treatment of chronic mental disorders.
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Affiliation(s)
- Niko Flink
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Kirsi Honkalampi
- School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Soili M Lehto
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Virpi Leppänen
- City of Oulu, Social and Health Services, Mental Health Services, Oulu, Finland
| | - Heimo Viinamäki
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
| | - Sari Lindeman
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Central Finland Health Care District, Jyväskylä Central Hospital, Jyväskylä, Finland
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22
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Soloff PH, Chiappetta L. Suicidal Behavior and Psychosocial Outcome in Borderline Personality Disorder at 8-Year Follow-Up. J Pers Disord 2017; 31:774-789. [PMID: 28263092 PMCID: PMC6544464 DOI: 10.1521/pedi_2017_31_280] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We sought predictors of both suicidal behavior and psychosocial outcome in subjects with BPD followed for 8 years and asked if there was a relationship between these outcomes. One hundred twenty-three BPD subjects, recruited from inpatient (35.8%), outpatient (30.9%) and community (33.3%) sources, were assessed annually for known risk factors for suicidal behavior. Interval attempts were reported by 25 subjects (20.2%). Increased risk of suicide attempt was associated with negative affectivity, aggression, inpatient recruitment, hospitalizations, minority race, and frequent changes in employment. Decreased risk was associated with increased education. Poor psychosocial outcome was predicted by impulsivity, negative affectivity, and antisocial traits at baseline, and by comorbid MDD at 8-year follow-up. There was no significant relationship between poor psychosocial outcome at 8-year follow-up and risk of suicidal behavior. Predictors of suicidality include modifiable risk factors. Rehabilitation models are needed to address educational and vocational deficits associated with suicidality, especially among minorities.
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Affiliation(s)
- Paul H. Soloff
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Laurel Chiappetta
- Department of Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Turner BJ, Jin HM, Anestis MD, Dixon-Gordon KL, Gratz KL. Personality pathology and intentional self-harm: cross-cutting insights from categorical and dimensional models. Curr Opin Psychol 2017; 21:55-59. [PMID: 29017093 DOI: 10.1016/j.copsyc.2017.09.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 09/08/2017] [Accepted: 09/14/2017] [Indexed: 02/07/2023]
Abstract
This paper reviews current literature on the links between personality pathology and intentional self-harm, including nonsuicidal self-injury (NSSI) and suicidal behaviors. Specifically, this review highlights recent advances stemming from longitudinal, epidemiological, and health registry studies, as well as emerging research on pathological personality traits and intentional self-harm, and integrates current knowledge across dimensional and categorical frameworks to provide recommendations for clinical practice and future research. This review provides strong evidence that personality disorders marked by intense and unstable negative affect, detachment/low extraversion, aggression/hostility, and specific facets of impulsivity may be considered risk factors for suicidal behaviors. Further, there is some evidence of a stronger relation between maladaptive personality traits and suicidal versus non-suicidal intentional self-harm.
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Affiliation(s)
- Brianna J Turner
- Department of Psychology, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada V8W 2Y2
| | - Hyejin M Jin
- Department of Psychology, University of Southern Mississippi, 118 College Drive, Box #5025, Hattiesburg, MS 39406, USA
| | - Michael D Anestis
- Department of Psychology, University of Southern Mississippi, 118 College Drive, Box #5025, Hattiesburg, MS 39406, USA
| | - Katherine L Dixon-Gordon
- Department of Psychological and Brain Sciences, University of Massachusetts, 135 Hicks Way, Amherst, MA 01003, USA
| | - Kim L Gratz
- Department of Psychology, University of Toledo, 2801 West Bancroft Street, Toledo, OH 43606, USA.
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Duarte DGG, Neves MDCL, Albuquerque MR, Turecki G, Ding Y, de Souza-Duran FL, Busatto G, Correa H. Structural brain abnormalities in patients with type I bipolar disorder and suicidal behavior. Psychiatry Res Neuroimaging 2017; 265:9-17. [PMID: 28494347 DOI: 10.1016/j.pscychresns.2017.04.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 04/24/2017] [Accepted: 04/28/2017] [Indexed: 12/20/2022]
Abstract
Some studies have identified brain morphological changes in the frontolimbic network (FLN) in bipolar subjects who attempt suicide (SA). The present study investigated neuroanatomical abnormalities in the FLN to find a possible neural signature for suicidal behavior in patients with bipolar disorder type I (BD-I). We used voxel-based morphometry to compare euthymic patients with BD-I who had attempted suicide (n=20), who had not attempted suicide (n=19) and healthy controls (HCs) (n=20). We also assessed the highest medical lethality of their previous SA. Compared to the participants who had not attempted suicide, the patients with BD-I who had attempted suicide exhibited significantly increased gray matter volume (GMV) in the right rostral anterior cingulate cortex (ACC), which was more pronounced and extended further to the left ACC in the high-lethality subgroup (p<0.05, with family-wise error (FWE) correction for multiple comparisons using small-volume correction). GMV in the insula and orbitofrontal cortex was also related to suicide lethality (p<0.05, FWE-corrected). The current findings suggest that morphological changes in the FLN could be a signature of previous etiopathogenic processes affecting regions related to suicidality and its severity in BD-I patients.
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Affiliation(s)
- Dante G G Duarte
- Mental Health Department, Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Brazil.
| | - Maila de Castro L Neves
- Mental Health Department, Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Brazil.
| | | | - Gustavo Turecki
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Montreal, Canada.
| | - Yang Ding
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, Montreal, Canada.
| | - Fabio Luis de Souza-Duran
- Laboratory of Neuroimaging in Psychiatry (LIM-21), Research in Applied Neuroscience, Support Care of the University of São Paulo (NAPNA-USP), São Paulo, Brazil.
| | - Geraldo Busatto
- Laboratory of Neuroimaging in Psychiatry (LIM-21), Research in Applied Neuroscience, Support Care of the University of São Paulo (NAPNA-USP), São Paulo, Brazil.
| | - Humberto Correa
- Mental Health Department, Universidade Federal de Minas Gerais (UFMG), Minas Gerais, Brazil.
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Huang X, Ribeiro JD, Musacchio KM, Franklin JC. Demographics as predictors of suicidal thoughts and behaviors: A meta-analysis. PLoS One 2017; 12:e0180793. [PMID: 28700728 PMCID: PMC5507259 DOI: 10.1371/journal.pone.0180793] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 06/21/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Certain demographic factors have long been cited to confer risk or protection for suicidal thoughts and behaviors. However, many studies have found weak or non-significant effects. Determining the effect strength and clinical utility of demographics as predictors is crucial for suicide risk assessment and theory development. As such, we conducted a meta-analysis to determine the effect strength and clinical utility of demographics as predictors. METHODS We searched PsycInfo, PubMed, and GoogleScholar for studies published before January 1st, 2015. Inclusion criteria required that studies use at least one demographic factor to longitudinally predict suicide ideation, attempt, or death. The initial search yielded 2,541 studies, 159 of which were eligible. A total of 752 unique statistical tests were included in analysis. RESULTS Suicide death was the most commonly studied outcome, followed by attempt and ideation. The average follow-up length was 9.4 years. The overall effects of demographic factors studied in the field as risk factors were significant but weak, and that of demographic factors studied as protective factors were non-significant. Adjusting for publication bias further reduced effect estimates. No specific demographic factors appeared to be strong predictors. The effects were consistent across multiple moderators. CONCLUSIONS At least within the narrow methodological constraints of the existing literature, demographic factors were statistically significant risk factors, but not protective factors. Even as risk factors, demographics offer very little improvement in predictive accuracy. Future studies that go beyond the limitations of the existing literature are needed to further understand the effects of demographics.
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Affiliation(s)
- Xieyining Huang
- Department of Psychology, Florida State University, Tallahassee, Florida, United States of America
| | - Jessica D. Ribeiro
- Department of Psychology, Florida State University, Tallahassee, Florida, United States of America
- Military Suicide Research Consortium, Tallahassee, Florida, United States of America
| | - Katherine M. Musacchio
- Department of Psychology, Florida State University, Tallahassee, Florida, United States of America
| | - Joseph C. Franklin
- Department of Psychology, Florida State University, Tallahassee, Florida, United States of America
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26
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Ayehu M, Solomon T, Lemma K. Socio-demographic characteristics, clinical profile and prevalence of existing mental illness among suicide attempters attending emergency services at two hospitals in Hawassa city, South Ethiopia: a cross-sectional study. Int J Ment Health Syst 2017; 11:32. [PMID: 28439293 PMCID: PMC5399339 DOI: 10.1186/s13033-017-0136-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/06/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicide is a major public health problem worldwide. It contributes for more than one million deaths each year. Since previous suicidal attempt was considered as the best predictor of future suicide, identifying factors behind suicidal attempt are helpful to design suicide prevention strategies. The aim of this study was to assess socio-demographic characteristics, clinical profile and prevalence of existing mental illness among patients presenting with suicidal attempt to emergency services of general hospitals in South Ethiopia. METHODS We conducted a cross-sectional study on patients presenting with complications of suicidal attempt to emergency departments of two general hospitals in Hawassa city from November, 2014 to August, 2015. Data was collected using semi-structured questionnaire which contained socio-demographic and clinical variables. The Mini International Neuropsychiatric Interview version 5 (MINI PLUs) was used to assess the prevalence of existing mental illness among study participants. Data was entered and analyzed using IBM SPSS statistics 21 software package. RESULTS A total of 96 individuals were assessed, of whom 56 (58.3%) were females. The mean age of study participants was 21.5 (8.0) years. The majority, 75 (78.1%), of the study participants were aged below 25 years. Ingesting pesticide poisons and corrosive agent were used by the majority to attempt suicide. Mental illness was found in only three (3.1%) of the study participants. Impulsivity (the time between decision to attempt suicide and the actual attempt of less than 5 min) was reported by 30 (31.2%) of the study participants, of whom 18 (60%) were males. Males were found three times more likely to attempt suicide impulsively than women (COR = 3.0, 95% CI 1.2-7.3). Quarreling with family members, facing financial crisis, and having unplanned and unwanted pregnancy were reported by the majority of study participants as immediate reasons to attempt suicide. CONCLUSIONS The presence of stressful life events and impulsivity behind suicidal behavior of the younger generation implies that designing suicide prevention strategies for this group is crucial. Moreover, further research is needed to systematically examine the relationship between the presence of mental illness and suicidal attempt with a larger sample size and more robust methodology.
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Affiliation(s)
- Moges Ayehu
- School of Medicine, Hawassa University, Hawassa, Ethiopia.,College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Tarekegn Solomon
- School of Public and Environmental Health, Hawassa University, Hawassa, Ethiopia.,College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Kinfe Lemma
- School of Medicine, Hawassa University, Hawassa, Ethiopia.,College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Snir A, Levi-Belz Y, Solomon Z. Is the war really over? A 20-year longitudinal study on trajectories of suicidal ideation and posttraumatic stress symptoms following combat. Psychiatry Res 2017; 247:33-38. [PMID: 27863316 DOI: 10.1016/j.psychres.2016.10.065] [Citation(s) in RCA: 7] [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] [Received: 02/06/2016] [Revised: 07/06/2016] [Accepted: 10/29/2016] [Indexed: 11/18/2022]
Abstract
Combat stress reaction (CSR) has widespread long-term consequences, including profound psychopathology in the form of posttraumatic stress disorder (PTSD). Studies have established the link between combat, PTSD, and suicidality. However, little is known about the temporal course of suicidal ideation (SI) in general, specifically among war veterans. We aimed to trace the trajectories of SI in the aftermath of war and to explore the role of CSR and PTSD in SI trajectories. Israeli veterans with CSR (n=164) and a matched control group (NCSR, n=111) were assessed, using self-report measures at three points over the course of 20 years. Veterans with CSR reported significantly higher levels of SI, compared to the NCSR group at all measurement points. Among veterans with CSR, SI increased 2 years after the war and then decreased 20 years following the war. This pattern was particularly characteristic of veterans with chronic PTSD. The results indicate that CSR is a strong predictor of subsequent PTSD and suicidality. These findings highlight the importance of prevention and treatment efforts for these traumatized veterans, who are at risk for suicide even 20 years after the end of the war.
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Affiliation(s)
- Avigal Snir
- The Bob Shappel School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Yossi Levi-Belz
- Department of Behavioral Sciences, Ruppin Academic Center, Emek-Hefer, Israel
| | - Zahava Solomon
- The Bob Shappel School of Social Work, Tel Aviv University, Tel Aviv, Israel
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28
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Tucker RP, Lengel GJ, Smith CE, Capron DW, Mullins-Sweatt SN, Wingate LR. Maladaptive Five Factor Model personality traits associated with Borderline Personality Disorder indirectly affect susceptibility to suicide ideation through increased anxiety sensitivity cognitive concerns. Psychiatry Res 2016; 246:432-437. [PMID: 27788465 DOI: 10.1016/j.psychres.2016.08.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 08/17/2016] [Indexed: 11/18/2022]
Abstract
The current study investigated the relationship between maladaptive Five-Factor Model (FFM) personality traits, anxiety sensitivity cognitive concerns, and suicide ideation in a sample of 131 undergraduate students who were selected based on their scores on a screening questionnaire regarding Borderline Personality Disorder (BPD) symptoms. Those who endorsed elevated BPD symptoms in a pre-screen analyses completed at the beginning of each semester were oversampled in comparison to those with low or moderate symptoms. Indirect effect (mediation) results indicated that the maladaptive personality traits of anxious/uncertainty, dysregulated anger, self-disturbance, behavioral dysregulation, dissociative tendencies, distrust, manipulativeness, oppositional, and rashness had indirect effects on suicide ideation through anxiety sensitivity cognitive concerns. All of these personality traits correlated to suicide ideation as well. The maladaptive personality traits of despondence, affective dysregulation, and fragility were positive correlates of suicide ideation and predicted suicide ideation when all traits were entered in one linear regression model, but were not indirectly related through anxiety sensitivity cognitive concerns. The implication for targeting anxiety sensitivity cognitive concerns in evidence-based practices for reducing suicide risk in those with BPD is discussed.
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Affiliation(s)
- Raymond P Tucker
- Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA
| | - Greg J Lengel
- Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA
| | - Caitlin E Smith
- Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA
| | - Dan W Capron
- University of Southern Mississippi, 118 College Drive #5025, Hattiesburg, MS 39406-5025, USA
| | | | - LaRicka R Wingate
- Oklahoma State University, 116 North Murray, Stillwater, OK 74078, USA.
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29
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Pronounced prefronto-temporal cortical thinning in schizophrenia: Neuroanatomical correlate of suicidal behavior? Schizophr Res 2016; 176:151-157. [PMID: 27567290 DOI: 10.1016/j.schres.2016.08.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 08/10/2016] [Accepted: 08/10/2016] [Indexed: 11/21/2022]
Abstract
Schizophrenia is characterized by increased mortality for which suicidality is the decisive factor. An analysis of cortical thickness and folding to further elucidate neuroanatomical correlates of suicidality in schizophrenia has not yet been performed. We searched for relevant brain regions with such differences between patients with suicide-attempts, patients without any suicidal thoughts and healthy controls. 37 schizophrenia patients (14 suicide-attempters and 23 non-suicidal) and 50 age- and gender-matched healthy controls were included. Suicidality was documented through clinical interview and chart review. All participants underwent T1-weighted MRI scans. Whole brain node-by-node cortical thickness and folding were estimated (FreeSurfer Software) and compared. Additionally a three group comparison for prefrontal regions-of-interest was performed in SPSS using a multifactorial GLM. Compared with the healthy controls patients showed a typical pattern of cortical thinning in prefronto-temporal regions and altered cortical folding in the right medial temporal cortex. Patients with suicidal behavior compared with non-suicidal patients demonstrated pronounced (p<0.05) cortical thinning in the right DLPFC and the superior temporal cortex. Comparing cortical thickness in suicidal patients with non-suicidal patients significant (p<0.05) cortical thinning was additionally found in the right superior and middle temporal, temporopolar and insular cortex. Our findings extend the evidence for neuroanatomical underpinnings of suicidal behaviour in schizophrenia. We identified cortical thinning in a network strongly involved in regulation of impulsivity, emotions and planning of behaviour in suicide attempters, which might lead to neuronal dysregulation in this network and consequently to a higher risk of suicidal behavior.
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30
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Tong Y, Phillips MR, Conner KR. DSM-IV Axis II personality disorders and suicide and attempted suicide in China. Br J Psychiatry 2016; 209:319-326. [PMID: 26585099 PMCID: PMC6173803 DOI: 10.1192/bjp.bp.114.151076] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2014] [Accepted: 03/01/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are meagre data on Axis II personality disorders and suicidal behaviour in China. AIMS To describe the prevalence of Axis II personality disorders in suicides and suicide attempts in China and to estimate risk for these outcomes associated with personality disorders. METHOD People who died by suicide (n = 151), people who attempted suicide (n = 118) and living community controls (n = 140) were randomly sampled from four Chinese counties and studied using the Structured Clinical Interviews for DSM-IV-TR Axis I Disorders (SCID-I) and Axis II Personality Disorders (SCID-II). We also determined the prevalence of subthreshold versions of ten DSM-IV personality disorders. RESULTS Axis II personality disorders were present in 7% of the suicide group, 6% of the suicide attempt group and 1% of the control group. Threshold and subthreshold personality disorders had adjusted odds ratios (point estimates) in the range of 2.7-8.0 for suicide and for suicide attempts. CONCLUSIONS Axis II personality disorders may confer increased risk for suicidal behaviour in China, but their low prevalence in the community and among people with suicidal behaviour suggests that other personality constructs such as select dimensional traits may be a more fruitful avenue for understanding and preventing suicide in China.
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Affiliation(s)
- Yongsheng Tong
- Yongsheng Tong, MD, PhD, Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, WHO Collaborating Center for Research and Training in Suicide Prevention, Beijing, China, and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York, USA; Michael R. Phillips, MD, MA, MPH, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Departments of Psychiatry and Public Health, Emory University, Atlanta Georgia, USA, and Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China; Kenneth R. Conner, PsyD, MPH, Department of Psychiatry, University of Rochester Medical Center, Rochester, New York and US Department of Veterans Affairs VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
| | - Michael R. Phillips
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China, Departments of Psychiatry and Public Health, Emory University, Atlanta Georgia, USA, and Beijing Suicide Research and Prevention Center, Beijing Hui Long Guan Hospital, Beijing, China
| | - Kenneth R. Conner
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NewYork and US Department of Veterans Affairs VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, New York, USA
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Distel MA, Smit JH, Spinhoven P, Penninx BWJH. Borderline personality features in depressed or anxious patients. Psychiatry Res 2016; 241:224-31. [PMID: 27183108 DOI: 10.1016/j.psychres.2016.05.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 05/03/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Abstract
Anxiety and depression frequently co-occur with borderline personality disorder. Relatively little research examined the presence of borderline personality features and its main domains (affective instability, identity problems, negative relationships and self-harm) in individuals with remitted and current anxiety and depression. Participants with current (n=597) or remitted (n=1115) anxiety and/or depression and healthy controls (n=431) were selected from the Netherlands Study of Depression and Anxiety. Assessments included the Personality Assessment Inventory - Borderline Features Scale and several clinical characteristics of anxiety and depression. Borderline personality features were more common in depression than in anxiety. Current comorbid anxiety and depression was associated with most borderline personality features. Anxiety and depression status explained 29.7% of the variance in borderline personality features and 3.8% (self-harm) to 31% (identity problems) of the variance in the four domains. A large part of the variance was shared between anxiety and depression but both disorders also explained a significant amount of unique variance. The severity of anxiety and depression and the level of daily dysfunctioning was positively associated with borderline personality features. Individuals with a longer duration of anxiety and depression showed more affective instability and identity problems. These findings suggest that patients with anxiety and depression may benefit from an assessment of personality pathology as it may have implications for psychological and pharmacological treatment.
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Affiliation(s)
- Marijn A Distel
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Johannes H Smit
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Leiden University, Leiden, The Netherlands; Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, EMGO Institute for Health and Care Research and Neuroscience Campus Amsterdam, VU University Medical Centre, Amsterdam, The Netherlands
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32
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Cramer RJ, Bryson CN, Gardner BO, Webber WB. Can preferences in information processing aid in understanding suicide risk among emerging adults? DEATH STUDIES 2016; 40:383-391. [PMID: 27007001 DOI: 10.1080/07481187.2016.1166161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The present study evaluated emerging adult (n = 192 college students) preferences in information processing (PIP), defined by the need for affect (NFA) and need for cognition (NFC), as they may be associated with suicide risk. The following were direct indicators of elevated suicide risk: presence of lifetime exposure to suicide (i.e., lifetime yes/no), elevated depressive symptoms, and greater NFA avoidance. Two different interactions resulted in elevated suicide risk: high depressive symptoms and high NFA avoidance, and high NFC and high NFA. Present results concerning PIP hold the potential to inform suicide risk assessment and prevention efforts among young adults.
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Affiliation(s)
- Robert J Cramer
- a School of Community & Environmental Health Sciences , Old Dominion University , Norfolk , Virginia , USA
| | - Claire N Bryson
- b Department of Psychology , Sam Houston State University , Huntsville , Texas , USA
| | - Brett O Gardner
- b Department of Psychology , Sam Houston State University , Huntsville , Texas , USA
| | - Wesley B Webber
- c Department of Counselor Education , University of Alabama , Tuscaloosa , Alabama , USA
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Jylhä P, Rosenström T, Mantere O, Suominen K, Melartin T, Vuorilehto M, Holma M, Riihimäki K, Oquendo MA, Keltikangas-Järvinen L, Isometsä ET. Personality disorders and suicide attempts in unipolar and bipolar mood disorders. J Affect Disord 2016; 190:632-639. [PMID: 26590510 DOI: 10.1016/j.jad.2015.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/07/2015] [Accepted: 11/02/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Comorbid personality disorders may predispose patients with mood disorders to suicide attempts (SAs), but factors mediating this effect are not well known. METHODS Altogether 597 patients from three prospective cohort studies (Vantaa Depression Study, Jorvi Bipolar Study, and Vantaa Primary Care Depression Study) were interviewed at baseline, at 18 months, and in VDS and PC-VDS at 5 years. Personality disorders (PDs) at baseline, number of previous SAs, life-charted time spent in major depressive episodes (MDEs), and precise timing of SAs during follow-up were determined and investigated. RESULTS Overall, 219 (36.7%) patients had a total of 718 lifetime SAs; 88 (14.7%) patients had 242 SAs during the prospective follow-up. Having any PD diagnosis increased the SA rate, both lifetime and prospectively evaluated, by 90% and 102%, respectively. All PD clusters increased the rate of new SAs, although cluster C PDs more than the others. After adjusting for time spent in MDEs, only cluster C further increased the SA rate (by 52%). Mediation analyses of PD effects on prospectively ascertained SAs indicated significant mediated effects through time at risk in MDEs, but also some direct effects. LIMITATIONS Findings generalizable only to patients with mood disorders. CONCLUSIONS Among mood disorder patients, comorbid PDs increase the risk of SAs to approximately two-fold. The excess risk is mostly due to patients with comorbid PDs spending more time in depressive episodes than those without. Consequently, risk appears highest for PDs that most predispose to chronicity and recurrences. However, also direct risk-modifying effects of PDs exist.
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Affiliation(s)
- Pekka Jylhä
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland
| | - Tom Rosenström
- IBS, Unit of Personality, Work and Health Psychology,University of Helsinki, Helsinki, Finland
| | - Outi Mantere
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland
| | - Kirsi Suominen
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; City of Helsinki, Social Services and Healthcare, Department of Mental Health and Substance Abuse, Helsinki, Finland
| | - Tarja Melartin
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland
| | - Maria Vuorilehto
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland
| | - Mikael Holma
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland
| | - Kirsi Riihimäki
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; Healthcare and Social Services, City of Järvenpää, Järvenpää, Finland
| | - Maria A Oquendo
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | | | - Erkki T Isometsä
- Department of Mental Health and Substance Use,National Institute of Health and Welfare, Helsinki, Finland; University of Helsinki and Helsinki University Hospital, Psychiatry, Helsinki, Finland.
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Ribeiro JD, Franklin JC, Fox KR, Bentley KH, Kleiman EM, Chang BP, Nock MK. Self-injurious thoughts and behaviors as risk factors for future suicide ideation, attempts, and death: a meta-analysis of longitudinal studies. Psychol Med 2016; 46:225-236. [PMID: 26370729 PMCID: PMC4774896 DOI: 10.1017/s0033291715001804] [Citation(s) in RCA: 709] [Impact Index Per Article: 88.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A history of self-injurious thoughts and behaviors (SITBs) is consistently cited as one of the strongest predictors of future suicidal behavior. However, stark discrepancies in the literature raise questions about the true magnitude of these associations. The objective of this study is to examine the magnitude and clinical utility of the associations between SITBs and subsequent suicide ideation, attempts, and death. METHOD We searched PubMed, PsycInfo, and Google Scholar for papers published through December 2014. Inclusion required that studies include at least one longitudinal analysis predicting suicide ideation, attempts, or death using any SITB variable. We identified 2179 longitudinal studies; 172 met inclusion criteria. RESULTS The most common outcome was suicide attempt (47.80%), followed by death (40.50%) and ideation (11.60%). Median follow-up was 52 months (mean = 82.52, s.d. = 102.29). Overall prediction was weak, with weighted mean odds ratios (ORs) of 2.07 [95% confidence interval (CI) 1.76-2.43] for ideation, 2.14 (95% CI 2.00-2.30) for attempts, and 1.54 (95% CI 1.39-1.71) for death. Adjusting for publication bias further reduced estimates. Diagnostic accuracy analyses indicated acceptable specificity (86-87%) and poor sensitivity (10-26%), with areas under the curve marginally above chance (0.60-0.62). Most risk factors generated OR estimates of <2.0 and no risk factor exceeded 4.5. Effects were consistent regardless of sample severity, sample age groups, or follow-up length. CONCLUSIONS Prior SITBs confer risk for later suicidal thoughts and behaviors. However, they only provide a marginal improvement in diagnostic accuracy above chance. Addressing gaps in study design, assessment, and underlying mechanisms may prove useful in improving prediction and prevention of suicidal thoughts and behaviors.
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Affiliation(s)
- J. D. Ribeiro
- Department of Psychology, Harvard University, Cambridge, MA, USA
- Military Suicide Research Consortium, Florida State University, Tallahassee, FL, USA
- Department of Psychological Sciences, Vanderbilt University, Nashville, TN, USA
| | - J. C. Franklin
- Department of Psychology, Harvard University, Cambridge, MA, USA
- Department of Psychological Sciences, Vanderbilt University, Nashville, TN, USA
| | - K. R. Fox
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - K. H. Bentley
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
| | - E. M. Kleiman
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - B. P. Chang
- Department of Medicine, Columbia University, New York, NY, USA
| | - M. K. Nock
- Department of Psychology, Harvard University, Cambridge, MA, USA
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Sulzer SH. Does "difficult patient" status contribute to de facto demedicalization? The case of borderline personality disorder. Soc Sci Med 2015; 142:82-9. [PMID: 26298091 DOI: 10.1016/j.socscimed.2015.08.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Revised: 07/29/2015] [Accepted: 08/05/2015] [Indexed: 11/30/2022]
Abstract
A diagnosis of Borderline Personality Disorder (BPD) often signals the quintessential "difficult patient" status to clinicians, with at least one scholar arguing the condition itself was created to name and group difficult patients. While patients who are deemed difficult are often dispreferred for care, does this have an impact on their overall status as medicalized patients who have successfully achieved a sick role? This study relies on (n = 22) in-depth interviews with mental health clinicians in the United States from 2012 to evaluate how they describe patients with BPD, how the diagnosis of BPD affects the treatment clinicians are willing to provide, and the implications for patients. My findings suggest patients with BPD are routinely labeled "difficult," and subsequently routed out of care through a variety of direct and indirect means. This process creates a functional form of demedicalization where the actual diagnosis of BPD remains de jure medicalized, but the de facto or treatment component of medicalization is harder to secure for patients.
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Affiliation(s)
- Sandra H Sulzer
- Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 1100 Delaplaine Court, Madison, WI 53715, USA; Department of Sociology, Xavier University of Louisiana, 1 Drexel Drive, New Orleans, LA 70125, USA.
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Desrosiers L, Saint-Jean M, Breton JJ. Treatment planning: A key milestone to prevent treatment dropout in adolescents with borderline personality disorder. Psychol Psychother 2015; 88:178-96. [PMID: 24957784 DOI: 10.1111/papt.12033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 04/24/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study was to gain a broader appreciation of processes involved in treatment dropout in adolescents with borderline personality disorder (BPD). DESIGN A constructivist grounded theory was chosen using a multiple-case research design with three embedded levels of analysis (adolescent, parent, and care setting). METHOD Theoretical sampling and the different stages of analysis specific to grounded theory were performed according to the iterative process of constant comparative analysis. Twelve cases were examined (nine dropouts among adolescents with BPD and for the purpose of falsification, one dropout of suicidal adolescent without BPD and two completed treatments among adolescents with BPD). To document the cases, three groups of informants were recruited (adolescents, parents, and therapists involved in the treatment) and 34 interviews were conducted. RESULTS Psychological characteristics, perception of mental illness and mental health care, and help-seeking context were the specific treatment dropout vulnerabilities identified in adolescents with BPD and in their parents. However, their disengagement became an issue only when care-setting response--including mitigation of accessibility problems, adaptation of services to needs of adolescents with BPD, preparation for treatment, and concern for clinicians' disposition to treat--was ill-suited to these treatment dropout vulnerabilities. Treatment planning proves to be a key milestone to properly engage adolescents with BPD and their parent. CONCLUSIONS Systematic assessment of treatment dropout vulnerabilities before the intervention plan is laid out could foster better-suited responses of the care setting thus decreasing the incidence of treatment discontinuation in adolescents with BPD. PRACTITIONER POINTS Treatment dropout vulnerabilities specific to adolescents with BPD and their parents can be detected before the beginning of treatment. Premature treatment termination may be prevented if the care setting considers these vulnerabilities at treatment planning. Fears and negative reaction to treatment can be attenuated if the reasons behind the therapeutic orientation are explained and if the adolescent understand how the treatment will affect his condition. Concerns for autonomy of the adolescent, parental help-seeking context as well as ensuring that the clinician has the skills, interest, and motivation to work with the family may have a positive effect on families' commitment to treatment.
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Affiliation(s)
- Lyne Desrosiers
- Occupational Therapy Program, School of Rehabilitation, Medical Faculty, University of Montréal, Québec, Canada.,Research Center of the Montréal Mental Health University Institute, Montréal, Québec, Canada.,Mood Disorders Clinic, Child and Adolescent Psychiatry Program, Rivière-des-Prairies Hospital, Montréal, Québec, Canada
| | - Micheline Saint-Jean
- Occupational Therapy Program, School of Rehabilitation, Medical Faculty, University of Montréal, Québec, Canada
| | - Jean-Jacques Breton
- Occupational Therapy Program, School of Rehabilitation, Medical Faculty, University of Montréal, Québec, Canada.,Research Center of the Montréal Mental Health University Institute, Montréal, Québec, Canada
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Abstract
Borderline personality disorder (BPD) and major depressive disorder (MDD) commonly co-occur, but the relationship between these disorders remains unclear. While BPD patients often suffer from depression, their subjective experience and treatment response are different from that experienced by MDD patients without BPD. Surveying the current literature on the interface of these two pathologies, we find that depression in BPD has distinct symptoms, treatment responses, remission predictors, and suicide risks. It tends to be subjectively more severe, more interpersonally fueled, and more persistent than MDD without BPD. BPD depression responds less well to biological treatments and may be fueled by the neurobiology of BPD. These findings suggest that clinicians should recognize the unique features of BPD depression and anticipate a clinical trajectory that may be different from MDD without BPD, keeping in mind that BPD depression tends not to improve until BPD improves.
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van den Bosch LMC, Sinnaeve R, Hakkaart-van Roijen L, van Furth EF. Efficacy and cost-effectiveness of an experimental short-term inpatient Dialectical Behavior Therapy (DBT) program: study protocol for a randomized controlled trial. Trials 2014; 15:152. [PMID: 24885551 PMCID: PMC4017823 DOI: 10.1186/1745-6215-15-152] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/27/2014] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is a serious psychiatric condition associated with substantial mortality, burden and public health costs. DBT is the treatment model with the largest number of published research articles showing effectiveness. However, some patients are not sufficiently engaged in outpatient treatment while presenting severe parasuicidal behavior, making hospitalization necessary. The Center for Personality Disorders Jelgersma developed an intensive 12-week inpatient DBT program that (i) rapidly reduces core borderline symptoms like suicidal behavior, (ii) minimizes the negative effects of an inpatient setting, and (iii) enhances compliance with outpatient treatment. We evaluate the (cost-) effectiveness of this experimental program. METHODS/DESIGN Seventy patients, aged 18 to 45 years with a primary diagnosis of BPD, showing a chronic pattern of parasuicidal gestures and/or reporting high degrees of severity of other borderline symptoms, are randomly allocated to the control and intervention groups. Subjects in the control group receive standard outpatient DBT, provided in one of three regular mental health settings in GGZ Rivierduinen. Subjects in the intervention group receive 12 weeks of intensified inpatient DBT plus six months of standard DBT, provided in the Center for Personality Disorders Jelgersma. The primary outcome is the number of suicide attempts/self-harming acts. Secondary outcomes are severity of other borderline complaints, quality of life, general psychopathological symptoms and health care utilization and productivity costs. Data are gathered using a prospective, two (group: intervention and control) by five (time of measurement) repeated measures factorial design.Participants will complete three-monthly outcome assessments in the course of therapy: at baseline, and 12, 24, 36 and 52 weeks after the start of the treatment. The period of recruitment started in March 2012 and the study will end in December 2014. DISCUSSION Highly suicidal outpatient patients can pose a dilemma for mental health care professionals. Although hospitalization seems inevitable under some circumstances, it has proven to be harmful in its own right. This paper outlines the background and methods of a randomized trial evaluating the possible surplus value of a short-term inpatient DBT program.
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Affiliation(s)
| | - Roland Sinnaeve
- Center for Personality Disorders Jelgersma, Postbox 750, 2300 Leiden, AT, the Netherlands
| | - Leona Hakkaart-van Roijen
- Institute of Health Policy and Management (iBMG) and institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Postbus 1738, 3000 Rotterdam, DR, the Netherlands
| | - Eric F van Furth
- Department of Psychiatry, Leiden University Medical Center, Postbox 9600, 2300 Leiden, RC, the Netherlands
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Trajectories of suicidal ideation and posttraumatic stress symptoms among former prisoners of war: a 17-year longitudinal study. J Psychiatr Res 2014; 49:83-9. [PMID: 24280653 DOI: 10.1016/j.jpsychires.2013.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 11/02/2013] [Accepted: 11/06/2013] [Indexed: 11/21/2022]
Abstract
War captivity is one of the most severe human-inflicted traumatic experiences with wide and substantial long-term negative effects. However, only one retrospective study examined suicidal ideation (SI) among ex-prisoners of war (ex-POWs). This study aimed to prospectively assess SI among ex-POWs and its associations with posttraumatic stress disorder (PTSD) symptoms over a 17-year period. Two groups of male Israeli veterans from the 1973 Yom Kippur War were examined: ex-POWs and comparable veterans who were not taken captive. Both groups were assessed via self-report measures of SI and PTSD symptoms at three time points: T1 18 (1991), T2 30 (2003), and T3 35 (2008) years after the war. Latent growth curve modeling (LGM) results showed that ex-POWs reported higher levels of SI at T2 and T3 and a pattern of increase in SI levels trajectory over time, compared to control veterans. Furthermore, among ex-POWs, PTSD symptoms at T1 contributed to the increase in rate of change in SI overtime. In addition, PTSD symptoms affected SI at the same measurement, above and beyond above the trajectories of SI. Clinical implications of these findings for the relations between captivity trauma and suicidality are discussed.
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Barzilay S, Apter A. Predictors of suicide in adolescents and adults with mood and common comorbid disorders. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/npy.13.86] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
PURPOSE OF REVIEW Durability has traditionally been considered to be a defining feature of personality disorders, but recent studies have challenged this notion. We review the most recent findings on the stability and course of personality pathology. RECENT FINDINGS Personality disorders seem to remit more often and faster than previously thought, and their relapse rate is low. However, the recent optimism regarding these disorders is mitigated by the existence of highly heterogeneous trajectories among patients and traits, the identification of certain methodological shortcomings, and the maintenance of psychosocial impairment long after symptomatic relief. The causes of personality improvement are largely unknown, but involve intermingled genetic and environmental effects. SUMMARY Recent follow-up studies of patients with personality pathology are changing orthodox conceptions of their inevitably negative prognosis. The current taxonomies must be reviewed and future research should be integrated with adjacent fields. Treatments need to target the enduring real-life hardships of these patients, apart from their acute symptoms.
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Stringer B, van Meijel B, Eikelenboom M, Koekkoek B, Licht CMM, Kerkhof AJFM, Penninx BWJH, Beekman ATF. Recurrent suicide attempts in patients with depressive and anxiety disorders: the role of borderline personality traits. J Affect Disord 2013; 151:23-30. [PMID: 23623006 DOI: 10.1016/j.jad.2013.02.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Revised: 02/28/2013] [Accepted: 02/28/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND The presence of a comorbid borderline personality disorder (BPD) may be associated with an increase of suicidal behaviors in patients with depressive and anxiety disorders. The aim of this study is to examine the role of borderline personality traits on recurrent suicide attempts. METHODS The Netherlands Study on Depression and Anxiety included 1838 respondents with lifetime depressive and/or anxiety disorders, of whom 309 reported at least one previous suicide attempt. A univariable negative binomial regression analysis was performed to examine the association between comorbid borderline personality traits and suicide attempts. Univariable and multivariable negative binomial regression analyses were performed to identify risk factors for the number of recurrent suicide attempts in four clusters (type and severity of axis-I disorders, BPD traits, determinants of suicide attempts and socio-demographics). RESULTS In the total sample the suicide attempt rate ratio increased with 33% for every unit increase in BPD traits. A lifetime diagnosis of dysthymia and comorbid BPD traits, especially the symptoms anger and fights, were independently and significantly associated with recurrent suicide attempts in the final model (n=309). LIMITATIONS The screening of personality disorders was added to the NESDA assessments at the 4-year follow-up for the first time. Therefore we were not able to examine the influence of comorbid BPD traits on suicide attempts over time. CONCLUSIONS Persons with a lifetime diagnosis of dysthymia combined with borderline personality traits especially difficulties in coping with anger seemed to be at high risk for recurrent suicide attempts. For clinical practice, it is recommended to screen for comorbid borderline personality traits and to strengthen the patient's coping skills with regard to anger.
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Affiliation(s)
- Barbara Stringer
- Department of Psychiatry and the EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam/GGZ inGeest, Amsterdam, The Netherlands.
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Boisseau CL, Yen S, Markowitz JC, Grilo CM, Sanislow CA, Shea MT, Zanarini MC, Skodol AE, Gunderson JG, Morey LC, McGlashan TH. Individuals with single versus multiple suicide attempts over 10years of prospective follow-up. Compr Psychiatry 2013; 54:238-42. [PMID: 22995448 PMCID: PMC3541431 DOI: 10.1016/j.comppsych.2012.07.062] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/13/2012] [Accepted: 07/23/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The study attempted to identify characteristics that differentiate multiple suicide attempters from single attempters in individuals with personality disorders (PDs) and/or major depression. METHOD Participants were 431 participants enrolled in the Collaborative Longitudinal Study of Personality Disorders from July 1996 to June 2008. Suicide attempts were assessed with the Longitudinal Interval Follow-up Evaluation at 6 and 12months, then yearly through 10years. Logistic regression was used to compare single attempters to multiple attempters on Axis I and II psychiatric disorders and personality trait variables. RESULTS Twenty-one percent of participants attempted suicide during the 10years of observation, with 39 (9.0%) reporting a single suicide attempt and 54 (12.5%) reporting multiple suicide attempts. Although no significant differences in were found in baseline Axis I disorders, multiple attempters were significantly more likely to meet criteria for borderline personality disorder and to have higher impulsivity scores than single attempters. CONCLUSION These results underscore the importance of considering both personality disorders and traits in the assessment of suicidality.
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Affiliation(s)
- Christina L. Boisseau
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence, Rhode Island,Butler Hospital, Providence, Rhode Island
| | - Shirley Yen
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence, Rhode Island
| | - John C. Markowitz
- New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University
| | | | | | - M. Tracie Shea
- Department of Psychiatry and Human Behavior, Warren Alpert Brown Medical School, Providence, Rhode Island,Veterans Affairs Medical Center, Providence, Rhode Island
| | - Mary C. Zanarini
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Belmont, Massachusetts
| | - Andrew E. Skodol
- Sunbelt Collaborative and the University of Arizona College of Medicine, Tucson
| | - John G. Gunderson
- Department of Psychiatry, McLean Hospital and Harvard Medical School, Belmont, Massachusetts
| | - Leslie C. Morey
- Department of Psychology, Texas A&M University, College Station
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Links PS, Kolla NJ, Guimond T, McMain S. Prospective risk factors for suicide attempts in a treated sample of patients with borderline personality disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2013; 58:99-106. [PMID: 23442897 DOI: 10.1177/070674371305800207] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE People with borderline personality disorder (BPD) are at high risk for attempting suicide. There are some data to suggest that risk factors for suicide attempts change over time. We conducted a prospective cohort study to examine risk factors for suicide attempts in a treated sample of patients with BPD. METHOD One hundred eighty participants with BPD were followed over a year-long course of dialectical behaviour therapy or general psychiatric management and then for 2 more years in naturalistic follow-up. Participants were assessed for suicidal and self-injurious behaviours at baseline, every 4 months over the 1-year treatment phase, and every 6 months over a 2-year follow-up period. Participants were classified as suicide or non-suicide attempters based on their behaviour at the end of the 1-year treatment phase and after the 2-year follow-up period. Groups were then compared on baseline clinical and demographic variables. RESULTS Nearly 26% of participants made a suicide attempt during the 1-year treatment phase, while 16.7% reported a suicide attempt over the 2-year follow-up period. Baseline number of suicide attempts during the 4 months prior to study and severity of childhood sexual abuse predicted suicide attempts during the treatment year. Similarly, baseline suicide attempts, severity of childhood sexual abuse, and number of hospitalizations in the 4 months prior to study entry predicted suicide attempts during the 2-year follow-up. CONCLUSIONS Risk factors for suicide attempts in this treated sample of patients with BPD were fairly stable, largely non-modifiable, and unrelated to psychopathology or psychosocial functioning at baseline.
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Affiliation(s)
- Paul S Links
- Department of Psychiatry, The University of Western Ontario, London, Ontario, Canada.
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Howe E. Five ethical and clinical challenges psychiatrists may face when treating patients with borderline personality disorder who are or may become suicidal. INNOVATIONS IN CLINICAL NEUROSCIENCE 2013; 10:14-9. [PMID: 23440937 PMCID: PMC3579480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article discusses five core ethical and clinical questions psychiatrists should consider when they treat patients with borderline personality disorder who are or may be suicidal. These questions include whether psychiatrists should tell patients their diagnosis, what they should tell them about their suicide risk, whether they should be "always" available by phone, when they should hospitalize these patients involuntarily, and how they should respond after these patients have attempted suicide and return for further care. This discussion highlights the ethical components of these questions. Optimal ethical and clinical interventions, in most cases, overlap. Psychiatrists may accomplish the most clinically by sharing with these patients some of the above conflicts that they face and/or the rationales for doing what they will do. These interventions may maximize the autonomy patients with borderline personality disorder and at the same time be clinically optimal, increasing a sense of self-efficacy and patient-psychiatrist trust in the patients.
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Affiliation(s)
- Edmund Howe
- Dr. Howe is Professor, Department of Psychiatry, Director, Programs in Medical Ethics, and Senior Scientist, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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