Risk factors associated with death by suicide in people diagnosed with borderline personality disorder in comparison...

People with borderline personality disorder (BPD) often experience chronic suicidality and engage in deliberate self-harm (DSH) to manage intense emotions and psychological distress. Identifying reliable predictors of suicide risk that are inclusive of people with BPD remains challenging. This study was carried out to clarify whether factors associated with completed suicide in people with BPD differ from suicide-related factors in people with depression.

Clinical records of patients who died by suicide and had a primary diagnosis of either BPD (n = 13) or Major Depressive Disorder (MDD) (n = 18) were reviewed. A comprehensive risk assessment audit tool was developed. Four super-ordinal risk factor categories were derived using thematic analysis; historical, psychological, behavioural, and psychosocial.

While there were common precipitating factors for both cohorts, factors more likely to be associated with BPD were: childhood adversity, history of DSH, recent relationship breakdown, and recent change in the method or frequency of DSH. Precipitating factors associated more often with MDD were stressful life events and worsening substance use.

Multiple suicide risk factors differentiating BPD from MDD were identified, supporting the application of a BPD-specific lens when conducting suicide risk assessments in this population. Further research is required to examine whether this approach better captures changes in suicide risk that could improve outcomes for people with BPD.