This study aimed to assess the supply of and demand for treatment of borderline personality disorder (BPD) to inform current standards of care and training in the context of available resources worldwide. Methods:The total supply of mental health professionals and mental health professionals certified in specialist evidence-based treatments for BPD was estimated for 22 countries by using data from publicly available sources and training programs. BPD prevalence and treatmentseeking rates were drawn from large-scale national epidemiological studies. Ratios of treatment-seeking patients to available providers were computed to assess whether current systems are able to meet demand. Training and certification requirements were summarized. Results:The ratio of treatment-seeking patients with BPD to mental health professionals (irrespective of professionals' interest or training in treating BPD) ranged from approximately 4:1 in Australia, the Netherlands, and Norway to 192:1 in Singapore. The ratio of treatment-seeking patients to clinicians certified in providing evidence-based care ranged from 49:1 in Norway to 148,215:1 in Mexico. Certification requirements differed by treatment and by country.

Borderline personality disorder (BPD) is a serious mental illness associated with heightened disability, risk for suicide, and costs to society. This study aims to meta-analytically quantify dropout rates from psychotherapies of BPD, identify moderators, and assess reasons for dropout and time taken to dropout. PubMed, PsycINFO, and MEDLINE were screened from database inception to March 2020 for trials that investigated psychotherapies for individuals with BPD reporting dropout rates. The primary outcomes were pooled dropout rates and differential treatment retention across all studies, all randomized controlled trials (RCT), all outpatient studies, and all outpatient RCTs. Random effects meta-analysis, metaregression analyses, and publication bias tests were conducted. Information on reasons for dropout and time to dropout was synthesized qualitatively. Dropout rates were 22.3% considering all studies, and 28.2% when only considering outpatient randomized controlled trials. Odds of dropout were not significantly higher in the control condition than in the intervention condition. Longer duration, randomization, phone coaching, and outpatient setting were associated with higher dropout rates, but only when considering all studies. Publication bias-adjusted dropout rates were as high as 29.9%. Reasons for dropout included dissatisfaction with treatment, expulsion from treatment, and lack of motivation. Most dropouts occurred in the first half of treatment. Dropout is an important and prevalent issue in BPD psychotherapies. Reported rates are minimized by publication bias, and moderators of dropout rates are inconsistent. Subsequent research should identify obstacles to completing treatment and investigate ways to organize treatment allocation to enhance treatment retention.

Background Smartphone applications could improve symptoms of borderline personality disorder (BPD) in a scalable and resource-efficient manner in the context limited access to specialized care. Objective This systematic review and meta-analysis aims to evaluate the effectiveness of applications designed as treatment interventions for adults with symptoms such as anger, suicidality, or self-harm that commonly occur in BPD. Data sources Search terms for BPD symptoms, smartphone applications, and treatment interventions were combined on PubMed, MEDLINE, and PsycINFO from database inception to December 2019. Study selection Controlled and uncontrolled studies of smartphone interventions for adult participants with symptoms such as anger, suicidality, or self-harm that commonly occur in BPD were included. Study appraisal and synthesis methods Comprehensive Meta-Analysis v3 was used to compute between-groups effect sizes in controlled designs. The primary outcome was BPD-related symptoms such as anger, suicidality, and impulsivity; and the secondary outcome was general psychopathology. An average dropout rate across interventions was computed. Study quality, target audiences, therapeutic approach and targets, effectiveness, intended use, usability metrics, availability on market, and downloads were assessed qualitatively from the papers and through internet search. Results Twelve studies of 10 applications were included, reporting data from 408 participants. Between-groups meta-analyses of RCTs revealed no significant effect of smartphone applications above and beyond in-person treatments or a waitlist on BPD symptoms (Hedges’ g = − 0.066, 95% CI [−.257, .125]), nor on general psychopathology (Hedges’ g = 0.305, 95% CI [− 0.14, 0.75]). Across the 12 trials, dropout rates ranged from 0 to 56.7% (M = 22.5, 95% CI [0.15, 0.46]). A majority of interventions studied targeted emotion dysregulation and behavioral dyscontrol symptoms. Half of the applications are commercially available. Conclusions The effects of smartphone interventions on symptoms of BPD are unclear and there is currently a lack of evidence for their effectiveness. More research is needed to build on these preliminary findings in BPD to investigate both positive and adverse effects of smartphone applications and identify the role these technologies may provide in expanding mental healthcare resources.

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