Effects of Psychiatric Admissions on Self-harm and Suicide in People With Borderline Personality Disorder

The current study aims to evaluate the impact of long (>5 days) and/or compulsory psychiatric inpatient care on subsequent healthcare utilization for self-harm and suicide in people with borderline personality disorder, a condition characterized by frequent self-harm.

The basis for this study is the diversity of clinical practices across Swedish regions. By categorizing clinics based on their practices with respect to long and/or compulsory psychiatric inpatient care, it is possible to explore the impact of these practices on subsequent somatic and psychiatric healthcare, including emergency care due to self-harm as well as on completed suicides.

All psychiatric clinics across Sweden authorized to administer compulsory care for adults, totalling 78 clinics will be included. Each clinic per specific calendar year will represent one participant, identified by the clinic's name and the respective year (e.g., Umeå2010, Linköping2013, Malmö2022).

Data collection will involve the utilization of the national registers to capture outcome measures and account for confounding factors. The participants will be ranked based on a composite variable, which includes the average number of days spent in inpatient compulsory care and other psychiatric inpatient care exceeding 5 days, among individuals diagnosed with BPD. The top quartile of participants will be compared with the bottom quartile.

Study Overview

• Status: Active, not recruiting
• Conditions: Suicide; Borderline Personality Disorder; Self-harm; Non-suicidal Self-injury
• Intervention / Treatment: Other: High degree of long (>5 days) and/or compulsory psychiatric inpatient care

• Study Type: Observational
• Enrollment (Estimated): 390

Contacts and Locations

Study Locations

• Sweden
  • Lund, Sweden, 22185
    • Lund University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Probability Sample

Study Population

All psychiatric clinics across Sweden authorized to administer compulsory care for adults, totalling 78 clinics. Each clinic per specific calendar year will represent one participant, identified by the clinic's name and the respective year (e.g., Umeå2010, Linköping2013, Malmö2022).

Description

Inclusion Criteria:

• Psychiatric clinic in Sweden authorized to administer compulsory care for adults. Each clinic per specific calendar year will represent one participant, identified by the clinic's name and the respective year (e.g., Umeå2010, Linköping2013, Malmö2022).

Exclusion Criteria:

• No authorization to administer compulsory care for adults

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
High admission; The quartile of participants using the highest degree of long (>5 days) and/or compulsory psychiatric inpatient care.	Other: High degree of long (>5 days) and/or compulsory psychiatric inpatient care; High degree of long (>5 days) and/or compulsory psychiatric inpatient care
Low admission; The quartile of participants using the lowest degree of long (>5 days) and/or compulsory psychiatric inpatient care.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of healthcare visits due to self-harm	Number of healthcare visits due to self-harm in specialized inpatient or outpatient care, as defined in the NPR (X60-X84; Intentional self-harm) divided by the number of individuals diagnosed with BPD per clinic and calendar year.	1 year
Number of deaths by suicide	Number of deaths by suicide (X60-X84; Intentional self-harm or Y10-34; Events of undetermined intent) in individuals diagnosed with BPD divided by the number of individuals diagnosed with BPD per clinic and calendar year.	1 year
Number of deaths by suicide within 30 days after discharge	Number of deaths by suicide (X60-X84; Intentional self-harm or Y10-34; Events of undetermined intent) within 30 days after discharge, in individuals diagnosed with BPD divided by the number of individuals diagnosed with BPD, per clinic and calendar year	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of days between admissions to psychiatric inpatient care	Number of days between admissions to psychiatric inpatient care for people diagnosed with BPD divided by the number of individuals diagnosed with BPD per clinic and calendar year.	1 year
Number of days between death by suicide and discharge	Number of days between death by suicide (X60-X84; Intentional self-harm or Y10-34; Events of undetermined intent) and discharge in individuals diagnosed with BPD. For this variable, death by suicide during inpatient admission will be labelled 0.	1 year
Number of days in somatic (non-psychiatric) inpatient care after self-harm	Number of days in somatic (non-psychiatric) inpatient care after self-harm (X60-X84; Intentional self-harm) divided by the number of individuals diagnosed with BPD per clinic and calendar year.	1 year

Collaborators and Investigators

• Sponsor: Lund University
• Collaborators: Linkoeping University
• Investigators: Principal Investigator: Sofie Westling, MD, PhD, Lund University

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2010
• Primary Completion (Actual): December 1, 2024
• Study Completion (Estimated): December 31, 2026

Study Registration Dates

• First Submitted: May 16, 2024
• First Submitted That Met QC Criteria: May 16, 2024
• First Posted (Actual): May 22, 2024

Study Record Updates

• Last Update Posted (Actual): August 7, 2026
• Last Update Submitted That Met QC Criteria: August 6, 2026
• Last Verified: August 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Behavioral Symptoms; Personality Disorders; Behavior; Suicide; Borderline Personality Disorder; Self-Injurious Behavior
• Other Study ID Numbers: 2024-00589-01

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No