Recurrence of suicidal episodes in individuals with probable borderline personality disorder: one-year follow-up study

Abstract

Borderline personality disorder (BPD) is strongly associated with suicidal behavior and high rates of reattempts. Short-term prediction of recurrent emergency presentations after a suicidal crisis in individuals with BPD traits remains clinically challenging, despite extensive study of suicidality in BPD more broadly. This study examined sociodemographic, clinical, and psychiatric predictors of suicidal recurrence and time to recurrence over 12 months in individuals with probable BPD presenting with suicidal behavior. A prospective cohort study enrolled adults with probable BPD — defined as meeting the validated MSIBPD screening cut-off (≥7) and/or having a pre-existing formal clinical diagnosis of BPD documented in medical records — with recent suicidal behavior from psychiatric emergency departments across four hospitals in Madrid, Spain. Participants were followed for 12 months and classified as recurrent or non-recurrent based on new suicidal behavior requiring emergency or hospital care within the participating hospital network. Group comparisons used chi-square tests and analysis of variance. Recurrence was estimated with Kaplan–Meier analyses. A multivariable Cox model assessed predictors including baseline depressive severity, lifetime mood disorders, lifetime anxiety-related disorders, and their interaction. A total of 266 participants were included (mean age 31.2 years; 70% female). Seventy-six participants (28.6%) experienced recurrent suicidal behavior; the Kaplan–Meier-estimated 12-month recurrence rate was 28.6% (95%CI 23.1–34.0%), closely matching the crude proportion since no participant was censored before completing the full 12-month observation window. Sociodemographic characteristics were not associated with recurrence. Higher baseline depressive severity was independently associated with increased recurrence hazard (hazard ratio [HR] 1.03, 95%CI 1.01–1.05; p=0.003). Lifetime anxiety-related disorders were not independently associated with recurrence, and lifetime mood disorders showed a non-significant trend (HR 0.23; p=0.061). A statistically significant, though imprecisely estimated, interaction between lifetime mood and anxiety-related disorders was observed (HR 6.66, 95%CI 1.35–32.71; p=0.020). Recurrent suicidal behavior among individuals with probable BPD was associated with acute depressive severity and with an imprecisely estimated interaction between lifetime mood and anxiety-related disorders, independent of sociodemographic factors. These hypothesis-generating findings support closer monitoring of depressive symptoms and affective-anxiety comorbidity as part of post-crisis risk stratification, pending replication in larger, prospectively diagnosed samples. NCT04775160.