Borderline personality disorder (BPD) and history of prior suicide attempt (SA) have been shown to be high predictors for subsequent suicide. However, no previous study has examined how both factors interact to modify clinical and suicide severity among adolescents. This study presents a comprehensive assessment of 302 adolescents (265 girls, mean age = 14.7 years) hospitalized after a SA. To test clinical interactions between BPD and history of prior SA, the sample was divided into single attempters without BPD (non-BPD-SA, N = 80), single attempters with BPD (BPD-SA, N = 127) and multiple attempters with BPD (BPD-MA, N = 95). Univariate analyses revealed a severity gradient among the 3 groups with an additive effect of BPD on the clinical and suicide severity already conferred by a history of SA. This gradient encompassed categorical (anxiety and conduct disorders and non-suicidal-self-injury [NSSI]) and dimensional comorbidities (substance use and depression severity) and suicide characteristics (age at first SA). According to regression analyses, the BPD-MA group that was associated with the most severe clinical presentation also showed specific features: the first SA at a younger age and a higher prevalence of non-suicidal self-injury (NSSI) and anxiety disorders. The BPD-MA group was not associated with higher impulsivity or frequency of negative life events. Based on these findings and to improve youth suicide prevention, future studies should systematically consider BPD and the efficacy of reinforcing early interventions for anxiety disorders and NSSI.

中文翻译：

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边缘性人格障碍和先前的自杀未遂定义了住院的青少年自杀未遂者中的严重程度梯度

边缘性人格障碍（BPD）和先前的自杀未遂史（SA）已被证明是随后自杀的重要预测因素。但是，以前没有研究检查过这两个因素如何相互作用以改变青少年的临床和自杀严重程度。这项研究对SA后住院的302名青少年（265名女孩，平均年龄= 14.7岁）进行了全面评估。为了测试BPD和既往SA病史之间的临床相互作用，将样本分为无BPD的单次尝试（非BPD-SA，N = 80），具有BPD的单次尝试（BPD-SA，N = 127）和具有BPD的多次尝试。 BPD（BPD-MA，N = 95）。单因素分析揭示了三组之间的严重程度梯度，BPD对已经由SA病史赋予的临床和自杀严重性具有加和作用。该梯度包括类别（焦虑和品行障碍和非自杀性自我伤害[NSSI]）和尺寸合并症（药物使用和抑郁严重程度）和自杀特征（首次SA年龄）。根据回归分析，与最严重的临床表现相关的BPD-MA组也显示出特定特征：年轻时首次出现SA，非自杀性自残（NSSI）和焦虑症的患病率更高。BPD-MA组与较高的冲动性或负面生活事件发生频率无关。基于这些发现并改善青少年自杀预防，未来的研究应系统地考虑BPD以及加强对焦虑症和NSSI的早期干预的有效性。