Telehealth Treatment of Patients With Borderline Personality Disorder in a Partial Hospital Setting During the COVID-19 Pandemic: Comparative Safety, Patient Satisfaction, and Effectiveness of In-Person Treatment

There are no studies of the safety and effectiveness of telehealth psychiatric treatment of partial hospital level of care, in general, and for borderline personality disorder (BPD) in particular. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, the authors compared the effectiveness of their partial hospital treatment program in treating patients with BPD. For both the in-person and telehealth partial hospital level of care, patients with BPD were highly satisfied with treatment and reported a significant reduction in symptoms from admission to discharge. Both groups reported a significant improvement in functioning, coping ability, positive mental health, and general well-being. A large effect size of treatment was found in both treatment groups. No patients attempted suicide. Telehealth partial hospital treatment was as effective as in-person treatment in terms of patient satisfaction, symptom reduction, and improved functioning and well-being for patients with BPD.

The Clinical Characteristics of Patients With Borderline Personality Disorder in Different Treatment Settings

The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project compares patients with borderline personality disorder (BPD) in an outpatient practice (n = 390) and a partial hospital setting (n = 358) on diagnostic comorbidities, symptoms experienced, suicidality, and occupational impairment. The patients in the partial program were diagnosed with significantly more psychiatric disorders and were more frequently diagnosed with dysthymia, generalized anxiety disorder, alcohol and substance use disorders, adjustment disorders, and posttraumatic stress disorder. Those at the partial hospital had significantly higher levels of suicidal ideation than those in the outpatient practice. The samples did not differ on utilization of disability or suicide attempts. Treatment setting may have implications in the recognition of the disorder in clinical practice, the development and support of etiological theories, identification of core deficits, and evaluation of psychosocial morbidity associated with BPD.

Longitudinal Measurement Invariance of the PHQ-9 and GAD-7

Intraindividual change over time is commonly used to estimate treatment effectiveness. However, patients may not respond similarly to a scale after treatment, rendering pre–post change an unreliable metric. The current objective was to investigate longitudinal measurement invariance of the Patient Health Questionnaire–9 and Generalized Anxiety Disorder Scale–7 among 4,323 patients completing a partial hospital program. We used confirmatory factor analysis to determine (1) factor structure at pretreatment and posttreatment and (2) longitudinal invariance, accounting for dependent observations, using both classical and approximate measurement invariance approaches. Results indicated a two-factor solution for both scales. Longitudinal invariance was not established for either scale, thus, using raw score differences from the Patient Health Questionnaire–9 and Generalized Anxiety Disorder Scale–7 for measuring symptom change over time may be problematic. The most longitudinally consistent items captured somatic as opposed to affective/cognitive symptoms. We discuss the potential use of these measures for diagnostic screening and between-group comparisons and suggest alternative ways to monitor client progress over time. Limitations included a majority White sample and uniqueness of a partial hospital setting.