Kaufman Erin A, Coon Hilary, Shabalin Andrey A, Monson Eric T, Chen Danli, Staley Michael J, Keeshin Brooks R, Docherty Anna R, Bakian Amanda V, DiBlasi Emily
Department of Psychiatry & Huntsman Mental Health Institute, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
Office of the Medical Examiner, Utah Department of Health and Human Services, Salt Lake City, UT, USA.
Psychol Med. 2024 Nov 18;54(15):1-10. doi: 10.1017/S0033291724002034.
Borderline personality disorder (BPD) is a debilitating condition characterized by pervasive instability across multiple major domains of functioning. The majority of persons with BPD engage in self-injury and up to 10% die by suicide - rendering persons with this condition at exceptionally elevated risk of comorbidity and premature mortality. Better characterization of clinical risk factors among persons with BPD who die by suicide is urgently needed.
We examined patterns of medical and psychiatric diagnoses (1580 to 1700 Phecodes) among persons with BPD who died by suicide ( = 379) via a large suicide death data resource and biobank. In phenotype-based phenome-wide association tests, we compared these individuals to three other groups: (1) persons who died by suicide without a history of BPD ( = 9468), (2) persons still living with a history of BPD diagnosis ( = 280), and (3) persons who died by suicide with a different personality disorder (other PD = 589).
Multivariable logistic regression models revealed that persons with BPD who died by suicide were more likely to present with co-occurring psychiatric diagnoses, and have a documented history of self-harm in the medical system prior to death, relative to suicides without BPD. Posttraumatic stress disorder was more elevated among those with BPD who died by suicide relative to the other PD group.
We found significant differences among persons with BPD who died by suicide and all other comparison groups. Such differences may be clinically informative for identifying high-risk subtypes and providing targeted intervention approaches.
边缘性人格障碍（BPD）是一种使人衰弱的病症，其特征是在多个主要功能领域普遍存在不稳定。大多数BPD患者会进行自我伤害，高达10%的患者死于自杀，这使得患有这种病症的人患合并症和过早死亡的风险异常升高。迫切需要更好地描述自杀身亡的BPD患者的临床风险因素。
我们通过一个大型自杀死亡数据资源和生物样本库，研究了自杀身亡的BPD患者（n = 379）的医学和精神科诊断模式（1580至1700个疾病编码）。在基于表型的全表型关联测试中，我们将这些个体与其他三组进行了比较：（1）没有BPD病史的自杀者（n = 9468），（2）有BPD诊断史的在世者（n = 280），以及（3）患有其他人格障碍（其他PD，n = 589）的自杀者。
多变量逻辑回归模型显示，与没有BPD的自杀者相比，自杀身亡的BPD患者更有可能同时出现精神科诊断，并且在死亡前医疗系统中有自我伤害的记录。与其他人格障碍组相比，自杀身亡的BPD患者中创伤后应激障碍更为高发。
我们发现自杀身亡的BPD患者与所有其他比较组之间存在显著差异。这些差异可能在临床上有助于识别高危亚型并提供有针对性的干预方法。
