title: Borderline personality disorder among primary care depressive patients: a five-year study.
abstract: BACKGROUND
  Studies of depressive disorders with concurrent borderline personality disorder (BPD) in primary health care are scarce and methodologically weak. Limited epidemiological evidence suggests BPD may be common among users of primary care services. Prevalence, characteristics and outcome of primary care depressive patients with co-morbid BPD are unknown.
  
  
  METHODS
  The Vantaa Primary Care Depression Study is a prospective five-year cohort study. A stratified random sample of 1119 patients aged 20 to 69 years was screened for depression using the Prime-MD. SCID-I/P and SCID-II interviews were used to diagnose depressive all co-morbid axis I and II disorders. Of the 137 depressive patients at baseline, 82% completed the five-year follow-up. Characteristics and outcome of patients with or without concurrent BPD were compared.
  
  
  RESULTS
  BPD cases accounted for 26% at baseline and 19% at follow-up. At baseline, BPD patients had a two-fold prevalence of anxiety and previous depressive episodes; a three-fold prevalence of substance use disorders, suicidal ideation and severe economic difficulties, and a four-fold prevalence of preceding suicide attempts or unemployment compared to those without BPD. By follow-up, patients with BPD had spent more time depressed, achieved full remission slower and a higher proportion were chronically depressed.
  
  
  CONCLUSIONS
  Diagnostic reliability of depressive disorders was excellent, but of BPD not tested. Generalizability to other primary care settings remains unknown.
  
  
  CONCLUSIONS
  Concurrent BPD may be relatively common among depressed primary care patients. These patients have specific, adverse characteristics and poor long-term outcome, which should be considered when developing treatments for depression in primary care.
authors.affiliation: Mood, Depression and Suicidal Behaviour Unit, National Institute for Health and Welfare, Helsinki, Finland.
authors.forename: Kirsi
authors.initials: K
authors.lastname: Riihimäki
authors.affiliation: Mood, Depression and Suicidal Behaviour Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, Helsinki University Central, Hospital (HUCH), Helsinki, Finland.
authors.forename: Maria
authors.initials: M
authors.lastname: Vuorilehto
authors.affiliation: Mood, Depression and Suicidal Behaviour Unit, National Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, Helsinki University Central, Hospital (HUCH), Helsinki, Finland; Department of Psychiatry, Institute of Clinical Medicine, University of Helsinki, Helsinki, Finland. Electronic address: erkki.isometsa@hus.fi.
authors.forename: Erkki
authors.initials: E
authors.lastname: Isometsä
mesh_terms: D000328:Adult; D000368:Aged; D001883:Borderline Personality Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome; D055815:Young Adult
keywords: Borderline personality disorder; Co-morbidity; Depression; Follow-up; Primary care