title: Factors associated with high use of public mental health services by persons with borderline personality disorder.
abstract: OBJECTIVE
  The research presented here was a pilot study to identify clinical factors associated with high use (as opposed to lower use) of inpatient psychiatric services by persons with borderline personality disorder.
  
  
  METHODS
  The initial sample was a random sample of English- and Spanish-speaking persons aged 18 to 60 years who had received at least one outpatient mental health service in the previous 90-day period and were enrolled in one of the participating mental health centers in King County, Washington. A random sample of persons who met selection criteria was randomly drawn; persons with high levels of use were oversampled to ensure adequate representation. Twenty-nine participants met full criteria for borderline personality disorder on the Personality Disorders Examination structured interview and completed all measures. Fifteen (52 percent) of these had a high level of use of inpatient services, and 14 did not.
  
  
  RESULTS
  High use of inpatient psychiatric services was predicted by a history of parasuicide in the previous two years but not by the number or severity of parasuicides; by the presence and number of anxiety disorders but not by depression or psychotic or substance use disorders; and by poorer cognitive functioning. Life stressors, global functioning, and health service variables did not differentiate patients with high levels of service use from other patients with borderline personality disorder.
  
  
  CONCLUSIONS
  Further research should explore these predictors of service use to determine whether they are replicated in larger samples, and treatments that target these variables should be evaluated.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, 98195, USA. comtois@u.washington.edu
authors.forename: Katherine Anne
authors.initials: KA
authors.lastname: Comtois
authors.forename: Joan
authors.initials: J
authors.lastname: Russo
authors.forename: Mark
authors.initials: M
authors.lastname: Snowden
authors.forename: Debra
authors.initials: D
authors.lastname: Srebnik
authors.forename: Richard
authors.initials: R
authors.lastname: Ries
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
mesh_terms: D000293:Adolescent; D000328:Adult; D001883:Borderline Personality Disorder / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D003155:Community Mental Health Centers; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D013406:Suicide, Attempted; D016896:Treatment Outcome; D014600:Utilization Review; D014861:Washington