Mortality in borderline personality disorder: A 13-year nation-wide retrospective cohort study
Otis Williams, Chris Frampton, Matthew Tennant, Arahia Kirikiri, Ben BeagleholeObjectives:
Borderline personality disorder is associated with high rates of suicide mortality and poor physical health. However, few studies have reported all-cause or non-suicide mortality in this group, and little is known about borderline personality disorder mortality outside Europe and North America. This study examines mortality among people diagnosed with borderline personality disorder in Aotearoa New Zealand.
Methods:
Comprehensive national datasets were used to identify mortality outcomes for all individuals with a diagnosis of borderline personality disorder recorded during contact with publicly funded secondary health services between 2009 and 2021. Standardised mortality ratios were calculated comparing mortality among people with borderline personality disorder to age- and gender-standardised rates in the general population. Outcomes were reported overall and stratified by gender and ethnicity.
Results:
The cohort comprised 10,059 people with borderline personality disorder, contributing 63,849 years of follow-up. Comorbid mental health conditions were common, with 84% of the cohort also diagnosed with at least one other mental health condition. During the study period, 639 deaths occurred, with one third (216) caused by suicide. All-cause mortality among this group was 5.8 times higher than the general population (standardised mortality ratio = 5.78, 95% confidence interval = 5.34–6.24), suicide mortality was 29 times higher (standardised mortality ratio = 29.0, 95% confidence interval = 25.23–33.12) and non-suicide mortality was 4.1 times higher (standardised mortality ratio = 4.11, 95% confidence interval = 3.72–4.52).
Conclusions:
People with borderline personality disorder in Aotearoa experience substantially higher mortality than the general population from both suicide and non-suicide causes. These findings suggest an unmet need for wider implementation of evidence-based treatments and integrating mental and physical health interventions for people with borderline personality disorder.