Scheidell Joy D, Lejuez Carl W, Golin Carol E, Hobbs Marcia M, Wohl David A, Adimora Adaora A, Khan Maria R
From the *Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University School of Medicine, New York, NY; †Center for Addictions, Personality, and Emotion Research, University of Maryland, College Park, MD; ‡Division of General Internal Medicine and Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; §Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; ¶Division of Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC; and ∥Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.
Sex Transm Dis. 2016 May;43(5):317-23. doi: 10.1097/OLQ.0000000000000433.
Sexually transmitted infections (STI)/HIV rates are disproportionately high among men involved in the criminal justice system. Mental health disorders, including personality disorders, are also elevated among inmates. Borderline personality disorder (BPD) may be an important risk factor for STI/HIV, yet remains relatively understudied, particularly among inmates.
We used baseline data from Project DISRUPT, a cohort study of African American men being released from prison in North Carolina who were in heterosexual relationships at prison entry (n=189), to assess their STI/HIV risk in the 6 months before incarceration and BPD symptoms focused on emotional lability and relationship dysfunction. We created a continuous BPD symptom severity score and a dichotomous BPD indicator split at the top quartile of the score (BPD-TQ) to examine associations between BPD and STI/HIV outcomes using logistic regression. We also examined associations between individual symptoms and outcomes.
After adjustment for sociodemographics and antisocial personality disorder, BPD-TQ was associated with sexual risk behaviors including multiple partnerships (adjusted odds ratio, 2.58; 95% confidence interval, 1.24-5.36) and sex with nonmonogamous partners (adjusted odds ratio, 2.54; 95% confidence interval, 1.17-5.51). Prevalence of previous STI (47.5% vs. 29.6%) and prevalent chlamydial infection (6.9% vs. 3.1%) seemed higher in those in BPD-TQ, although the associations were not statistically significant. Associations were similar to those with the continuous score. Borderline personality disorder symptoms most associated with STI/HIV risk were abandonment worry, mood swings, and shifts in opinions.
Borderline personality disorder is strongly associated with STI/HIV risk in this sample. Researchers should further evaluate the relationship between STI/HIV and BPD, in addition to mood disorders.
性传播感染（STI）/艾滋病毒（HIV）在涉及刑事司法系统的男性中发病率极高。包括人格障碍在内的心理健康障碍在囚犯中也较为普遍。边缘性人格障碍（BPD）可能是性传播感染/艾滋病毒的一个重要风险因素，但相关研究仍相对较少，尤其是在囚犯群体中。
我们使用了“破坏计划”的基线数据，该队列研究对象为北卡罗来纳州出狱的非裔美国男性，他们入狱时处于异性恋关系（n = 189），旨在评估他们入狱前6个月的性传播感染/艾滋病毒风险以及关注情绪不稳定和关系功能障碍的边缘性人格障碍症状。我们创建了一个连续的边缘性人格障碍症状严重程度评分和一个二分的边缘性人格障碍指标，该指标在评分的上四分位数处划分（BPD-TQ），以使用逻辑回归分析边缘性人格障碍与性传播感染/艾滋病毒结果之间的关联。我们还研究了个体症状与结果之间的关联。
在对社会人口统计学和反社会人格障碍进行调整后，BPD-TQ与性风险行为相关，包括多个性伴侣（调整后的优势比，2.58；95%置信区间，1.24 - 5.36）以及与非一夫一妻制伴侣发生性行为（调整后的优势比，2.54；95%置信区间，1.17 - 5.51）。BPD-TQ组中既往性传播感染的患病率（47.5%对29.6%）和衣原体感染的患病率（6.9%对3.1%）似乎更高，尽管这些关联在统计学上并不显著。这些关联与连续评分的情况相似。与性传播感染/艾滋病毒风险最相关的边缘性人格障碍症状是被抛弃担忧、情绪波动和观点转变。
在该样本中，边缘性人格障碍与性传播感染/艾滋病毒风险密切相关。除了情绪障碍外，研究人员还应进一步评估性传播感染/艾滋病毒与边缘性人格障碍之间的关系。
