Psychosocial determinants of suicidal behaviour of female patients with borderline personality disorder and borderline personality accentuation

Borderline type of emotionally unstable personality disorder (borderline personality disorder, BPD) is a topical issue, including due to the high incidence of autoaggressive behavior. Subclinical forms of BPD in the form of borderline accentuation of character (BAC) are studied separately. In the conceptual integrative model of suicidal behavior by B.S. Polozhego, all factors of a specific "diathesis" are divided into determinants of three ranks, while the determinants of autoaggressive behavior in these conditions are poorly described. The aim of this study is to identify significant psychosocial determinants (independent risk factors) of suicidal behavior in women with BPD and BAC. Materials and methods. The work is a continuous prospective cohort analytical study. A total of 115 women who were inpatients at the State Budgetary Institution of the Rostov Region Regional Clinical Psychiatric Hospital and the State Budgetary Institution of the Rostov Region Regional Clinical Narcological Dispenser from October 2023 to March 2025 and had BPD personality traits were included. Based on the Revised Diagnostic Interview for Borderline Personality Disorder, they were divided into a group of “BPD Patients” (n=49, mean age 28.4 [25.7; 31.1] years) and “BAC Patients” (n=60, mean age 25.6 [23.3; 27.9] years). The dependent variable reflecting the severity of autoaggressive potential was the Pro-suicidal Tension Index (PSTI), and independent risk factors (determinants) were assessed using the data of the clinical and social questionnaire, the Personality Questionnaire for DSM-5, the Suicide Risk Questionnaire, the Brief Version of the Attitudes to Death Questionnaire, the Brief Version of the Fear of Personal Death Questionnaire, the Barratt Impulsivity Scale, the Positive and Negative Affect Scale (PANAS), the Standardized Multifactorial Method of Personality Research (MINI-SMIL), and the Symptomatic Questionnaire SCL-90-R. Statistical analysis of the data was performed in the free system of statistical data processing and programming R. Correlation analysis and construction of multiple regression models were performed. Results and discussion. The groups of BPD and BAC patients did not have statistically significant differences in mean age and the presence of comorbid mental disorders. The average level of the PSTI in the BPD group was 1.29 [1.06; 1.37] points, which is statistically significantly higher than the average PSTI in the BAC group: 0.86 [0.58; 1.07] points. Statistically significant positive correlations of the PSTI with the levels of anxiety and depression, disturbances of time perspective and failure as causes of AA behavior, increased negative affect, as well as with scales associated with anxiety, depression and sensitivity in both groups were revealed. At the same time, in patients with BAC, in contrast to the BPD group, significant negative correlations were found between the PSTI and the anti-suicidal factor of OSN, consequences for the personality and for the body when assessing the fear of personal death, avoidance strategy when assessing the attitude towards death, as well as with scales of positive affect. In the obtained regression model for patients with BAC, there was only one significant factor – the level of depression (OR=1.44), and in the group of patients with BPD, three dependent variables with positive coefficients were revealed – the number of suicide attempts (OR=1.05), self-control disorders (OR=1.02) and emotional lability (OR=1.1), and one variable with a negative coefficient – hypomania (OR = 0.89). Conclusions. The main psychosocial determinant of suicidal behavior in patients with BAC is the level of depression. In patients with BPD, the pro- suicidal determinants are the number of suicide attempts in the past, self-control disorders and emotional lability, the anti-suicidal determinant is hypomania.