Particular vulnerability of patients with borderline personality disorder during the COVID-19 pandemic - a retrospective chart review.

Background: Mental health consequences of the COVID-19 pandemic have been a major research focus since its beginning. A specific vulnerability of patients with borderline personality disorder (BPD) following social distancing measures has been reported, however there is a lack of adequately sized studies that provide evidence of this vulnerability. Suicide attempts may reflect mental health effects of the COVID-19 pandemic in psychiatric settings.
Methods: Retrospective follow-up analysis of clinical documentation in a psychiatric emergency department (pED) of a major academic psychiatric hospital in Berlin, Germany. Observation periods include the first- (3/2/2020-5/24/2020) and second-wave (9/15/2020-3/1/2021) of the COVID-19 pandemic in Germany and respective periods one year earlier as control-periods. Poisson-regression was used for statistical modelling of individual counts of pED presentations after a suicide attempt.
Results: N = 4110 patients attended the pED during the four observation periods. BPD patients were associated with elevated risk of pED presentation after a suicide attempt during COVID-periods (RR = 3.4; p = .014). Schizophrenia and psychotic disorders showed lower risk of pED presentation after a suicide attempt during COVID-periods (RR = 0.4; p = .048). Other diagnostic groups did not show significant interaction effects with COVID-periods. The first-wave was a risk factor for pED presentation after a suicide attempt affecting the sample across all diagnostic groups (RR = 3.1; p = .006).
Conclusions: BPD patients seem to be particularly vulnerable during the COVID-19 pandemic showing increased rates of suicide attempts during both COVID-periods. This should be addressed in future health crises by ensuring availability of psychosocial help. There is a need for further research regarding BPD patients in public health crisis situations.
Competing Interests: Declarations. Ethics approval and consent to participate: This retrospective study was approved by the local ethics committee ​(Ethikkommission der Charité – Universitätsmedizin Berlin; number of approval: EA 110/20). As only retrospective and pseudonymised routinely assessed data was concerned, informed consent was waived by the ethics committee of Charité – Universitätsmedizin Berlin (Ethikkommission der Charité – Universitätsmedizin Berlin; number of approval: EA 110/20). The study was conducted following the declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.
(© 2024. The Author(s).)