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Predictors of suicide attempts in patients with borderline personality disorder over 16 years of prospective follow-up

Published online by Cambridge University Press:  22 March 2012

M. M. Wedig ,
M. H. Silverman ,
F. R. Frankenburg ,
D. Bradford Reich ,
G. Fitzmaurice  and
M. C. Zanarini
M. M. Wedig*
Affiliation:
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
M. H. Silverman
Affiliation:
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA, USA
F. R. Frankenburg
Affiliation:
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA, USA Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
D. Bradford Reich
Affiliation:
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
G. Fitzmaurice
Affiliation:
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
M. C. Zanarini
Affiliation:
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA, USA Department of Psychiatry, Harvard Medical School, Boston, MA, USA
*
*Address for correspondence: M. M. Wedig, Ph.D., Laboratory for the Study of Adult Development, McLean Hospital, 115 Mill St, Mail Stop 329, Belmont, MA 02478, USA. (Email: [email protected])
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Abstract

Background

It is clinically important to understand the factors that increase the likelihood of the frequent and recurrent suicide attempts seen in those with borderline personality disorder (BPD). Although several studies have examined this subject in a cross-sectional manner, the aim of this study was to determine the most clinically relevant baseline and time-varying predictors of suicide attempts over 16 years of prospective follow-up among patients with BPD.

Method

Two-hundred and ninety in-patients meeting Revised Diagnostic Interview for Borderlines (DIB-R) and DSM-III-R criteria for BPD were assessed during their index admission using a series of semistructured interviews and self-report measures. These subjects were then reassessed using the same instruments every 2 years. The generalized estimating equations (GEE) approach was used to model the odds of suicide attempts in longitudinal analyses, controlling for assessment period, yielding an odds ratio (OR) and 95% confidence interval (CI) for each predictor.

Results

Nineteen variables were found to be significant bivariate predictors of suicide attempts. Eight of these, seven of which were time-varying, remained significant in multivariate analyses: diagnosis of major depressive disorder (MDD), substance use disorder (SUD), post-traumatic stress disorder (PTSD), presence of self-harm, adult sexual assault, having a caretaker who has completed suicide, affective instability, and more severe dissociation.

Conclusions

The results of this study suggest that prediction of suicide attempts among borderline patients is complex, involving co-occurring disorders, co-occurring symptoms of BPD (self-harm, affective reactivity and dissociation), adult adversity, and a family history of completed suicide.

Keywords

Borderline personality disorderlongitudinal coursepredictorssuicide attempts
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 11 , November 2012 , pp. 2395 - 2404
Copyright
Copyright © Cambridge University Press 2012

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