Orygen, Melbourne, VIC, Australia.
Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.
Aust N Z J Psychiatry. 2023 Nov;57(11):1453-1464. doi: 10.1177/00048674231172108. Epub 2023 May 12.
Preliminary evidence indicates that interventions designed to support family and friends ('carers') of young people with early-stage borderline personality disorder effectively improve carer outcomes. None of these interventions have been tested in a randomised controlled trial.
This clustered, partially nested, randomised controlled trial was conducted at Orygen, Melbourne, Australia. Carers of young people (aged 15-25 years) with borderline personality disorder features were randomly assigned as a unit in a 1:1 ratio, balanced for young person's sex and age, to receive a 15-day intervention comprising: (1) the three-session, in-person, Making Sense of BPD (MS-BPD) multi-family group programme, plus two self-directed online psychoeducational modules (MS-BPD + Online, = 38), or (2) the two self-directed online psychoeducational modules alone (Online, = 41). The primary outcome was 'negative experiences of care', measured with the Experience of Caregiving Inventory, at the 7-week endpoint.
A total of 79 carers were randomised (pool of 281, 197 excluded, 94 declined) and 73 carers (51 females [69.9%], M = 43.8 years [standard deviation, SD = 12.9], MS-BPD + Online = 35 [47.9%], Online = 38 [52.1%]) provided follow-up data and were included in the intent-to-treat analysis. The intent-to-treat (and per protocol) analyses did not find any significant differences between the groups on the primary ( = -0.32; 95% confidence interval = [-17.05, 3.97]) or secondary outcomes. Regardless of treatment group, caregivers improved significantly in their personality disorder knowledge.
Delivering MS-BPD in conjunction with an online psychoeducational intervention was not found to provide additional benefit over and above access to an online intervention alone. In accordance with national guidelines, carer interventions should be routinely offered by youth mental health services as part of early intervention programmes for borderline personality disorder. Further research is warranted into which interventions work for whom, carers' preferences for support and barriers to care.
初步证据表明，旨在支持患有早期边缘型人格障碍的年轻人的家属和朋友（“照顾者”）的干预措施可有效改善照顾者的结局。这些干预措施均未在随机对照试验中进行过测试。
这项集群、部分嵌套的随机对照试验在澳大利亚墨尔本的 Orygen 进行。患有边缘型人格障碍特征的年轻人（年龄在 15-25 岁之间）的照顾者作为一个单位，以 1:1 的比例随机分配，根据年轻人的性别和年龄进行平衡，接受为期 15 天的干预，包括：（1）三次面对面的“理解边缘型人格障碍”（MS-BPD）多家庭小组方案，加上两个自我指导的在线心理教育模块（MS-BPD+在线，=38），或（2）仅接受两个自我指导的在线心理教育模块（在线，=41）。主要结局是在 7 周的终点用照顾体验量表测量的“照顾的负面体验”。
共有 79 名照顾者被随机分配（共 281 名，197 名排除，94 名拒绝），73 名照顾者（51 名女性[69.9%]，M=43.8 岁[标准差，SD=12.9]，MS-BPD+在线=35 [47.9%]，在线=38 [52.1%]）提供了随访数据，并纳入意向治疗分析。意向治疗（和按方案）分析未发现两组在主要结局（ = -0.32；95%置信区间[CI]：[-17.05，3.97]）或次要结局上有任何显著差异。无论治疗组如何，照顾者的人格障碍知识都显著提高。
与单独提供在线心理教育干预相比，同时提供 MS-BPD 并没有提供额外的益处。根据国家指南，青少年心理健康服务机构应作为边缘型人格障碍早期干预计划的一部分，常规为照顾者提供干预措施。进一步的研究需要确定哪些干预措施对哪些人有效、照顾者对支持的偏好以及照顾的障碍。
