When in crisis, people with borderline personality disorder (BPD) frequently seek care in emergency departments (EDs) often presenting with suicide and self-harm behaviour. There is no established evidence-based brief treatment for patients with BPD in ED settings, however a 4-session treatment for people with personality disorders in ED settings was tested in Australia and showed promising results in reducing health care use and improving symptoms. A recent pilot feasibility randomized controlled trial (RCT) comparing this 4-session treatment to treatment as usual was conducted at the Centre for Addiction and Mental Health and preliminary findings have shown that the treatment is feasible to deliver and acceptable to both patients and clinicians. The proposed fully powered RCT will build on this pilot data to assess the efficacy of delivering this 4-session intervention in the ED for people with BPD who present with suicidal ideation or self-harm with the aim of reducing emergency health care use and improving BPD symptoms, functioning and quality of life.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
SINGLE
Enrollment
180
A 4-session manualized intervention consisting of weekly scheduled 50-minute 1:1 sessions focused on psycho-education, here-and-now problem solving and safety planning. One of the sessions can involve a significant other to provide psychoeducation about the disorder and to facilitate support.
Access to psychiatric assessment, medication review, and unscheduled sessions with allied health professionals using a drop-in model of care.
Centre for Addiction and Mental Health
Toronto, Ontario, Canada
Suicidal Ideation
Suicidal Ideation Attributes Scale (SIDAS): is a self-report questionnaire that assesses history and severity of suicidal behaviour and ideation. Scores range from 0-50 with lower scores indicating less suicidal ideation.
Time frame: 6 Month Follow Up
Suicidal Ideation
Suicidal Ideation Attributes Scale (SIDAS): is a self-report questionnaire that assesses history and severity of suicidal behaviour and ideation. Scores range from 0-50 with lower scores indicating less suicidal ideation.
Time frame: 3 Month Follow Up
Health Care Use
Client Service Receipt Inventory (CSRI): is a brief self-report questionnaire assessing the frequency of patient contact with health, social care or other professionals, as well as emergency departments visits and hospital admissions.
Time frame: 3 and 6 Month Follow Up
Borderline Personality Disorder Symptoms
Borderline Symptom Checklist-23 (BSL-23): is a self report questionnaire that assesses BPD symptoms during the previous week. The 23-item questionnaire has patients rate their experience of symptoms on a 5-point scale from 0 (not at all) to 4 (very strong). Total score is an average with a minimum of 0 and a maximum of 4. Higher scores indicate more BPD symptoms.
Time frame: 3 and 6 Month Follow Up
Self-Harm Behavior
Deliberate Self-Harm Inventory (DSHI): is a 17-item self-report questionnaire measuring frequency, severity, duration, and type of self-harm, which is defined as the direct destruction of body tissue.
Time frame: 3 and 6 Month Follow Up
Emotion Regulation
Difficulties in Emotion Regulation Scale (DERS): ) is a self-report questionnaire that measures six facets of emotion regulation. Scores range from 0-180 with higher scores indicating more emotional dysregulation.
Time frame: 3 and 6 Month Follow Up
Depressive Symptoms
Patient Health Questionnaire-9 (PHQ-9): is a 9-item self-report questionnaire assessing depression severity. Scores range from 0-27 with higher scores indicating more severe depression.
Time frame: 3 and 6 Month Follow Up
Functioning
WHO Disability Assessment Schedule (WHODAS): is a self-report questionnaire measuring health and disability across all diseases, including mental, neurological and addictive disorders. It assesses functioning in cognition, mobility, self-care, getting along, life activities and participation. Total score can range from 0-100 with 100 indicating full disability.
Time frame: 3 and 6 Month Follow Up
Quality of Life
WHO Quality of Life (WHOQOL): is a brief self-report questionnaire assessing quality of life in domains of physical and psychological health, interpersonal relationships and environment. Scores range from 0-100 with 100 indicating the best possible state of health.
Time frame: 3 and 6 Month Follow Up
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