Borderline Personality Disorder Increases Suicide Risk in Depression, Bipolar Disorder

John Söderholm, MD

Credit: Research Gate

A new study aimed to further the understanding of suicide risk in individuals with major depressive disorder (MDD), bipolar disorder (BD), and borderline personality disorder (BPD), revealing the significant impact of comorbid BPD on the risk of suicide attempt.¹

Suicide claims the lives of millions of people worldwide each year. The findings underscore the importance of considering both the severity of BPD features and changes in depressive symptoms when assessing risk of suicide.

“Don’t try to manage their suicidality with repeated hospitalizations if you can do something different,” Choi-Kain said in a previous interview with HCPLive. “Don’t give them polypharmacy if it’s not guided. Give them reasonable expectations for what those medications could do.”²

Among individuals with mental health disorders, those diagnosed with MDD, BD, and BPD face particularly high suicide risks. However, understanding the similarities and differences in suicidal ideation and suicide attempts between these disorders is still an area of ongoing research.¹

John J Söderholm, Department of Psychiatry, University of Helsinki and Helsinki University Hospital, and investigators sought to summarize the findings of a study that examined the risk levels and factors associated with suicide ideation and suicide attempt in patients with MDD, BD, and BPD.

The cohort study followed a group of treatment-seeking patients experiencing a major depressive episode (MDE) over a period of 6 months. The patients were divided into 3 subcohorts: MDE/MDD, MDE/BD, and MDE/BPD.

Investigators utilized biweekly online surveys, specifically modified versions of the Patient Health Questionnaire 9, to assess depression severity and suicide ideation. Multi-level modeling was employed to analyze the relationship between changes in depression symptoms and suicide ideation over time.

Results revealed individuals diagnosed with BPD had a significantly higher risk of suicide attempt (22.2%) compared with non-BPD patients (4.23%). Regression models demonstrated that the severity of BPD symptoms was strongly correlated with the risk of suicide attempt and clinically significant suicide ideation.

Investigators noted that regardless of the specific diagnosis, the mean depression severity and changes in depressive symptoms were associated with suicide ideation risk during the follow-up period.

These findings suggest an emphasis of consideration on comorbid BPD in individuals with depression, as it appears to be a significant predictor of higher suicide attempt risk. The severity of BPD features should be taken into account when assessing the risk of both suicide attempt and suicide ideation in patients experiencing a MDE.

Investigators wrote these changes in depressive symptoms can serve as an indicator of concurrent fluctuations in suicide ideation risk and monitoring depressive symptoms continuously may prove to be a useful index for assessing suicide risk.

Further, the results highlight the need for clinicians to be vigilant in identifying and addressing suicide risk, particularly in patients with comorbid BPD and depression, the study noted. The findings also emphasized the importance of ongoing monitoring of depressive symptoms to assess changes in suicide risk over time.

Investigators acknowledged further research is needed explore effective intervention strategies and identify specific factors contributing to the heightened suicide risk associated with BPD, as well as evaluate the impact of targeted treatments for reducing suicide risk in this population.

“Concurrent BPD in depression seems predictive for high risk of SA. Severity of BPD features is relevant for assessing risk of SA and SI in MDE,” the team wrote. “Changes in depressive symptoms indicate concurrent changes in risk of SI. BPD status at intake can index risk for future SA, whereas depressive symptoms appear a useful continuously monitored risk index.”

References:

1. Söderholm JJ, Socada JL, Rosenström TH, Ekelund J, Isometsä E. Borderline personality disorder and depression severity predict suicidal outcomes: A six-month prospective cohort study of depression, bipolar depression, and borderline personality disorder [published online ahead of print, 2023 Jul 12]. Acta Psychiatr Scand. 2023;10.1111/acps.13586. doi:10.1111/acps.13586