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Prevalence of borderline personality disorder in immigrants in a psychiatric inpatient setting Friedrich Nielsen, Marc Ziegenbein and Marcel Sieberer Department of Mental Health, Hanover Medical School, Hanover, Germany Corresponding author: Friedrich Nielsen, Ostwender Str. 8a, Hannover, 30161, Germany Email:
[email protected] DOI: 10.1177/0004867413518618
To the Editor Information about the relationship between personality disorder and ethnicity or migration is sparse. The few studies regarding the prevalence of borderline personality disorder (BPD) in immigrants compared to an indigenous population are inconsistent. Castaneda and Franco (1985) found no ethnic group differences in rates of BPD, whereas the study of Pascual et al. (2008) showed that immigrants in a psychiatric emergency service had a lower likelihood of being diagnosed with BPD. The aim of the present study was to compare the frequency of borderline
The challenge of routine follow-up in e-mental health services Simone N Rodda and Dan I Lubman Turning Point, Eastern Health and Eastern Health Clinical School, Monash University, Melbourne, Australia Corresponding author: Simone Rodda, Turning Point, 54-62 Gertrude Street, Fitzroy, VIC 3065, Australia Email:
[email protected] DOI: 10.1177/0004867413515530
ANZJP Correspondence personality disorder in psychiatric inpatients with an immigrant background vs. the indigenous group. A total of 2494 consecutive patients over a three-year period at a psychiatric university hospital were reviewed. Data included socio-demographic and clinical variables and also information about an immigrant background, although no specific data of the provenance of the individual migrant patient were obtainable. The psychiatric diagnosis was limited to information available from the digital documentation system of the psychiatric clinic and additionally from discharge letters. The diagnosis of borderline personality disorder was based on ICD-10 criteria. Of the study population 374 individuals (15%) had an immigrant background. The rates of BPD were 6.5% in the indigenous group (n=2120) vs. 3.5% in the immigrant group (n=374). The difference between the indigenous and the immigrant group regarding the rates of BPD-diagnoses was statistically significant (chi2=5,02, df=1, p=0,025). In accordance to the findings of Pascual et al. (2008) and challenging the results of Castaneda and Franco (1985), our findings suggest that in a clinical sample BPD was diagnosed less frequently in the immigrant group than in the indigenous group.Therefore, our results do not support the concept of immigration as a risk factor for BPD.
Possible explanations for our finding are a true lower prevalence of BPD amongst the immigrant group, or ethnic variations in the symptomatology of BPD (Selby and Thomas, 2009), or a cross-cultural bias in the diagnostic process. However, future investigations with a prospective study design and at epidemiological levels need to be conducted in order to get more precise information about the true prevalence of BPD in different immigrant groups and to derive an explanation for the apparent discrepancy in prevalence, and the influence of a cross-cultural setting on the diagnostic process.
To the Editor
clients except those who actively elected to opt-out (i.e., unchecked the box). While 80% did not opt out, only one in five (22%) responded to a follow-up email despite multiple requests (up to three emails). The survey was administered between one and 10 weeks following the initial session, with the highest response rate (35%) evident when clients were contacted three weeks after the initial session. Clients were invited to address queries or requests for further assistance via email to administrative staff.
Despite the exponential growth of e-therapy in Australia, few services are evaluated. Indeed, Jorm et al. (2013), in a recent editorial on the future of e-mental health, suggest evaluation is challenging, as practice is moving faster than the evidence base can be established. We recently explored client responsiveness to a follow-up email after a single session of web-based counselling for problem gambling (www.gamblinghelponline. com). Follow-up was provided to all
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
References Castaneda R and Franco H (1985) Sex and ethnic distribution of borderline personality disorder. American Journal of Psychiatry 142: 1202–1203. Pascual JC, Malagon A, Corcoles D, et al. (2008) Immigrants and borderline personality disorder at a psychiatric emergency service. British Journal of Psychiatry 193: 471–476. Selby EA and Thomas EJ (2009) Ethnic variations in the structure of borderline personality disorder symptomatology. Journal of Psychiatric Research 43: 115–123.
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ANZJP Correspondence Of the 73 clients who responded (out of possible 331 (22%)), 60 clients provided a qualitative response in addition to completing a brief evaluation. Frequently, clients expressed appreciation of follow-up, which was variously perceived as uplifting, empathic, caring and supportive (68%). A surprisingly profuse response was received from clients who used it as an opportunity for self-reflection with almost 48 out of 60 (80%) providing unprompted information on their goals, plans and priorities, as well as action taken since their initial contact with the service, which had not been requested. This evaluation identified multiple issues related to follow-up in an e-mental health service. First, 33% of those who responded requested additional information or help in managing their gambling problem. Second, some
clients required an immediate clinical response (i.e., low mood and possible self-harm reported). Third, there were a high number of emails that bounced, as well as extended periods of time between follow-up and response (explained as holidays, not checking emails, finishing employment or just being busy). While client follow-up is logistically easier to deliver and receive online, it imposes new challenges in terms of obtaining a reasonable response rate. The findings of this evaluation suggest follow-up often requires a clinical response as well as helping clients reconnect with services. Future evaluations should consider building in therapeutic support options at every client contact, especially given low response rates within community settings.
Acknowledgements The authors would like to acknowledge the efforts by states and territories in forming a collaborative funding agreement for Gambling Help Online and in particular the Victorian Responsible Gambling Foundation as contract managers.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Reference Jorm AF, Morgan AJ and Malhi GS (2013) The future of e-mental health. Australian and New Zealand Journal of Psychiatry 47: 104–106.
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