Center of Medical Genetics,Tzu Chi General Hospital, Hualien, Taiwan.
Management Office for Health Data, China Medical University Hospital, and College of Medicine, China Medical University, Taichung, Taiwan.
Sex Transm Infect. 2019 Nov;95(7):529-533. doi: 10.1136/sextrans-2018-053812. Epub 2019 Apr 13.
Several features of borderline personality disorder (BPD) are likely to be associated with sexual health problems, such as unstable attachment, unstable sexual identity and sexual impulsivity. Since the issue of sex is not openly discussed in Taiwanese society, sexual health needs, including screening and prevention of sexually transmitted infections (STI), are often neglected in this population.
The study aims to determine whether BPD is associated with an increased risk of subsequent STI in Taiwan.
Overall 669 patients with BPD and 2676 controls matched by gender and age were enrolled between 2000 and 2012 and followed until the end of 2013 using Taiwan's National Health Insurance Research Database. During the follow-up period, participants who developed STI (human immunodeficiency virus, syphilis, genital warts, gonorrhoea, chlamydia and trichomoniasis) were identified. Cox regression analysis was used to calculate the hazard ratio (HR) with 95% confidence interval (CI) of the STI incidence rate between patients with BPD and unaffected controls.
Patients with BPD were predisposed to developing STI (HR: 4.17, 95% CI 1.62 to 10.8) after adjusting for demographic data and psychiatric comorbidities. The stratification analysis revealed a similar risk trend with BPD and subsequent STI in each gender and age group and was significant in the subgroups of male (HR: 11.3, 95% CI 2.97 to 42.7) and those aged 18-34 years (HR: 4.85, 95% CI 1.71 to 13.7). Also, the comorbidity stratification analysis revealed that, when the effect of comorbidities was excluded, patients with pure BPD significantly exhibited the risk association for subsequent STI after adjusting for all variables (HR: 4.24, 95% CI 1.25 to 14.4).
Given the greater potential of BPD to be associated with an increased risk of STI, there should be direct implications for the development of targeted prevention interventions in Taiwan's mental health clinics.
边缘型人格障碍（BPD）的几个特征可能与性健康问题有关，例如不稳定的依恋、不稳定的性身份和性冲动。由于性问题在台湾社会没有得到公开讨论，因此该人群的性健康需求，包括性传播感染（STI）的筛查和预防，经常被忽视。
本研究旨在确定 BPD 是否与台湾性传播感染（STI）的风险增加有关。
2000 年至 2012 年间共纳入 669 例 BPD 患者和 2676 例性别和年龄匹配的对照者，并使用台湾全民健康保险研究数据库随访至 2013 年底。在随访期间，确定参与者是否患有 STI（人类免疫缺陷病毒、梅毒、生殖器疣、淋病、衣原体和滴虫病）。使用 Cox 回归分析计算 BPD 患者与无影响对照者 STI 发生率的风险比（HR）及其 95%置信区间（CI）。
在调整人口统计学数据和精神共病后，BPD 患者发生 STI 的风险更高（HR：4.17，95%CI 1.62 至 10.8）。分层分析显示，BPD 与各性别和年龄组的后续 STI 存在相似的风险趋势，且在男性亚组（HR：11.3，95%CI 2.97 至 42.7）和 18-34 岁年龄组（HR：4.85，95%CI 1.71 至 13.7）中显著。此外，共病分层分析显示，当排除共病的影响时，在调整所有变量后，单纯 BPD 患者的后续 STI 风险显著增加（HR：4.24，95%CI 1.25 至 14.4）。
鉴于 BPD 与 STI 风险增加的关联更大，这应该对台湾精神卫生诊所制定有针对性的预防干预措施产生直接影响。
