ABSTRACT
Objective: To investigate associations between patients with borderline personality disorder (BPD)–related symptoms and their hospital presentations as well as the effect of inpatient length of stay (LOS) on time to hospital re-presentation.
Methods: A retrospective cohort design was used to investigate mental health emergency department (ED) visits and inpatient admissions. The cohort comprised 13,320 men and 12,290 women with a follow-up period between January 1, 2014, and December 31, 2019.
Results: Across all presentations in the study period, approximately 4% of mental health patients were discharged from ED or inpatient admission with primary diagnosis of BPD. Both male and female patients with BPD were at higher risk of hospital re-presentation when compared to patients with any other type of mental disorder (P < .01). Patients with BPD who had LOS > 14 days in their first inpatient admission were, on average, more likely to experience a repeat ED or inpatient presentation 58 days sooner than patients who had LOS < 2 days (P = .036).
Conclusions: Findings suggest the need for (a) more accurate recording of BPD and related presentations, (b) more in-depth investigations of BPD care pathways, and (c) identifications of subpopulations who may benefit from a specific inpatient length of stay.
Prim Care Companion CNS Disord 2024;26(1):23m03559
Author affiliations are listed at the end of this article.
Free Access: Please Log In
This content is completely free—but you need to be logged in to read the full article. If you already have an account, please log in below. Otherwise, register for free to unlock instant access.
References (25)
- Paris J, Zweig-Frank H. A 27-year follow-up of borderline patients. Compr Psychiatry. 2001;42:482–487. PubMed CrossRef
- Stone MH. The Fate of Borderline Patients: Successful Outcome and Psychiatric Practice. Guilford Press; 1990.
- Gunderson JG, Stout RL, McGlashan TH, et al. Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study. Arch Gen Psychiatry. 2011;68(8):827–837. PubMed CrossRef
- Temes CM, Frankenburg FR, Fitzmaurice GM, et al. Deaths by suicide and other causes among patients with borderline personality disorder and personality-disordered comparison subjects over 24 years of prospective follow-up. J Clin Psychiatry. 2019;80(1):18m12436. PubMed CrossRef
- Zanarini MC, Frankenburg FR, Dubo ED, et al. Axis I comorbidity of borderline personality disorder. Am J Psychiatry. 1998;155(12):1733–1739. PubMed CrossRef
- Ansell EB, Sanislow CA, McGlashan TH, et al. Psychosocial impairment and treatment utilization by patients with borderline personality disorder, other personality disorders, mood and anxiety disorders, and a healthy comparison group. Compr Psychiatry. 2007;48(4):329–336. PubMed CrossRef
- Pascual JC, Córcoles D, Castaño J, et al. Hospitalization and pharmacotherapy for borderline personality disorder in a psychiatric emergency service. Psychiatr Serv. 2007;58(9):1199–1204. PubMed CrossRef
- Vandyk AD, VanDenKerkhof EG, Graham ID, et al. Profiling frequent presenters to the emergency department for mental health complaints: socio-demographic, clinical, and service use characteristics. Arch Psychiatr Nurs. 2014;28(6):420–425. PubMed CrossRef
- Leontieva L, Gregory R. Characteristics of patients with borderline personality disorder in a state psychiatric hospital. J Pers Disord. 2013;27(2):222–232. PubMed CrossRef
- Berrino A, Ohlendorf P, Duriaux S, et al. Crisis intervention at the general hospital: an appropriate treatment choice for acutely suicidal borderline patients. Psychiatry Res. 2011;186(2–3):287–292. PubMed CrossRef
- National Collaborating Centre for Mental Health (UK). Borderline personality disorder: treatment and management. NICE Clinical Guidelines. 2009;(78):1854334778.
- Shoka A, Lazzari C, Gower K. Length of admission into psychiatric hospitals according to diagnoses. Eur Psychiatry. 2017;41(S1):S250. CrossRef
- Lewis KL, Fanaian M, Kotze B, et al. Mental health presentations to acute psychiatric services: 3-year study of prevalence and readmission risk for personality disorders compared with psychotic, affective, substance or other disorders. BJPsych Open. 2019;5(1):e1. PubMed CrossRef
- Chen S, Kong N, Sun X, et al. Claims data-driven modeling of hospital time-to-readmission risk with latent heterogeneity. Health Care Manage Sci. 2019;22(1):156–179. PubMed CrossRef
- Stata Statistical Software. Release 16.1. StataCorp LLC; 2019.
- Westbury LD, Syddall HE, Simmonds SJ, et al. Identification of risk factors for hospital admission using multiple-failure survival models: a toolkit for researchers. BMC Med Res Methodol. 2016;16(1):46. PubMed CrossRef
- Clayton JA, Tannenbaum C. Reporting sex, gender, or both in clinical research? JAMA. 2016;316(18):1863–1864. PubMed CrossRef
- Austin PC, Stuart EA. Moving towards best practice when using inverse probability of treatment weighting (IPTW) using the propensity score to estimate causal treatment effects in observational studies. Stat Med. 2015;34(28):3661–3679. PubMed CrossRef
- Fegan J, Doherty AM. Adjustment disorder and suicidal behaviours presenting in the general medical setting: a systematic review. Int J Environ Res Public Health. 2019;16(16):2967. PubMed CrossRef
- Kryzhanovskaya L, Canterbury R. Suicidal behavior in patients with adjustment disorders. Crisis. 2001;22(3):125–131. PubMed CrossRef
- Gregory R, Sperry SD, Williamson D, et al. High prevalence of borderline personality disorder among psychiatric inpatients admitted for suicidality. J Pers Disord. 2021;35(5):776–787. PubMed CrossRef
- National Health and Medical Research Council. Clinical Practice Guideline for the Management of Borderline Personality Disorder 2012. https://www.nhmrc.gov.au/about-us/publications/clinical-practice-guideline-borderline-personality-disorder
- Lawn S, McMahon J. Experiences of care by Australians with a diagnosis of borderline personality disorder. J Psychiatr Ment Health Nurs. 2015;22(7):510–521. PubMed CrossRef
- Trebble TM, Hansi N, Hydes T, et al. Process mapping the patient journey: an introduction. BMJ. 2010;341(aug13 1):c4078. PubMed CrossRef
- Stefanick ML, Schiebinger L. Analysing how sex and gender interact. Lancet. 2020;396(10262):1553–1554. PubMed CrossRef
Please sign in or purchase this PDF for $40.