Development and validation of a screening instrument for borderline personality disorder (SI-Bord) for use among univers
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RESEARCH ARTICLE
Open Access
Development and validation of a screening instrument for borderline personality disorder (SI-Bord) for use among university students Trustsavin Lohanan1†, Thanakorn Leesawat1†, Tinakon Wongpakaran2* , Nahathai Wongpakaran2, Nuntaporn Karawekpanyawong2, Awirut Oon-Arom2 and Pimolpun Kuntawong2
Abstract Background: The screening instrument for borderline personality disorder (SI-Bord) consists of a 5-item self-reported questionnaire on the key features of BPD from the DSM-5 using a 5-point Likert scale. This study investigated its validity and reliability in screening for BPD in university students. Methods: A cross-sectional study was conducted on a sample of university students in Thailand between November and December 2019. An online assessment gathered demographic data and results from the SI-Bord, the Perceived Stress Scale-10 (PSS-10) and the Patient Health Questionnaire-9 (PHQ-9). Participants whose SI-Bord scores were ≥ 1 were randomly selected to be interviewed and assessed for a BPD diagnosis by four psychiatrists using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) as a reference point. An intraclass correlation coefficient (ICC) of 0.925 (95% CI, 0.805–0.979) ensured inter-rater reliability between the four psychiatrists. The diagnostic sensitivity and specificity of the SI-Bord, as compared to that of the SCID-II, were determined to indicate the cut-off score. The Receiver Operating Characteristics (ROC) was analyzed to evaluate its diagnostic accuracy. Results: The study included 342 students aged 18–25 years (the mean age was 20.25 ± 1.4 years), 80.4% of whom were female. Among the 68 participants selected for an online interview, 16 were diagnosed with BPD. The cut-off score of the SI-Bord was > 9, as suggested by the Youden index, yielding a sensitivity of 56.3% and a specificity of 92.3%. It had a positive predictive value of 69.2% and negative predictive value of 87.3%. The SI-Bord had adequate discriminative power between cases and non-cases of BPD, with the area under the ROC curve being 0.83. Cronbach’s alpha for the SI-Bord was 0.76, indicating acceptable internal consistency. The SI-Bord score was positively correlated to PHQ-9 and PSS-10 scores (r = 0.67 and r = 0.69, p < 0.001, respectively) and negatively correlated to MSPSS (r = − 0.50, p < 0.001). The prevalence of BPD in the sample was 6.4%, according to the cut-off score > 9. Conclusion: The SI-Bord demonstrated good reliability and validity for screening BPD in university students. However, a study in non-Thai and other population groups should be warranted. Keywords: Borderline personality disorder, Screening, Validation, Instrument, Undergraduate
* Correspondence: [email protected] Trustsavin Lohanan and Thanakorn Leesawat Equally first authored 2 Department of Psychiatry, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Rd., T. Sriphum, A. Muang, Chiang Mai 50200, Thailand Full list of author information is available at the end of the article © The A
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