Comorbid Borderline Personality Disorder Increases Suicide Risk in MDD and Bipolar Disorder

A new study published in Acta Psychiatrica Scandinavica has shed light on the significant impact of comorbid borderline personality disorder (BPD) on the risk of suicide attempts in individuals with major depressive disorder (MDD) and bipolar disorder (BD). The findings underscore the importance of considering the severity of BPD features and changes in depressive symptoms when assessing suicide risk.

Suicide claims the lives of millions of people worldwide each year, and individuals with mental health disorders, including MDD, BD, and BPD, face particularly high risks. However, understanding the similarities and differences in suicidal ideation and attempts among these disorders is an ongoing area of research.

Led by John J Söderholm from the Department of Psychiatry at the University of Helsinki and Helsinki University Hospital, the study aimed to summarize the findings of a cohort study that examined suicide risk levels and associated factors in patients with MDD, BD, and BPD.

The study followed a group of treatment-seeking patients experiencing a major depressive episode (MDE) over a 6-month period. The patients were divided into three sub cohorts: MDE/MDD, MDE/BD, and MDE/BPD. The severity of depression and suicide ideation were assessed using biweekly online surveys, specifically modified versions of the Patient Health Questionnaire 9. Multi-level modeling was used to analyze the relationship between changes in depressive symptoms and suicide ideation over time.

● The results revealed that individuals diagnosed with BPD had a significantly higher risk of suicide attempts (22.2%) compared to those without BPD (4.23%).

● Regression models showed a strong correlation between the severity of BPD symptoms and the risk of suicide attempts and clinically significant suicide ideation.

The study highlighted the need for clinicians to be vigilant in identifying and addressing suicide risk, particularly in patients with comorbid BPD and depression. Ongoing monitoring of depressive symptoms was also emphasized to assess changes in suicide risk over time.

These findings suggest that comorbid BPD should be considered when assessing suicide risk in individuals with depression, as it appears to be a significant predictor of higher risk for suicide attempts. Additionally, monitoring changes in depressive symptoms may serve as an indicator of concurrent fluctuations in suicide ideation risk.

Further research is needed to explore effective intervention strategies and identify specific factors contributing to the heightened suicide risk associated with BPD. Additionally, evaluating the impact of targeted treatments for reducing suicide risk in this population is essential.

The study concluded that comorbid BPD in depression is predictive of a high risk of suicide attempts. The severity of BPD features is relevant for assessing the risk of suicide attempts

and suicide ideation in individuals experiencing a major depressive episode. Continuous monitoring of depressive symptoms can be a useful index for assessing suicide risk.

These findings contribute to our understanding of suicide risk in patients with MDD, BD, and BPD, and they highlight the importance of comprehensive assessment and ongoing monitoring to prevent suicide in these vulnerable populations.

Reference:

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