Cultural, gender and geographic variations in suicidality among individuals with BPD

Abstract

Suicidal thoughts and behaviors in borderline personality disorder are common, but their frequency and forms vary across cultures, genders, and regions. Inequity-focused systematized review using the PROGRESS-Plus framework. Adult studies were included if suicidality was reported by at least one equity domain. We extracted simple proportions and risk differences, used vote-counting by direction of effect, and summarized medians across subgroups (gender, gender identity, ethnicity, migration, region, urbanicity). Recent studies indicate lifetime suicidal ideation ~70–85%, suicide attempts ~40–60%, and suicide deaths ~3–10%. Women show higher attempt prevalence than men (≈55% vs 35–45%), whereas men have higher death proportions (≈5–9% vs 3–5%). Sexual and gender minority groups report elevated attempts (≈60–70% vs 40–55% in cisgender groups). Cultural/ethnic minority status and migration are associated with +10–20% attempts and more emergency presentations. Regional comparisons show 20–30% variation in attempt prevalence and differences in methods and service use; urban settings report ~10–20% more emergency presentations than rural. Measurement heterogeneity and under-representation of low- and middle-income regions limit precision; disparities are consistent in direction but vary in magnitude, underscoring the need for standardized, disaggregated reporting and culturally adapted prevention.