Borderline Personality Disorder Linked to Increased Hospital Revisits

Summary: Patients diagnosed with Borderline Personality Disorder (BPD) are more likely to have recurrent hospital visits compared to those with other mental disorders. Analyzing over 86,000 episodes of care for 25,619 mental health patients in South Australian hospitals from 2014 to 2019, the research highlights BPD’s significant impact on healthcare systems.

Findings indicate that shorter initial inpatient stays correlate with quicker hospital readmissions for BPD patients, suggesting the need for improved care pathways and in-depth analysis of treatment durations. This study underscores the importance of developing tailored healthcare strategies for BPD patients to enhance outcomes and reduce emergency department presentations and hospital admissions.

Key Facts:

  1. BPD patients are at a higher risk of recurrent hospital visits compared to patients with other mental health disorders.
  2. The study analyzed 86,740 Emergency Department and inpatient episodes across South Australian public hospitals, focusing on the association between BPD diagnosis and hospital re-admissions.
  3. Shorter initial hospital stays were linked to faster re-admission for BPD patients, highlighting the necessity for optimized treatment plans and healthcare pathways.

Source: Flinders University

A new study by Flinders University has uncovered links between a patient’s initial diagnosis of Borderline Personality Disorder, or BPD, and their recurrent visits to hospital.

The study investigated associations between patients with BPD and their hospital presentations as well as the effect of inpatient length of stay on time to hospital re-presentation. 

The study reviewed a South Australian (SA) cohort of 86,740 Emergency Department (ED) and inpatient episodes of care for 25,619 mental patients presenting to SA public hospitals between 2014 and 2019.

This shows a hospital room.
Of particular interest is the association between initial inpatient length of stay in hospital and the number of days before they sought hospital treatment again. Credit: Neuroscience News

Patients with BPD were at higher risk of returning to hospital when compared to patients with any other type of mental disorder says lead author Dr David Smith from the College of Medicine and Public Health.

BPD is the most common personality disorder in Australia, affecting up to 5 percent of the population at some stage.  It is a complex mental disorder that is often misunderstood. 

BPD patients frequently present with other co-occurring problems, including substance abuse, depression, anxiety, and bipolar affective disorder.  Furthermore, BPD is associated with considerable psychosocial impairment, including poor social functioning, unemployment, and loss of income.

Worryingly BPD patients have high rates of self-harm and suicide, leading to frequent presentations to emergency departments and mental health services with a reported mortality rate of up to 10 per cent.

“We found that approximately four per cent of all mental health patients were discharged from an Emergency Department (ED) or inpatient admission with a diagnosis of BPD recorded as the primary discharge diagnosis. Those patients were then at higher risk of hospital re-admission compared to other mental health diagnostic groups in this study cohort,” says Dr Smith.

“Of particular interest is the association between initial inpatient length of stay in hospital and the number of days before they sought hospital treatment again.

“Those patients whose initial stay in hospital was up to 14 days returned to hospital on average 58 days sooner than those patients who stayed for two days or less,” he says.

Dr Smith says that further research, such as a more detailed pathway analysis, could determine factors that predicted whether, for BPD, any overnight stay and stays of less or greater than two days were associated with harm or benefit.

“There is no doubt that more needs to be done to provide better healthcare pathways for patients with BPD.  We need to get more accurate recordings of BPD patients, and related presentations, more in-depth investigations of care pathways, and identifications of individuals who may benefit from a specific inpatient length of stay.

“We’d like to trace the patient’s journey in hospital from the patient’s perspective that would allow clinicians and managers to see and understand patients’ experience by separating the management of a specific psychiatric condition and treatment into a series of consecutive events or steps (for example, activities, interventions, or staff interactions). 

“This approach would also need to address BPD-related questions about sex and gender, such as how do sex and gender intersect with age, race and ethnicity, and other sociocultural factors as well as determine outcomes.

“The synthesis of this type of information with data, such as from the current study, would provide deeper insights into patient journeys, including when things went right and when they did not,” says Dr Smith.

“We believe that building on existing resources would improve health and community-based services and staff training, and not only boost the health and wellbeing of all Australians but significantly contribute to a reduction in emergency department presentations and hospital admissions,” Dr Smith adds.

Funding: The research was commissioned by the South Australian Borderline Personality Disorder Collaborative (contract number: SAH2019-1146) through funding received from the Barossa Hills Fleurieu Local Health Network.

About this borderline personality disorder research news

Author: Sally Lauder
Source: Flinders University
Contact: Sally Lauder – Flinders University
Image: The image is credited to Neuroscience News

Original Research: Open access.
Recurrent Mental Health Presentations to Public Hospital Services: A Focus on Borderline Personality Disorder” by David Smith et al. Primary Care Companion for CNS Disorders


Abstract

Recurrent Mental Health Presentations to Public Hospital Services: A Focus on Borderline Personality Disorder

Objective: To investigate associations between patients with borderline personality disorder (BPD)–related symptoms and their hospital presentations as well as the effect of inpatient length of stay (LOS) on time to hospital re-presentation.

Methods: A retrospective cohort design was used to investigate mental health emergency department (ED) visits and inpatient admissions. The cohort comprised 13,320 men and 12,290 women with a follow-up period between January 1, 2014, and December 31, 2019.

Results: Across all presentations in the study period, approximately 4% of mental health patients were discharged from ED or inpatient admission with primary diagnosis of BPD. Both male and female patients with BPD were at higher risk of hospital re-presentation when compared to patients with any other type of mental disorder (P < .01). Patients with BPD who had LOS > 14 days in their first inpatient admission were, on average, more likely to experience a repeat ED or inpatient presentation 58 days sooner than patients who had LOS < 2 days (P = .036).

Conclusions: Findings suggest the need for (a) more accurate recording of BPD and related presentations, (b) more in-depth investigations of BPD care pathways, and (c) identifications of subpopulations who may benefit from a specific inpatient length of stay.

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