Citation

Temes CM, Frankenburg FR, Fitzmaurice GM, Zanarini MC. J. Clin. Psychiatry 2019; 80(1): e12436.

Affiliation

Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.

Copyright

(Copyright © 2019, Physicians Postgraduate Press)

DOI

10.4088/JCP.18m12436

PMID

30688417

Abstract

OBJECTIVE: This study has 4 aims. The first is to determine rates of mortality due to suicide and other causes for patients with borderline personality disorder (BPD) and personality-disordered comparison subjects over 24 years of prospective follow-up. The second and third aims are to determine the best predictors of time-to-suicide and time-to-premature death (not due to suicide) in patients with BPD. A final aim is to determine whether mortality rates are impacted by recovery status.

METHODS: A total of 290 adult inpatients meeting rigorous Revised Diagnostic Interview for Borderlines and DSM-III-R criteria for BPD and 72 personality-disordered comparison subjects were recruited during inpatient admission at McLean Hospital between June 1992 and December 1995. Participants were followed and reassessed every 2 years, with data collection now entering its 26th year. Participant deaths were tracked over time.

RESULTS: A total of 5.9% of borderline patients and 1.4% of comparison subjects died by suicide. Additionally, 14.0% of borderline patients and 5.5% of comparison subjects died by non-suicide causes. Among borderline patients, number of prior hospitalizations significantly predicted completed suicide (HR = 1.62, P =.037). Sociodemographic factors, physical health indicators, and psychiatric history significantly predicted premature death (not due to suicide) in bivariate analyses (all P values <.05). In multivariate analyses, male sex (HR = 3.56, P =.003) and more prior psychiatric hospitalizations (HR = 2.93, P <.001) significantly predicted premature death. Most borderline patients who died either by suicide (87.5%) or non-suicide-related causes (88%) were not recovered before death.

CONCLUSIONS: Taken together, these findings suggest that individuals with BPD are at elevated risk of premature death. Patients who did not achieve recovery were at a disproportionately higher risk of early death than recovered patients.

© Copyright 2019 Physicians Postgraduate Press, Inc.

Language: en