Department of Psychiatry and the EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam/GGZ inGeest, Amsterdam, The Netherlands.
J Affect Disord. 2013 Oct;151(1):23-30. doi: 10.1016/j.jad.2013.02.038. Epub 2013 Apr 25.
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.
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).
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).
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.
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.
伴发边缘型人格障碍（BPD）可能与抑郁和焦虑障碍患者自杀行为的增加有关。本研究旨在探讨边缘型人格特质对复发性自杀企图的作用。
荷兰抑郁和焦虑研究纳入了 1838 名有终生抑郁和/或焦虑障碍的受访者，其中 309 名报告至少有一次既往自杀企图。采用单变量负二项回归分析，考察伴发边缘型人格特质与自杀企图之间的关联。采用单变量和多变量负二项回归分析，确定四个聚类（轴 I 障碍的类型和严重程度、BPD 特质、自杀企图的决定因素和社会人口统计学）中复发性自杀企图次数的危险因素。
在总样本中，BPD 特质每增加一个单位，自杀企图率比增加 33%。终生诊断为心境恶劣和伴发 BPD 特质，尤其是愤怒和争吵的症状，在最终模型（n=309）中与复发性自杀企图独立且显著相关。
人格障碍的筛查是在 NESDA 评估的第 4 年随访时首次加入的。因此，我们无法在整个研究期间检查伴发 BPD 特质对自杀企图的影响。
有心境恶劣和边缘型人格特质伴发的患者，特别是在处理愤怒方面有困难的患者，似乎有复发性自杀企图的高风险。对于临床实践，建议筛查伴发边缘型人格特质，并加强患者处理愤怒的技能。
