As we know, this is the first study examining SA and its associated factors in BPD patients in China. The results showed that the prevalence of lifetime SA in Chinese BPD patients was up to 61.9%, being consistent with the high rate in western countries [8–10]. Significant correlates of SA in this patient population were MDD, hostility, and self-aggression, partly replicating the findings from western studies [11, 13–16, 18, 20].
Some studies [11, 15, 18] showed that MDD, as a typical and severe type of depressive disorders, was associated with SA in BPD patients. Compared with state depression and temporary psychological symptoms, MDD refers to more profound and persistent mood problems, which may lead the patients to the unfortunate assumption that suicide is the only way to end their painful life. It is consistent with the characteristics of repeated SAs in BPD patients, rather than occasional suicidal impulse, as well as state depression. Some researchers indicated that it is unlikely for acute symptoms to have predict value for suicidal behavior in a long term . Similarly, the correlations of current depressive and hopeless symptoms to SA in this patient population were not found in this study, although previous studies had the opposite results [11, 19]. This is a primarily cross-sectional study, rather than a longitudinal follow-up study, but the history of SAs was reviewed and several retrospective questionnaires were used. Therefore, the relationships revealed in this paper were not only over a single period, but also what we want to achieve.
Aggression, especially hostility and self-aggression with a relatively weak effect, is also a significant correlate of SA in BPD patients, partly replicating the findings of previous studies [11, 13, 14, 16, 18]. There is an intrinsic correlation between self-aggression and aggression toward others, while self-aggression is often used as a psychological explanation for suicidal behavior. In other words, from the pathogenic mechanism of BPD, the hate for important objects caused by severe psychological trauma in the early years and the symbiotic relationship with those objects lead to the extreme self-violence, namely suicide. However, the types of aggression being more associated with SA should be further confirmed. In contrast, impulsiveness is another personality trait of BPD, which does not show an association with SA, and could be explained by the possibility of overlapping between aggression and impulsiveness [28, 29]. Aggression might be closer to suicide in BPD patients.
The effect of childhood sexual abuse has not been found probably due to taboo in Oriental culture about talking about sex; some Asian studies showed lower rates of sexual abuse in psychiatric patients than other types of abuse [30, 31]. In addition, demographic characteristics and times of hospitalization were not found to be associated with SA in BPD patients. Indeed, there are few literatures to support that BPD patients have different SA risk for different genders, occupations, education levels, or marital status. However, patients’ ages and times of hospitalization were also not associated with SA in this study, which were not consistent with the results of the other BPD studies [17, 20], possibly because the majority of the patients were relatively young and had multiple hospitalizations (tow or more times).
There are several limitations in this study. First, the subjects were clinical patients from a psychiatric hospital of a city in middle China, with sample limits of severity and region. Second, the cross-sectional studies determined that causality could not be elucidated. Third, this is a preliminary study, and certain data fail to be collected or analyzed further, such as family history of suicide, psychosocial functioning, manner, and frequency of suicide.