Borderline Personality Traits Do Not Moderate the Relationship Between Depression, Beliefs, and Suicidal Thoughts and Behaviors

Abstract

Adults with clinically significant borderline personality disorder traits (BPTs) are at high risk of experiencing suicidal thoughts and behaviors (STBs). STBs among those with BPTs have been associated with suicidal beliefs (e.g., that one is unlovable or that distress is intolerable). However, the extent to which suicidal beliefs uniquely mediate the relationship between emotional distress and STBs among individuals with BPTs is not known. Individuals admitted to an inpatient unit (N = 198) with recent STBs completed assessments of BPTs, depression, suicidal beliefs, suicidal ideation, and suicide attempt history. Moderated mediation models were used to explore whether suicidal beliefs mediated the relationship between depression and STBs conditional on BPTs. Suicidal patients with versus without BPTs reported stronger suicidal beliefs and more severe STBs (i.e., suicidal ideation, lifetime attempts). Exploratory moderated mediation analysis demonstrated that suicidal beliefs mediated the relationship between depression and suicidal ideation as well as suicide attempts. The mediation effect of suicidal beliefs on the depression-ideation and depression-attempt relationship was not significantly moderated by BPTs. This study was cross-sectional and therefore the estimated mediation models must be considered exploratory. Longitudinal research will be needed to assess the potential causal mediation of suicidal beliefs on the relationship between depression and STBs. The results of this study suggest that suicidal beliefs may play a significant role in the relationship between depression and STBs for inpatients with a history of suicidality regardless of BPTs. This suggests suicidal beliefs may be an important treatment target for adults with a history of STBs.

Keywords:

• Borderline personality disorder
• inpatient
• moderation

ACKNOWLEDGMENTS

The authors wish to thank Jessica Bimstein, Sarah Collett, Kate Everhardt, and Tyler Rice for serving as research assistants; and Dr. Hannah Levy, Dr. Kayla Lord, Dr. Emily O’Bryan, and Dr. Blaise Worden for serving as study therapists and/or independent evaluators.

DISCLOSURE STATEMENT

Dr. Diefenbach reported receiving grant funding, material support, and consultant fees from Oui Therapeutics. Dr. Tolin reported receiving grant funding, material support, and consultant fees from Oui Therapeutics; consultant fees from Mindyra LLC; and royalties from Psychwire, Guilford Press, Oxford University Press, Cambridge University Press, John Wiley and Sons, Springer Publications, and New Harbinger Publications. Dr. Rudd reported receiving royalties from American Psychological Association, Guilford, and Springer publications, and owning Oui Therapeutics stock. Dr. Stubbing, Dr. Sain, and Mx. Everhardt have no known conflicts of interest to disclose.

Notes

1 We also completed the analyses presented in this paper for actual attempts with interrupted attempts as the dependent variable – with the same findings. Only results for actual attempts are reported here for the sake of parsimony.

Additional information

Funding

This study was supported by Grant #STR-0-038-18 from the American Foundation for Suicide Prevention (Tolin). The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Foundation for Suicide Prevention. ClinicalTrials.gov ID NCT04168645.

Notes on contributors

Jessica Stubbing

Jessica Stubbing, The Center for Informed Futures, The University of Auckland, New Zealand.

David F. Tolin

David F. Tolin, Anxiety Disorders Center, Institute of Living, Hartford, CT, USA; Yale University School of Medicine, New Haven, CT, USA.

Kimberly S. Sain

Kimberly S. Sain, Anxiety Disorders Center, Institute of Living, Hartford, CT, USA.

Kate Everhardt

Kate Everhardt, San Jose State University, Clinical Mental Health Counseling Program.

M. David Rudd

M. David Rudd, University of Memphis, Memphis, TN, USA.

Gretchen J. Diefenbach

Gretchen J. Diefenbach, Anxiety Disorders Center, Institute of Living, Hartford, CT, USA; Yale University School of Medicine, New Haven, CT, USA.