Improvements in depression severity in hospitalized patients with and without borderline personality features.

Abstract

Patients with borderline personality disorder (BPD) often struggle with treatment-resistant depression. To date, few studies have specifically assessed the rate of improvement of depressive symptoms during an acute inpatient hospitalization in patients who screen positive for BPD compared with those who do not. A sample of 245 psychiatric inpatients was divided into 2 groups on the basis of whether or not they tested positive on the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD). Hamilton Depression Rating Scale (Ham-D) scores were compared from admission to discharge. At admission, the MSI-BPD group (n=64) endorsed significantly more depressive symptoms than the MSI-BPD group (n=181), as measured by higher mean Ham-D scores (34.1 vs. 30.3, P=0.0002). Although both groups demonstrated improvements in Ham-D scores by discharge, the MSI-BPD group showed a markedly more robust change (22.1 vs. 18.2, P=0.002). This effect remained significant using a propensity score model to account for differences in baseline characteristics between the 2 groups (22.1 vs. 18.8, P=0.022). These findings suggest that patients who test positive on this BPD screening tool tend to be admitted in greater distress and to subsequently improve more robustly in the setting of an inpatient hospitalization. This finding lends support to the theory that the depressive symptoms associated with borderline personality pathology emerge in the context of interpersonal hypersensitivity and relationship instability and therefore that the holding environment of the hospital can result in rapid improvement.