Buronfosse Alice, Robin Marion, Speranza Mario, Duriez Philibert, Silva Jérôme, Corcos Maurice, Perdereau Fabienne, Younes Nadia, Cailhol Lionel, Gorwood Philip, Pham-Scottez Alexandra
Centre Psychiatrique d'Orientation et d'Accueil, GHU Paris Psychiatrie et Neurosciences, Paris, France.
Service de psychiatrie de l'adolescent et du jeune adulte, Institut Mutualiste Montsouris, Paris, France.
Front Psychiatry. 2024 Jan 4;14:1288195. doi: 10.3389/fpsyt.2023.1288195. eCollection 2023.
Borderline personality disorder is often associated with self-injurious behaviors that cause personal suffering, family distress, and substantial medical costs. Mental health hotlines exist in many countries and have been shown to be effective in some contexts, but none have been specifically designed for borderline patients. The aim of the present study is to evaluate the impact of a 24/7 hotline dedicated to patients with borderline personality disorder on suicide attempts and self-injurious behaviors.
We conducted a single-blind, multicenter (9 French centers) clinical trial with stratified randomization (by age, sex and center). Patients ( = 315) with a diagnosis of borderline personality disorder (according to the SIDP-IV) were randomized into two groups with or without access to the hotline in addition to treatment as usual. The number of suicide attempts and self-injurious behaviors in each group within 12 month were analyzed in the "per protocol" population (Student's -tests, 5% significance threshold), adjusting for possible confounders in a multivariate analysis (using Poisson regression). The percentage of patients with suicide attempts and with self-injurious behaviors (and other percentages) were analyzed in the per protocol population (χ-tests or exact Fischer tests, 5% significance threshold).
The mean number of suicide attempts was 3 times lower in the hotline group (0.41 vs. 1.18, = 0.005) and the mean number of self-injurious behaviors was 9 times lower (0.90 vs. 9.5, = 0.006). Multivariate analysis confirmed the effectiveness of the hotline in reducing suicide attempts and self-harm.
This study supports the effectiveness of hotlines in reducing self-aggressive behavior in patients with borderline personality disorder. Such support is easy to use, cheap and flexible, and therefore easy to implement on a large scale.
边缘型人格障碍常与自我伤害行为相关，这些行为会给个人带来痛苦、给家庭造成困扰，并产生高昂的医疗费用。许多国家都设有心理健康热线，并且在某些情况下已被证明是有效的，但尚无专门为边缘型人格障碍患者设计的热线。本研究的目的是评估一条专为边缘型人格障碍患者设立的全天候热线对自杀未遂和自我伤害行为的影响。
我们进行了一项单盲、多中心（9个法国中心）的临床试验，采用分层随机化（按年龄、性别和中心）。诊断为边缘型人格障碍（根据《国际人格障碍检查表第四版》）的患者（n = 315）被随机分为两组，一组除常规治疗外可使用热线，另一组则不能。在“符合方案”人群中分析每组在12个月内的自杀未遂和自我伤害行为的数量（采用学生t检验，显著性阈值为5%），并在多变量分析中对可能的混杂因素进行调整（使用泊松回归）。在符合方案人群中分析有自杀未遂和自我伤害行为的患者百分比（以及其他百分比）（采用卡方检验或精确费舍尔检验，显著性阈值为5%）。
热线组的自杀未遂平均次数低3倍（0.41对1.18，P = 0.005），自我伤害行为的平均次数低9倍（0.90对9.5，P = 0.006）。多变量分析证实了热线在减少自杀未遂和自我伤害方面的有效性。
本研究支持热线在减少边缘型人格障碍患者自我攻击行为方面的有效性。这种支持易于使用、成本低廉且灵活，因此易于大规模实施。
