Associations between borderline personality disorder features and the risk of first onset major depressive disorder: Findings from a 2-year longitudinal study in a sample of first-year university students in China

Background: : The objective of this study was to estimate the associations between specific BPD features on the risk of first onset MDD over 2 years and to investigate the roles of sex, baseline depression and anxiety in the associations. Methods: : A longitudinal study of Chinese first-year university students aged between 15 and 24 years and who did not have a lifetime MDD (n = 7,627). Random effect logistic regression modeling was used to estimate the associations between specific BPD features, the number of BPD features, and the risk of MDD. Results: : The feeling of emptiness (OR = 2.14, 95% CI: 1.57, 2.92), paranoid/dissociation (OR = 2.01, 95% CI: 1.43, 2.82), affective instability (OR = 1.71, 95% CI: 1.22, 2.39) conferred significant risk of MDD. Baseline depression and anxiety interacted with unstable relationship, identity disturbance and paranoid/disassociation in relation to the risk of MDD. A higher number of BPD features is associated with an increased risk of MDD. Limitations: : Data collection relied on self-report. Thus, recall and reporting biases are possible. Due to the pandemic public health restrictions, we had to change the method of data collection at second annual assessment, which resulted in a lower response rate (66.5%). Conclusions: : Mental health professionals should pay attention to the presence of BPD features in youth and young adults, as they are at high risk of developing a MDD in a short time period, and the risk increases with the number of BDP features.