Association of Borderline Personality Disorder Criteria With Suicide Attempts: Findings From the Collaborative Longitudinal Study of Personality Disorders Over 10 Years of Follow-up.
Association of Borderline Personality Disorder Criteria With Suicide Attempts: Findings From the Collaborative Longitudinal Study of Personality Disorders Over 10 Years of Follow-up.
复制标题
DOI：
10.1001/jamapsychiatry.2020.3598
复制
发表时间：
2020-11
期刊：
影响因子：
25.8
通讯作者：
S. Yen;S. Yen;Jessica R. Peters;Shivani Nishar;C. Grilo;C. Sanislow;M. Shea;M. Zanarini;T. McGlashan;L. Morey;A. Skodol
中科院分区：
文献类型：
--
作者：
S. Yen;S. Yen;Jessica R. Peters;Shivani Nishar;C. Grilo;C. Sanislow;M. Shea;M. Zanarini;T. McGlashan;L. Morey;A. Skodol
边缘型人格障碍（BPD）已被确定为自杀行为（包括自杀企图）的一个强有力的危险因素。描述增加风险的具体特征可以为干预措施提供信息。目的探讨人格障碍纵向协作研究（CLPS）中与前瞻性观察到的自杀企图相关的因素，重点关注BPD和BPD标准。设计、设置和参与者CLPS是一项多中心、自然主义、前瞻性研究，研究对象为4种人格障碍（PD）的成年受试者和重度抑郁障碍和最小PD特征的成年对照组。参与者都是寻求治疗的，从纽约、纽约、波士顿、马萨诸塞州、康涅狄格州纽黑文和罗得岛的普罗维登斯的住院、部分和门诊治疗机构招募。基线时共招募了733名参与者，其中701名完成了至少1次随访评估。这些队列的招募时间为1996年9月至1998年4月和2001年9月至2002年8月。在2019年3月至2020年8月期间分析了使用该随访样本（N = 701）的本研究数据。主要结果和衡量标准每年使用半结构化诊断访谈和各种自我报告衡量标准对参与者进行评估，持续长达10年。采用多因素logistic回归分析，研究基线人口统计学和临床危险因素，包括BPD和个体BPD标准，在10年的前瞻性随访中评估自杀企图。结果在701名参与者中，447人（64%）被确定为女性，488人（70%）为白色，527人（75%）为单身，433人（62%）失业，512人（73%）至少受过大学教育。在所有疾病中，即使在控制了显著的人口统计学（性别、就业和教育）和临床（儿童期性虐待、酒精使用障碍、物质使用障碍和创伤后应激障碍）因素后，BPD仍是与前瞻性观察到的自杀企图相关的最强有力的因素（比值比[OR]，4.18; 95%CI，2.68-6.52）。在BPD标准中，同一性障碍（OR，2.21; 95%CI，1.37-3.56），慢性空虚感（OR，1.63; 95%CI，1.03-2.57），并疯狂努力避免被遗弃（OR，1.93; 95%CI，1.17-3.16）是与随访期间自杀企图相关的重要独立因素，当与其他重要因素和BPD标准协变时。结论和相关性在对人格障碍成年人的多地点纵向研究中，身份障碍、慢性空虚感和疯狂地努力避免被遗弃与自杀企图显著相关。在自杀风险评估的背景下，身份障碍，慢性空虚感和疯狂的努力，以避免被遗弃可能是临床上忽视的BPD特征。鉴于BPD诊断缓解率很高，我们的研究结果表明，这些标准应作为自杀风险因素进行独立评估和进一步研究。
Importance Borderline personality disorder (BPD) has been identified as a strong risk factor for suicidal behavior, including suicide attempts. Delineating specific features that increase risk could inform interventions. Objective To examine factors associated with prospectively observed suicide attempts among participants in the Collaborative Longitudinal Study of Personality Disorders (CLPS), over 10 years of follow-up, with a focus on BPD and BPD criteria. Design, Setting, and Participants The CLPS is a multisite, naturalistic, prospective study of adult participants with 4 personality disorders (PDs) and a comparison group of adults with major depressive disorder and minimal PD features. Participants were all treatment-seeking and recruited from inpatient, partial, and outpatient treatment settings across New York, New York, Boston, Massachusetts, New Haven, Connecticut, and Providence, Rhode Island. A total of 733 participants were recruited at baseline, with 701 completing at least 1 follow-up assessment. The cohorts were recruited from September 1996 through April 1998 and September 2001 through August 2002. Data for this study using this follow-up sample (N = 701) were analyzed between March 2019 and August 2020. Main Outcomes and Measures Participants were assessed annually using semistructured diagnostic interviews and a variety of self-report measures for up to 10 years. Multiple logistic regression analyses were used to examine baseline demographic and clinical risk factors, including BPD and individual BPD criteria, of suicide attempt assessed over 10 years of prospective follow-up. Results Of the 701 participants, 447 (64%) identified as female, 488 (70%) as White, 527 (75%) as single, 433 (62%) were unemployed, and 512 (73%) reported at least some college education. Of all disorders, BPD emerged as the most robust factor associated with prospectively observed suicide attempt(s) (odds ratio [OR], 4.18; 95% CI, 2.68-6.52), even after controlling for significant demographic (sex, employment, and education) and clinical (childhood sexual abuse, alcohol use disorder, substance use disorder, and posttraumatic stress disorder) factors. Among BPD criteria, identity disturbance (OR, 2.21; 95% CI, 1.37-3.56), chronic feelings of emptiness (OR, 1.63; 95% CI, 1.03-2.57), and frantic efforts to avoid abandonment (OR, 1.93; 95% CI, 1.17-3.16) emerged as significant independent factors associated with suicide attempt(s) over follow-up, when covarying for other significant factors and BPD criteria. Conclusions and Relevance In the multisite, longitudinal study of adults with personality disorders, identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment were significantly associated with suicide attempts. Identity disturbance, chronic feelings of emptiness, and frantic efforts to avoid abandonment may be clinically overlooked features of BPD in context of suicide risk assessment. In light of the high rates of BPD diagnostic remission, our findings suggest that these criteria should be independently assessed and targeted for further study as suicide risk factors.