The impact of a telephone hotline on suicide attempts and self-injurious behaviors in patients with borderline personality disorder

Alice Buronfosse; Marion Robin; Mario Speranza; Philibert Duriez; Jérôme Silva; Maurice Corcos; Fabienne Perdereau; Nadia Younes; Lionel Cailhol; Philip Gorwood; Alexandra Pham-Scottez

doi:10.3389/fpsyt.2023.1288195

The impact of a telephone hotline on suicide attempts and self-injurious behaviors in patients with borderline personality disorder

Front Psychiatry. 2024 Jan 4:14:1288195. doi: 10.3389/fpsyt.2023.1288195. eCollection 2023.

Authors

Alice Buronfosse¹, Marion Robin², Mario Speranza^{3

4}, Philibert Duriez^{5

6}, Jérôme Silva¹, Maurice Corcos², Fabienne Perdereau⁷, Nadia Younes^{3

8}, Lionel Cailhol⁹, Philip Gorwood⁴, Alexandra Pham-Scottez¹

Affiliations

¹ Centre Psychiatrique d'Orientation et d'Accueil, GHU Paris Psychiatrie et Neurosciences, Paris, France.
² Service de psychiatrie de l'adolescent et du jeune adulte, Institut Mutualiste Montsouris, Paris, France.
³ Université Versailles Saint-Quentin, Université Paris-Saclay, Inserm U1018, CESP, Team DevPsy, Villejuif, France.
⁴ Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier de Versailles, Versailles, France.
⁵ Clinique des Maladies Mentales et de l'Encéphale, GHU Paris Psychiatrie et Neurosciences, Paris, France.
⁶ Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), Inserm, Paris, France.
⁷ Clinique Fondation Santé des Etudiants de France, Paris, France.
⁸ Service Hospitalo-Universitaire de Psychiatrie de l'Adulte et d'Addictologie, Centre Hospitalier de Versailles, Le Chesnay, France.
⁹ Department of Psychiatry, Institut Universitaire de Santé Mentale de Montréal, CIUSSS of East Montreal, University of Montreal, Montreal, QC, Canada.

Abstract

Background: Borderline personality disorder is often associated with self-injurious behaviors that cause personal suffering, family distress, and substantial medical costs. Mental health hotlines exist in many countries and have been shown to be effective in some contexts, but none have been specifically designed for borderline patients. The aim of the present study is to evaluate the impact of a 24/7 hotline dedicated to patients with borderline personality disorder on suicide attempts and self-injurious behaviors.

Methods: We conducted a single-blind, multicenter (9 French centers) clinical trial with stratified randomization (by age, sex and center). Patients (N = 315) with a diagnosis of borderline personality disorder (according to the SIDP-IV) were randomized into two groups with or without access to the hotline in addition to treatment as usual. The number of suicide attempts and self-injurious behaviors in each group within 12 month were analyzed in the "per protocol" population (Student's t-tests, 5% significance threshold), adjusting for possible confounders in a multivariate analysis (using Poisson regression). The percentage of patients with suicide attempts and with self-injurious behaviors (and other percentages) were analyzed in the per protocol population (χ²-tests or exact Fischer tests, 5% significance threshold).

Results: The mean number of suicide attempts was 3 times lower in the hotline group (0.41 vs. 1.18, p = 0.005) and the mean number of self-injurious behaviors was 9 times lower (0.90 vs. 9.5, p = 0.006). Multivariate analysis confirmed the effectiveness of the hotline in reducing suicide attempts and self-harm.

Conclusion: This study supports the effectiveness of hotlines in reducing self-aggressive behavior in patients with borderline personality disorder. Such support is easy to use, cheap and flexible, and therefore easy to implement on a large scale.

Keywords: borderline personality disorder; hotline; self-harm; self-injurious behavior; suicide attempt.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was funded by the French Ministry of Health, through a National Clinical Research Hospital Program (Programme Hospitalier de Recherche Clinique).