Clinical Summary: Recurrent Mental Health Presentations to Public Hospital Services: A Focus on Borderline Personality Disorder
Patients with borderline personality disorder often cycle through emergency departments and inpatient units, yet clinicians have had limited Australian data on how strongly BPD predicts repeat public hospital use. This study matters because it identifies BPD as the highest-risk diagnostic group for hospital re-presentation and shows that longer initial inpatient stays were linked to faster return to hospital.
Key Findings
- The overall test of diagnosis was significant for both male (χ28 = 3210, P < .001) and female patients (χ28 = 3697.1, P < .001), and all non-BPD diagnostic groups had hazard ratios less than 1 versus the BPD referent category, indicating lower risk of hospital re-presentation than borderline personality disorder.
- For BPD patients, the mean time to a second ED and/or inpatient admission was 199 days for LOS < 2 days, 179 days for LOS groups 2–7 days and 8–14 days, and 142 days for LOS > 14 days.
- Among patients with BPD, the mean time to a second hospital visit was 58 days sooner when all the patients had LOS > 14 days than when all the patients had LOS < 2 days (P = .036).
- The contrast between self-harm versus self-harm/adjustment disorder was significantly different for both male and female patients (P < .001), with self-harm associated with a higher risk of hospital re-presentation.
- For patients with other personality disorders, the mean time to a second hospital visit ranged from 199 days to 213 days across groups, and there was no statistically significant difference between pairwise comparisons.
In South Australian public hospitals, borderline personality disorder marked the highest risk for repeat mental health presentation compared with other diagnostic groups. For patients with borderline personality disorder who require admission, an initial stay > 14 days was associated with earlier return to hospital than a stay < 2 days.
Practice Implications
- Treat a diagnosis of borderline personality disorder as a high-risk flag for recurrent ED or inpatient use and plan assertive follow-up at discharge rather than assuming risk is similar to other mental health presentations.
- When assessing self-harm presentations, distinguish self-harm from self-harm/adjustment disorder, because the study found significantly higher re-presentation risk for self-harm in both sexes (P < .001).
- For borderline personality disorder admissions, be cautious about prolonged initial inpatient stays; in this cohort, LOS > 14 days was linked to a second hospital presentation 58 days sooner than LOS < 2 days (P = .036).
- Use inpatient care for borderline personality disorder selectively and pair discharge with clear outpatient pathways, since longer hospitalization did not translate into a longer interval before re-presentation in this dataset.
