Borderline Personality Disorder
Conditions
Keywords
mentalisation-based treatment, health care utilization, long-term follow-up, borderline personality disorder, psychosocial functioning, recovery, patient-reported outcomes, patient experiences, mixed-methods, qualitative research, health care costs
Brief summary
This study is a long-term follow-up study of a previous multicenter randomized controlled trial, in which n=114 participants were included. This RCT compared the effectiveness of two intensities of mentalisation-based treatment (MBT) for individuals with borderline personality disorder (BPD). The goal of this study is to learn how people who received MBT in the past for BPD are doing more than 10 years later. MBT is a type of psychotherapy that helps people understand and manage their thoughts and feelings, and supports improvements in identity and relationships, with the aim of improving daily life functioning. The main questions this study aims to answer are: 1. How are people who received MBT in the past functioning more than 10 years later, and how is their use of mental health care and associated costs at this point in their lives? 2. Do long-term outcomes differ between people who received day-hospital MBT and people who received intensive outpatient MBT, and are these outcomes influenced by how much time has passed since treatment ended or by clinical characteristics from the past, such as symptom severity, trauma history, or level of mentalizing? 3. How do people who received MBT experience its impact on their symptoms, daily life, and relationships both during treatment and in the years afterward, including the impact of treatment intensity? Participants will: * Fill in online questionnaires about symptoms, relationships, health, and daily functioning (about 60 minutes). * Take part in a short interview to check whether BPD symptoms are still present (about 20 minutes). * A smaller group will be invited for a longer semi-structured qualitative interview (about 60 minutes) to talk about their personal experiences with MBT and what has impacted their life after treatment. There are no new treatments in this study. All participants completed MBT many years ago. Participation happens online or in person based on personal preference.
Detailed description
This observational study examines long-term outcomes more than 10 years after people received mentalization-based treatment (MBT) for borderline personality disorder (BPD). Although improvements after MBT have been demonstrated up to three years after the start of treatment, little is known about how people function over a much longer period and whether treatment gains translate into sustained improvements in everyday life. This study focuses on broader developmental and psychosocial recovery, including interpersonal functioning, identity development, and participation in society, domains that have typically shown the least responsiveness to treatment compared with improvements in psychopathology or symptoms. Participants in this study took part in an earlier randomized controlled trial comparing two different MBT programs: a day-hospital program (MBT-DH) and an intensive outpatient program (MBT-IOP). Both programs showed positive effects in the original study up to three years after start of treatment, but the long-term course of functioning and service use after treatment remains unclear. Understanding how people have progressed in the years since treatment, and whether earlier characteristics influence their current functioning, may help refine treatment models and improve accessibility and cost-effectiveness of MBT. This study has three aims. 1. First, it examines current functioning, including symptoms, interpersonal relationships, daily life functioning, and mental health care use and costs more than 10 years after the start of treatment. It also investigates whether long-term outcomes are influenced by the time elapsed since the original treatment ended or by clinical characteristics from the past, such as symptom severity, trauma history, or level of mentalizing before treatment. 2. Second, it explores potential differences in long-term outcomes between people who received MBT-DH and people who received MBT-IOP. Third, it investigates participants' own perspectives on the impact of MBT, both during treatment and in the years following treatment, including their experiences with treatment intensity. All participants from the original trial, except the one person who declined to be contacted for future research, will be approached and invited to complete a set of online self-report questionnaires and a short interview to evaluate whether BPD symptoms are still present. A smaller group will also be invited for an in-depth qualitative interview about their experiences with MBT and how treatment may have influenced their lives and functioning. This mixed-methods follow-up approach will contribute to a better understanding of long-term adaptation after MBT and may inform the design of future treatment pathways for people with BPD.
Interventions
None listed
Sponsors
De Viersprong
Arkin
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Participation in the original randomized controlled trial of mentalization-based treatment (MBT-DH versus MBT-IOP) * Did not decline to be contacted for future research * Able to provide informed consent at the time of the long-term follow-up assessment (No separate
Exclusion criteria
are specified, as exclusion follows directly from these inclusion criteria.)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in borderline symptom severity between 3-year follow-up and long-term follow-up | Assessed at long-term follow-up (10-14 years after treatment start), using prior 3-year follow-up data for comparison | Borderline symptom severity is measured using the Personality Assessment Inventory-Borderline Features Scale (PAI-BOR). Scores range from 0 to 72, with higher scores indicating more severe borderline features. The primary estimate of interest is the change in PAI-BOR score from the 3-year follow-up assessment to the long-term follow-up assessment conducted 10-14 years after treatment start. Repeated measures collected between baseline and 3-year follow-up will be incorporated in the analyses to account for prior trajectories. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in general symptom severity | Assessed at long-term follow-up (10-14 years after treatment start), using prior 3-year follow-up data for comparison | General symptom severity as measured using the Brief Symptom Inventory (BSI-53). Items are scored on a 0 to 4 scale. The Global Severity Index (GSI) represents overall distress, with higher scores indicating greater severity of symptoms. The primary estimate of interest is the change in GSI score from the 3-year follow-up assessment to the long-term follow-up assessment conducted 10-14 years after treatment start. Repeated measures collected between baseline and 3-year follow-up will be incorporated in the analyses to account for prior trajectories. |
| Change in interpersonal problems | Assessed at long-term follow-up (10-14 years after treatment start), using prior 3-year follow-up data for comparison | Interpersonal problems are measured with the Inventory of Interpersonal Problems (IIP-64). Items are rated on a 0 to 4 scale, with higher scores indicating more interpersonal problems across eight domains (for example, nonassertive, socially inhibited). The primary estimate of interest is the change in IIP total score from the 3-year follow-up assessment to the long-term follow-up assessment conducted 10-14 years after treatment start. Repeated measures collected between baseline and 3-year follow-up will be incorporated in the analyses to account for prior trajectories. |
| Change in quality of life | Assessed at long-term follow-up (10-14 years after treatment start), using prior 3-year follow-up data for comparison | Quality of life is measured using the EuroQol-5D-3L (EQ-5D-3L). Each of five dimensions has three response levels. Higher values on the index score reflect better health-related quality of life. The primary estimate of interest is the change in the index score from the 3-year follow-up assessment to the long-term follow-up assessment conducted 10-14 years after treatment start. Repeated measures collected between baseline and 3-year follow-up will be incorporated in the analyses to account for prior trajectories. |
| Change in reflective functioning | Assessed at long-term follow-up (10-14 years after treatment start), using prior 3-year follow-up data for comparison | Reflective functioning is measured using the Reflective Functioning Questionnaire-8 (RFQ-8). Scores reflect uncertainty or certainty regarding mental states. The Uncertainty subscale has shown most sensitivity to change and evidence on the psychometric qualities concerning the Certainty subscale has shown mixed results, therefore we will focus on the subscale Uncertainty as outcome measure for the domain of reflective functioning. The primary estimate of interest is the change in Uncertainty subscale score from the 3-year follow-up assessment to the long-term follow-up assessment conducted 10-14 years after treatment start. Repeated measures collected between baseline and 3-year follow-up will be incorporated in the analyses to account for prior trajectories. |
| Change in personality functioning (self-reported) | Assessed at long-term follow-up (10-14 years after treatment start), using prior 3-year follow-up data for comparison | Personality functioning is assessed using the Severity Indices of Personality Problems-Short Form (SIPP-SF). Higher scores indicate better adaptive personality functioning across five core domains. The primary estimate of interest is the change in the five subscale scores from the 3-year follow-up assessment to the long-term follow-up assessment conducted 10-14 years after treatment start. Repeated measures collected between baseline and 3-year follow-up will be incorporated in the analyses to account for prior trajectories. |
| Level of personality functioning | Long-term follow-up only (10-14 years after treatment start) | Impairments in personality functioning are assessed using the Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0). Higher scores reflect greater impairment in self- and interpersonal functioning. No direct comparison will be made with previous assessments, as this measure was not included in the original trial. Scores at long-term follow-up will be interpreted using available normative scores to determine level of functioning. |
| Sense of belonging | Long-term follow-up only (10-14 years after treatment start) | Sense of belonging is measured by means of the PROMIS Short Form v2.0 Social Isolation. Participants indicate how often they feel left out, that people barely know them, isolated from others, and that people are around them but not with them in the past month on a Likert-type scale from 1 (never) to 5 (always). No direct comparison will be made with previous assessments, as this measure was not included in the original trial. Scores at long-term follow-up will be interpreted using available normative scores to determine level of functioning. |
| Life satisfaction | Long-term follow-up only (10-14 years after treatment start) | Life satisfaction is assessed by means of the Quality of Life Enjoyment and Satisfaction Questionnaire Short-Form (Q-LES-Q-SF). The Q-LES-Q-SF is a 16-item self-report questionnaire that measures the degree of enjoyment and satisfaction experienced in various domains of daily functioning, including work, social relationships, household activities, economic status and overall wellbeing on a 5 point likert scale ranging from 1 (very poor) to very good (5). No direct comparison will be made with previous assessments, as this measure was not included in the original trial. Scores at long-term follow-up will be interpreted using available normative scores to determine level of functioning. |
| Psychosocial functioning | Long-term follow-up only (10-14 years after treatment start) | Psychosocial functioning is assessed means of the 12-item WHO Disability Assessment Schedule (WHODAS 2.0). The WHODAS measures disability and functional impairment across six domains: cognition, mobility, self-care, interpersonal relationships, life activities, and participation in society. No direct comparison will be made with previous assessments, as this measure was not included in the original trial. Scores at long-term follow-up will be interpreted using available normative scores to determine level of functioning. |
| Changes in BPD diagnosis | Assessed at long-term follow-up (10-14 years after treatment start), using prior 3-year follow-up data for comparison. | BPD diagnosis is assessed using the BPD section of the Dutch version of the SCID-II. Diagnostic status is operationalized as the dimensional score on BPD criteria, the number of criteria met, and the presence or absence of a BPD diagnosis. Current diagnostic status at long-term follow-up (10-14 years post-treatment) will be compared with previously collected data from the 3-year follow-up. |
| Changes in health service utilization and productivity losses | Assessed at long-term follow-up (10-14 years after treatment start), using prior (baseline) data for comparison | Health service use and productivity losses are assessed using the TiC-P questionnaire. Higher estimates reflect greater service utilization and higher direct and indirect costs. Health care utilization during the year prior to the long-term follow-up assessment will be compared to utilization during year prior to the baseline, and the year prior to the 3-year follow-up assessment. |
| Patient-reported experiences and perceived impact of MBT | Long-term follow-up (10-14 years after treatment start) | Participants' experiences of MBT and its impact on symptoms, daily life functioning, and relationships, and views on treatment intensity, assessed through a semi-structured interview at long-term follow-up. |
Countries
Netherlands
Contacts
CONTACTMaaike L. Smits, Dr.
CONTACTDine J. Feenstra, Dr.
Outcome results
None listed