INdividual Vocational and Educational Support Trial (INVEST) for young people with borderline personality disorder: study protocol for a randomised controlled trial

Abstract

Background: The clinical onset of borderline personality disorder (BPD) usually occurs in young people (aged 12-25 years) and commonly leads to difficulty achieving and maintaining vocational (education and/or employment) engagement. While current psychosocial interventions lead to improvements in psychopathology, they have little effect upon functioning. Individual Placement and Support (IPS) is a client-driven model that assists individuals with severe mental illness to engage with education and/or employment appropriate to their personal goals, and that provides ongoing support to maintain this engagement. The objective of the INdividual Vocational and Educational Support Trial (INVEST) is to evaluate the effectiveness of adding IPS to an evidence-based early intervention programme for BPD, with the aim of improving vocational outcomes. Methods/design: INVEST is a single-blind, parallel-groups, randomised controlled trial (RCT). The randomisation is stratified by gender and age and uses random permuted blocks. The interventions are 39 weeks of either IPS, or 'usual vocational services' (UVS). Participants will comprise 108 help-seeking young people (aged 15-25 years) with three or more DSM-5 BPD features and a desire to study or work, recruited from the Helping Young People Early (HYPE) early intervention programme for BPD at Orygen, in Melbourne, Australia. All participants will receive the HYPE intervention. After baseline assessment, staff who are blind to the intervention group allocation will conduct assessments at 13, 26, 39 and 52 weeks. At the 52-week primary endpoint, the primary outcome is the number of days in mainstream education/employment since baseline. Secondary outcomes include the cost-effectiveness of the intervention, quality of life, and BPD severity.

Subjective and objective sleep in young people with borderline personality disorder features

“…Incongruous social and biological rhythms contribute to sleep restriction in healthy young people (Roenneberg et al, 2012). BPD is associated with poor social functioning, reduced engagement in social activities, and high unemployment rates (Chanen, Nicol, Betts, Bond, et al, 2020; Liebke et al, 2017). These factors likely alleviate social constraints on sleep timing which, combined with later (likely biologically and socially driven) chronotype, allows young people with BPD to sleep longer and later (Ong et al, 2007).…”

“…While young people aged 15-25 years represent a developmentally coherent age group (Chanen et al, 2021;Chanen, Nicol, Betts, Bond, et al, 2020), we acknowledge that there might still be meaningful age-related differences given that sleep patterns differ across adolescence and young adults (Ohayon et al, 2004). Mann-Whitney U tests with Benjamini-Hochberg's procedure revealed no significant differences between adolescents (aged 15-17 years) and young adults (aged 18-25 years) with BPD features; however, further research is needed to replicate these findings in a larger sample (Table 7).…”

“…Focussing on this developmental period is important because it co‐occurs with the clinical onset and peak prevalence of mental disorders including BPD (Chanen et al, 2017; Kessler et al, 2005), during which there are also normative developmental changes in sleep (Ohayon et al, 2004). BPD is associated with adverse long‐term personal, social and economic outcomes that include severe and persistent functional impairment, poor physical health, co‐occurring mental health disorders, family and carer burden, suicide, and premature mortality (Chanen, Nicol, Betts, Bond, et al, 2020; Chanen et al, 2017; Gunderson, 2011; Kaess et al, 2013; Leichsenring et al, 2011). Sleep disturbances are independently associated with functional impairment, reduced quality of life, and a poorer prognosis for BPD recovery (Adams et al, 2017; Plante et al, 2013).…”

Employment interventions to assist people who experience borderline personality disorder: A scoping review

“…Active involvement from the therapist in supporting consumers' goals, learning and problem solving was a feature of all programmes, with one programme (Comtois et al, 2010) including a group session on strategies to assist consumers with building relationships with health professionals. Providing opportunities for therapists to debrief or receive mentoring from others was also noted in three programmes (Chanen et al, 2020;Elliott & Konet, 2014;Elliott & Weissenborn, 2010;Koons et al, 2006).…”

“…(1) Programme design which specifically addressed the needs of consumers with BPD, particularly in group programmes where participants could offer support to each other (Elliott & Konet, 2014;Elliott & Weissenborn, 2010). ( 2) Including an emotional/psychotherapeutic component to the programme to assist participants with managing and problem-solving work-related stressors (Chanen et al, 2020;Elliot & Konet, 2014;Elliott & Weissenborn, 2010). (3) Good communication and coordination between key stakeholders and other therapies.…”