Baseline correlates of functional impairment at 12 months in young people with borderline personality disorder: Findings from the MOBY randomised controlled trial 

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Chanen, Holly Andrewes, Katie Nicol, Henry J Jackson, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4410142/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 May, 2025 Read the published version in European Child & Adolescent Psychiatry → Version 1 posted 10 You are reading this latest preprint version Abstract No studies have investigated baseline predictors of improved functioning among young people receiving treatment for BPD. The current study aimed to identify the baseline demographic, psychopathological and treatment correlates of improved functioning at 12 months among young people with BPD, who received early intervention in the Monitoring Outcomes of BPD in Youth (MOBY) randomised controlled trial. Of 139 randomised young people (aged 15 to 25 years) who completed interview and self-report measures at baseline (pre-treatment), 98 (M age = 18.7, SD = 2.7) provided data on the same measures at 12 months (primary endpoint). Adjusting for other demographic, clinical and treatment characteristics, hierarchical regression analyses revealed that better social adjustment at 12 months was predicted by having at least one caregiver engaged in employment at baseline (β = -0.25, p = 0.04, F 2 = 0.41). Higher levels of interpersonal functioning at 12 months were predicted by fewer interpersonal problems (β = 0.41, p = 0.02), fewer co-occurring personality disorder diagnoses (β = -0.31, p = 0.04), and lower BPD severity (β = -0.31, p = 0.04) at baseline ( F 2 = 0.52). These findings suggest that young people presenting with lower severity of BPD, better interpersonal functioning at baseline, and at least one caregiver in employment are more likely to have better functional outcomes following early intervention. The findings did not support suicide attempts and self-harm as predictors of functional outcome. Future research should focus upon individual or household indicators of social disadvantage as moderators of outcome in early intervention for BPD. Psychiatry Youth Adolescence Employment Early Intervention Functioning Introduction Borderline personality disorder (BPD) usually emerges during the developmental period spanning from puberty to emerging adulthood. BPD is associated with significant psychosocial functional impairment that persists long after its diagnostic features have attenuated [ 1 ]. Such impairments in the capacity for adaptive and age appropriate functioning in intimate, social, occupational and educational environments [ 2 , 3 ] emerge early in the course of BPD, during this vulnerable developmental period of transition from childhood to adulthood, and have the potential to interfere further with the acquisition of essential skills for adult role functioning [ 4 ]. Among both community dwelling adolescents [ 5 ] and young people aged 16–24 years with their first presentation to clinical services with BPD [ 6 ], functional problems include fewer and shorter friendships and a higher odds of school or work-related problems [ 5 ], or unemployment [ 6 ], compared with other adolescents or young people with other mental disorders. Among an epidemiological sample of community dwelling 24 year-olds, higher BPD severity has been associated with a higher likelihood of smoking cigarettes, experiencing anxiety or depression, being in receipt of welfare payments, and a lower likelihood of gaining tertiary qualifications [ 7 ]. In support of this latter finding, approximately 40% of young people (aged 15–25 years) recently diagnosed with BPD and presenting for the first time for BPD treatment were found to be disengaged from education, employment and training [ 8 ]. Early intervention aims to prevent or ameliorate these functional impairments, before they become entrenched [ 9 ]. Yet, only four randomised controlled trials (RCTs) of structured psychological interventions (versus active comparators) for young people with BPD have measured psychosocial functioning as an outcome [ 10 – 13 ], and only one of these nominated psychosocial functioning as the primary outcome [ 13 ]. All four RCTs reported slight to moderate improvements in psychosocial functioning, with only one of these finding superiority of the treatment over the comparator [ 11 ]. To the authors’ knowledge, the demographic, clinical, or specific treatment characteristics that might predict improved psychosocial functioning outcomes among this population are still unknown. Addressing this gap might offer insight into the individual characteristics of young people who experience higher levels of psychosocial functioning following treatment. Possible correlates of psychosocial functioning in this age group can only be gleaned from naturalistic prospective studies, which have found that lower BPD criteria scores are associated with fewer functional problems at two- [ 14 ], four- [ 15 ] and twenty-year [ 16 ] follow-up. Furthermore, lower personality disorder severity among a community sample of 24 year-olds ( n = 1443) has been associated with a higher odds of experiencing a long-term relationship at age 35 years, when adjusting for other pre-existing mental health issues, substance or social problems [ 7 ]. Studies among adults with BPD provide limited guidance for selecting potential correlates of psychosocial functioning. Meta-analytic data from naturalistic and treatment research investigating functional outcomes at 5-year follow-up found that being male was correlated with a greater improvement in functioning, while no relationship was found for other demographic characteristics, such as age [ 1 ]. Only four RCTs of treatments for adults with BPD have investigated the individual and treatment characteristics that might correlate with functional outcomes [ 17 – 20 ]. Three of these have focused upon process measures (e.g., emotion dysregulation, post-traumatic stress disorder (PTSD) cognitions and PTSD severity), rather than baseline characteristics [ 17 – 19 ]. Data from an RCT of Systems Training for Emotional Predictability and Problem Solving versus Treatment as Usual ( N = 164) found that baseline global assessment scale (GAS) score was predictive of global functioning at 12-month follow-up, regardless of treatment group [ 20 ]. The current study aimed to investigate baseline correlates of higher psychosocial functioning at 12-month follow-up among young people with ‘first-presentation’ BPD who had received early intervention for BPD. Psychosocial functioning was defined as a young person’s ability to develop and maintain interpersonal relationships and to perform in an age appropriate manner in work, education and social and leisure activities. Given the limited research and heterogeneity of the above findings, this exploratory analysis specifically assessed for inclusion variables found to be associated with improved functional outcomes in longitudinal studies and RCTs among adults with BPD, viz. BPD severity, sex, PTSD diagnoses, emotion dysregulation and global functioning. Method Design The present study involved a secondary analysis of the Monitoring Outcomes of BPD in Youth (MOBY) RCT, details of which have been published elsewhere [ 13 , 21 ]. Briefly, young people with first-presentation BPD were randomised to one of three early intervention treatments for BPD and assessed at baseline and then at 3, 6, 12 and 18 months. The primary outcome, at the 12-month post-randomisation primary endpoint, was psychosocial functioning, which was measured with the Social Adjustment Scale Self-report and the Inventory of Interpersonal Problems Circumplex Version. As treatment group allocation was found not to have a significant effect upon these outcomes [ 13 ], the three treatment groups were combined for the purposes of the current analyses. Participants Ninety-eight participants who had completed the 12-month outcome measures were included in the current study. Upon entry to the study, participants were aged 15 to 25 years, had recently-diagnosed BPD and had never received evidence-based BPD treatment (i.e., first-presentation BPD). Key exclusion criteria were (1) DSM-IV psychotic disorder within the past 12 months; (2) lifetime diagnosis of a schizophrenia spectrum or bipolar I or II disorder; and (3) prior evidence-based treatment for BPD. All participants (and a parent/legal guardian for minors) gave written informed consent. The study was approved by the Melbourne Health Human Research Ethics Committee (HREC2010.055). Measures Interpersonal functioning was measured by the 64-item, self-report Inventory of Interpersonal Problems Circumplex Version [ 22 ]. Scale scores range from 0–264. Social adjustment was assessed with the 54-item, self-report Social Adjustment Scale-Self Report [SAS-SR; 23], which rates functioning over the previous two weeks in three main domains: work, social and leisure activities, and relationships. Demographic variables collected at baseline are listed in Table 1 . Social disadvantage was measured using the Australian Bureau of Statistics Index of Relative Social Disadvantage and was divided into tertiles (Low, Medium, High). DSM diagnoses were derived using the Structured Clinical Interview for DSM-IV Axis I – Patient Edition [SCID-I/P; 24] and SCID-II [ 25 ]. In keeping with previous practice, criterion B for Antisocial personality disorder was ignored for participants aged under 18 years [ 13 ]. BPD severity was derived from the BPD severity index (BPDSI-IV), which assesses for the nine DSM-IV-TR BPD criteria (identical to DSM-5) over the previous 3 months [ 26 ]. Total scores range from 0–90. Emotion regulation was measured via the 36-item, self-report Difficulties in Emotion Regulation Scale [DERS; 27], with higher scores indicating higher levels of emotion dysregulation. Other measures included the 10-item Montgomery–Åsberg Depression Rating Scale [MADRS; 28], the clinician-rated Social and Occupational Functioning Assessment Scale [SOFAS; 29]. The classes and number of substances used over the past month was identified via Opiate Treatment Index [OTI; 30]. The total number and classes of medications was assessed with a questionnaire which identified all medications used by participants at baseline. Client satisfaction with the service was assessed via an 8-item questionnaire [ 31 ]. Satisfaction scores were averaged across all time points (baseline, 3, 6, and 12 months) to provide a final score. A number of other variables were identified but eliminated prior to the final regression analysis due to multicollinearity with other independent variables or insufficient correlation with the dependent variables (see Supplementary Table 1 and statistical analysis section for details). Statistical Analyses Two hierarchical multiple regression models were conducted to determine the symptom, behavioural (measured at baseline) and treatment characteristics (measured across a 12 month period) that predict social adjustment (Block 1; see Table 2 ) or interpersonal functioning (Block 2; see Table 3 ) at 12 months. Demographic characteristics were entered into the model first (Block 1a, 2a), followed by symptom/behavioural characteristics (Block 1b, 2b) and finally treatment characteristics (Block 1c, 2c) to assess whether the addition of each group of variables explained a significant variation in the dependent variable. Preliminary analyses were completed to ensure all assumptions were met. To reduce the number of dependent variables entered into the final models, variables were removed if not feasibly related to the outcome or if there was an insufficient rate of responses (less than 10%), dichotomous variables were removed where similar continuous variables existed, and overlapping numeric variables were recoded into one variable or the least relevant variable was removed. A correlation analysis (Pearsons or Point Biserial) was then completed to identify multicollinearity between independent variables, with duplicate variables removed if their correlation was > 0.7 [ 32 ]. Variables not correlated with the independent variables at a significance level of p < 0.15 were also removed (see Supplementary Table 1). All assumptions relating to hierarchical regression were assessed for each model [ 32 ]. From these models, variance (R²), change in variance (ΔR²) and the F statistic (ΔF) are presented along with the standardised regression values (𝛽) and squared semipartial values (sri 2 ). Cohen’s f 2 was used to identify effect sizes with f 2 ≥ 0.02, f 2 ≥ 0.15, and f 2 ≥ 0.35 representing small, medium, and large effect sizes, respectively [ 33 ]. All statistical analyses were completed using IBM ® SPSS ® Statistics 27. Results Participants Table 1 shows that the majority of participants were female, identified as medium or high social disadvantage status, and had a co-occurring mood or anxiety disorder. They had, on average, two co-occurring mental state disorders and one co-occurring personality disorder, in addition to BPD. The three most commonly co-occurring personality disorders were antisocial (29%), avoidant (26%), paranoid (21%). Table 1 Baseline demographic and clinical characteristics of participants who completed 12 month outcome measures Total sample (N = 98) n (%) Female 78 (79.6) Age, µ (σ) 18.8 (2.7) Social disadvantage rank Low 17 (17.3) Medium 49 (50.0) High 31 (31.6) Stability of accommodation Low 5 (5.1) Medium 26 (26.5) High 66 (67.3) Caregiver completed secondary education 38 (38.8) Achieved age-appropriate secondary school 63 (64.3) Parent(s) born in Australia 40 (40.8) English as main language spoken at home 94 (95.9) Not living with a biological parent 64 (65.3) In a relationship 38 (38.8) Children 5 (5.1) Current mental state diagnoses Number, µ (σ) 2.5 (1.4) Any mood disorder 80 (81.6) Any anxiety disorder a 73 (74.5) Any eating disorder 4 (4.1) Any somatoform disorder 7 (7.1) Post-traumatic stress disorder 31 (31.6) Current personality disorder diagnoses Number, including BPD, µ (σ) 2.3 (1.4) Note. NEET , not in education, employment or training; SOFAS Social and Occupational Functioning Assessment Scale. BPD Borderline Personality Disorder; a Excludes specific phobia and post-traumatic stress disorder. Hierarchical regression model 1: predictors of social adjustment at 12 months. The full model of demographic, symptom and behavioural and treatment characteristics to predict social adjustment at 12 months (SAS-SR) was statistically significant at p = 0.008, with a large effect size F 2 = 0.412 (see Table 3 ). After adjusting for demographic variables, symptom and behavioural characteristics, having at least one caregiver in employment at baseline was the only variable to predict less severe difficulties in social adjustment at 12 months. Having at least one caregiver in employment was the strongest predictor, uniquely contributing 6.0% of the variance in social adjustment at 12 months (see Table 2 ). Hierarchical regression model 2: predictors of interpersonal functioning at 12 months. The full model of demographic, symptom and behavioural and treatment characteristics predicting interpersonal functioning (IIP-C) at 12 months was statistically significant at p = 0.004 with a large effect size F 2 = 0.522 (see Table 3 ). An assessment of coefficients showed that, after adjusting for demographic variables, symptom and behavioural characteristics, higher ratings of interpersonal functioning, lower ratings of BPD severity and a lower number of personality disorder diagnoses at baseline predicted less severe interpersonal problems at 12 months. BPD severity was the strongest predictor, uniquely contributing 8.0% of the variance, followed by baseline values of interpersonal function which uniquely contributed 7.0% of the variance, followed by the number of personality disorders at baseline which uniquely contributed 6.0% of the variance in interpersonal problems at 12 months (see Table 3 ). Table 2 Model 1. Hierarchical Multiple Regression Model predicting social adjustment from demographic, symptom and behavioural, and treatment characteristics Social Adjustment/Role Function Block 1a Block 1b Block 1c Block 1d Variables (at Baseline) sr i 2 β sr i 2 β sr i 2 β sr i 2 β SAS-SR at Baseline 0.12 0.35*** 0.12 0.36*** 0.03 0.22 0.02 0.18 In relationship (Y/N) 0.06 -0.27* 0.05 -0.25* 0.03 -0.21 Social disadvantage status 0.02 0.15 0.04 0.21 0.04 0.21 Caregiver working (Y/N) 0.06 -0.25* 0.06 -0.26* 0.06 -0.25* NEET (Y/N) 0.01 -0.10 0.01 -0.11 0.01 -0.13 Number of PD 0.01 -0.13 0.01 -0.13 BPDSI 0.01 0.15 0.01 0.15 SOFAS 0.02 -0.19 0.03 -0.21 Number of Medications 0.01 0.12 0.02 0.14 Working Alliance Inventory 0.01 -0.13 R 2 0.12 0.29 0.33 0.34 F 8.68*** 4.70*** 2.94** 2.77** ΔR 2 0.12 0.17 0.04 0.01 ΔF 8.68*** 3.37** 0.82 1.14 Note. NEET Not in education, employment or training; PD = Personality disorders; BPDSI Borderline Personality Disorder Severity index; SOFAS Social and Occupational Functioning Assessment Scale. *p < 0.05, **p < = 0.01, ***p < 0.005 Table 3 Model 2. Hierarchical Multiple Regression Model predicting interpersonal problems from demographic, symptom and behavioural and treatment characteristics Interpersonal Functioning Block 2a Block 2b Block 2c Block 2d Variables (at Baseline) sr i 2 β sr i 2 β sr i 2 β sr i 2 β Interpersonal Functioning at Baseline 0.14 0.38** 0.14 0.39** 0.08 0.42* 0.07 0.41* In relationship (Y/N) 0.06 -0.25 0.04 -0.24 0.04 -0.22 Highest education reached by caregiver 0.03 0.17 0.02 0.15 0.02 0.14 Number of MSD 0.05 0.29 0.05 0.30 Number of PD 0.06 -0.32* 0.06 -0.31* BPDSI 0.08 0.38* 0.08 0.39* MADRS 0.01 -0.10 0.01 -0.14 DERS 0.04 -0.31 0.04 -0.31 SOFAS 0.04 -0.25 0.04 -0.25 Number of substances 0.01 0.10 0.01 0.08 Number of medications 0.02 0.15 0.02 0.16 Working Alliance Inventory 0.01 -0.10 R 2 0.14 0.21 0.43 0.44 F 9.22*** 4.70** 3.20*** 2.96*** ΔR 2 0.14 0.07 0.23 0.01 ΔF 9.22*** 2.24 2.30* 0.58 Note. MSD Mental State Disorder; PD Personality disorders; BPD Borderline Personality Disorder; MADRS Montgomery–Åsberg Depression Rating Scale; BPD-SI Borderline Personality Disorder Severity index; DERS Difficulties in Emotion Regulation Scale; SOFAS Social and Occupational Functioning Assessment Scale. *p < 0.05, **p < = 0.01, ***p < 0.005 Discussion This is the first study to investigate the baseline demographic, clinical, and treatment characteristics that predict improved functioning at 12-month follow up among young people receiving early intervention for BPD. Three main findings emerged from this study. First, having at least one caregiver in employment at baseline uniquely predicted better social adjustment at 12 months. Second, each of lower BPD severity, fewer co-occurring personality disorder diagnoses, and fewer interpersonal problems at baseline uniquely predicted fewer interpersonal problems at 12 months. Third, suicide attempts (SA) and non-suicidal self-injury (NSSI) over the previous 12 months did not seem to be influential upon functional outcomes and were not included in the final model. While better overall social adjustment (including occupational, leisure, social and relationships) at 12 months was uniquely predicted by having at least one caregiver in employment, it is noteworthy that this was not predicted by commonly used selection criteria for clinical service provision, i.e., general indicators of clinical severity, or the level of social adjustment. This supports findings from a large epidemiological study (N = 2281), which found that the lower levels of exposure to parental joblessness during childhood was associated with improved wage outcomes in early adulthood, even after adjusting for demographic and socioeconomic factors [ 34 ]. Although these findings are associations, two mechanisms might explain how caregiver employment might lead to improved long-term occupational functioning in their offspring. First, the ‘resource-based framework’ [ 35 ] suggests that parental employment increases a caregiver’s ability to gain access to resources that might be beneficial to the child’s development, including food, housing, and the capacity to invest in early educational environments conducive to growth and learning. In turn, this might enhance the formation of skills required for future labour force attachment [ 36 ]. Second, the ‘socialisation framework’ [ 37 ] suggests that the presence of work role models and positive parental attitudes toward employment might increase a child’s self-efficacy and motivation for employment [ 38 ]. The current findings highlight the importance of further research designed to investigate the potential roles of caregiver educational and occupational attainment in treatment outcome. The baseline characteristics that predict fewer interpersonal problems at 12 months (BPD severity, number of co-occurring PD diagnoses, severity of interpersonal problems) fall under the rubric of indicators of PD severity. The finding that lower BPD severity at baseline uniquely predicted fewer interpersonal problems following treatment is supported by previous epidemiological research showing that children and adolescents from the community with lower levels of BPD severity experienced improved peer relationships at two, four, nine and twenty year follow-up [ 14 – 16 , 39 ]. These findings are also supported by a cross-sectional study of adolescents (N = 177; aged 15–18 years) receiving outpatient treatment for BPD, which found that poorer peer relationships were predicted by a diagnosis of a PD (BPD or other PD), when adjusting for disruptive behaviour disorders, mood disorders, substance use disorders and anxiety disorders [ 40 ]. The finding that SA and NSSI over the previous 12 months do not seem to be influential in 12-month functional outcomes reinforces the case to reconsider entry criteria for early intervention treatment programs. In many clinical settings, recent SA and NSSI garner much of the short-term focus of care and are highly influential in clinical decision-making, especially with regard to offering treatment [ 41 ]. Evidence supports SA and NSSI as a population level transdiagnostic marker of psychopathology and suicide risk among young people [ 42 ]. However, the current finding adds weight to the argument that, among clinical populations, where SA and NSSI are ubiquitous [99% lifetime history among the MOBY sample; 43], and have limited utility as a test for later suicide because of their modest sensitivity and low positive predictive value [ 44 , 45 ], SA and NSSI should not exert disproportionate influence upon who is selected for treatment. Strengths and Limitations This is the first study to investigate predictors of functional outcomes among young people receiving early intervention for BPD. Strengths of this study include the intentional recruitment of a ‘real-world’ sample of young people, typical of frontline clinical services, who had never received a diagnosis of or specialised treatment for BPD. Also, the methodological process of eliminating variables prior to the final regression analysis, along with the relatively large sample size, meant that a large number of predictor variables could be examined, without compromising the power of the study. Despite the large number of variables measured, there remains a substantial amount of unexplained variance, suggesting that there might be important variables not usually measured in clinical trials for personality disorder that might influence functional outcomes. Limitations include that the method for defining social disadvantage rank was based upon postcode, rather than individual or household variables. It is possible that the relationship between having at least one caregiver in employment and better functional outcomes might be explained by other individual or household indicators of social disadvantage. It is also possible that participants with poor outcomes are under-represented at the 12-month time point, as the presence and number of mental disorders at follow-up, rather than baseline, has been found to be significantly associated with follow-up contact difficulty in longitudinal studies among young people [ 46 ]. Conclusions There were few baseline predictors of outcome identified in this clinical trial of early intervention for young people with first-presentation BPD. Of those that were identified, perhaps unsurprisingly, young people who presented with indicators of lower BPD severity were more likely to have better interpersonal functioning at 12-month outcome. The finding in regard to caregiver employment and better social adjustment suggests that future research should focus upon individual or household indicators of social disadvantage as moderators of outcome in early intervention for BPD. Finally, the lack of support for commonly used selection criteria for clinical service provision as predictors of functional outcome suggests the need for a reconsideration of these criteria and further studies to guide appropriate resource allocation. Declarations Acknowledgements The authors would like to acknowledge the clinicians, young people and their families involved in this study. Competing interests The author(s) declare no competing interests. Data availability Data supporting results is available upon request to the corresponding author. 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Dialogues Clin Neurosci 20:197–205 Allott K, Chanen AM, Yuen HP (2006) Attrition bias in longitudinal research involving adolescent psychiatric outpatients. J Nerv Ment Dis 194:958–961 Linehan MM, Comtois KA, Brown MZ, Heard HL, Wagner A (2006) Suicide attempt self-injury interview (SASII): Development, reliability, and validity of a scale to assess suicide attempts and intentional self-injury. Psychol Assess 18:303–312 Horvath AO, Greenberg LS (1989) Development and validation of the Working Alliance Inventory. J Couns Psychol 36:223–233 Additional Declarations No competing interests reported. Supplementary Files SupplementaryTable1.docx Cite Share Download PDF Status: Published Journal Publication published 28 May, 2025 Read the published version in European Child & Adolescent Psychiatry → Version 1 posted Editorial decision: Revision requested 24 Oct, 2024 Reviews received at journal 24 Oct, 2024 Reviewers agreed at journal 01 Oct, 2024 Reviews received at journal 10 Jul, 2024 Reviewers agreed at journal 09 Jun, 2024 Reviewers agreed at journal 05 Jun, 2024 Reviewers invited by journal 05 Jun, 2024 Submission checks completed at journal 13 May, 2024 Editor assigned by journal 13 May, 2024 First submitted to journal 12 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4410142","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":307756123,"identity":"0bf77239-0c41-4ba8-995a-cd1c0ad4d36e","order_by":0,"name":"Andrew M. Chanen","email":"data:image/png;base64,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","orcid":"","institution":"Orygen Youth Health","correspondingAuthor":true,"prefix":"","firstName":"Andrew","middleName":"M.","lastName":"Chanen","suffix":""},{"id":307756126,"identity":"36579cd2-6235-47fd-ac1a-98e2b1041c89","order_by":1,"name":"Holly Andrewes","email":"","orcid":"","institution":"Orygen Youth Health","correspondingAuthor":false,"prefix":"","firstName":"Holly","middleName":"","lastName":"Andrewes","suffix":""},{"id":307756127,"identity":"c8caa12e-b9ab-4554-8766-d472c8cc09a0","order_by":2,"name":"Katie Nicol","email":"","orcid":"","institution":"Orygen Youth Health","correspondingAuthor":false,"prefix":"","firstName":"Katie","middleName":"","lastName":"Nicol","suffix":""},{"id":307756131,"identity":"afa0fa4d-f4b3-4e01-9cc2-951e1e0b5f5b","order_by":3,"name":"Henry J Jackson","email":"","orcid":"","institution":"University of Melbourne","correspondingAuthor":false,"prefix":"","firstName":"Henry","middleName":"J","lastName":"Jackson","suffix":""},{"id":307756134,"identity":"b56f19c5-7db5-4942-a77b-b3a34307ae72","order_by":4,"name":"Sue M Cotton","email":"","orcid":"","institution":"Orygen Youth Health","correspondingAuthor":false,"prefix":"","firstName":"Sue","middleName":"M","lastName":"Cotton","suffix":""},{"id":307756135,"identity":"8176babc-2564-4370-a14f-d0ec637b10e0","order_by":5,"name":"John Gleeson","email":"","orcid":"","institution":"Australian Catholic University","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"","lastName":"Gleeson","suffix":""},{"id":307756137,"identity":"2f4eec19-8346-4655-8b93-5f26afa53003","order_by":6,"name":"Christopher G Davey","email":"","orcid":"","institution":"Orygen Youth Health","correspondingAuthor":false,"prefix":"","firstName":"Christopher","middleName":"G","lastName":"Davey","suffix":""},{"id":307756138,"identity":"544560f0-0871-4968-993f-2bb5e3ab92b8","order_by":7,"name":"Louise McCutcheon","email":"","orcid":"","institution":"Orygen Youth Health","correspondingAuthor":false,"prefix":"","firstName":"Louise","middleName":"","lastName":"McCutcheon","suffix":""},{"id":307756139,"identity":"f3ab1f09-71d6-4897-b334-72a76b0f5058","order_by":8,"name":"Sharnel Perera","email":"","orcid":"","institution":"Orygen Youth Health","correspondingAuthor":false,"prefix":"","firstName":"Sharnel","middleName":"","lastName":"Perera","suffix":""},{"id":307756141,"identity":"ce39283e-3c39-4196-b712-5ffcccab469a","order_by":9,"name":"Victoria Rayner","email":"","orcid":"","institution":"Orygen Youth Health","correspondingAuthor":false,"prefix":"","firstName":"Victoria","middleName":"","lastName":"Rayner","suffix":""},{"id":307756142,"identity":"db5116ce-fd47-495a-b88a-0e757652a549","order_by":10,"name":"Jennifer K Betts","email":"","orcid":"","institution":"Orygen Youth Health","correspondingAuthor":false,"prefix":"","firstName":"Jennifer","middleName":"K","lastName":"Betts","suffix":""}],"badges":[],"createdAt":"2024-05-13 01:59:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4410142/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4410142/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00787-025-02742-5","type":"published","date":"2025-05-28T15:57:33+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":83782897,"identity":"27eae58b-3c8e-4c01-accb-fd928899775f","added_by":"auto","created_at":"2025-06-02 16:08:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":824088,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4410142/v1/ed19bcbf-08d9-4341-b2ee-a197bcace375.pdf"},{"id":57392618,"identity":"89faacbd-4450-4864-89d8-3a36b7cedcfa","added_by":"auto","created_at":"2024-05-30 06:11:51","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21193,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryTable1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4410142/v1/aa445e336eb94c0b838669dd.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Baseline correlates of functional impairment at 12 months in young people with borderline personality disorder: Findings from the MOBY randomised controlled trial ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBorderline personality disorder (BPD) usually emerges during the developmental period spanning from puberty to emerging adulthood. BPD is associated with significant psychosocial functional impairment that persists long after its diagnostic features have attenuated [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Such impairments in the capacity for adaptive and age appropriate functioning in intimate, social, occupational and educational environments [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] emerge early in the course of BPD, during this vulnerable developmental period of transition from childhood to adulthood, and have the potential to interfere further with the acquisition of essential skills for adult role functioning [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAmong both community dwelling adolescents [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] and young people aged 16\u0026ndash;24 years with their first presentation to clinical services with BPD [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], functional problems include fewer and shorter friendships and a higher odds of school or work-related problems [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], or unemployment [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], compared with other adolescents or young people with other mental disorders. Among an epidemiological sample of community dwelling 24 year-olds, higher BPD severity has been associated with a higher likelihood of smoking cigarettes, experiencing anxiety or depression, being in receipt of welfare payments, and a lower likelihood of gaining tertiary qualifications [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In support of this latter finding, approximately 40% of young people (aged 15\u0026ndash;25 years) recently diagnosed with BPD and presenting for the first time for BPD treatment were found to be disengaged from education, employment and training [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEarly intervention aims to prevent or ameliorate these functional impairments, before they become entrenched [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Yet, only four randomised controlled trials (RCTs) of structured psychological interventions (versus active comparators) for young people with BPD have measured psychosocial functioning as an outcome [\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], and only one of these nominated psychosocial functioning as the primary outcome [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. All four RCTs reported slight to moderate improvements in psychosocial functioning, with only one of these finding superiority of the treatment over the comparator [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo the authors\u0026rsquo; knowledge, the demographic, clinical, or specific treatment characteristics that might predict improved psychosocial functioning outcomes among this population are still unknown. Addressing this gap might offer insight into the individual characteristics of young people who experience higher levels of psychosocial functioning following treatment. Possible correlates of psychosocial functioning in this age group can only be gleaned from naturalistic prospective studies, which have found that lower BPD criteria scores are associated with fewer functional problems at two- [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], four- [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] and twenty-year [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] follow-up. Furthermore, lower personality disorder severity among a community sample of 24 year-olds (\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1443) has been associated with a higher odds of experiencing a long-term relationship at age 35 years, when adjusting for other pre-existing mental health issues, substance or social problems [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStudies among adults with BPD provide limited guidance for selecting potential correlates of psychosocial functioning. Meta-analytic data from naturalistic and treatment research investigating functional outcomes at 5-year follow-up found that being male was correlated with a greater improvement in functioning, while no relationship was found for other demographic characteristics, such as age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Only four RCTs of treatments for adults with BPD have investigated the individual and treatment characteristics that might correlate with functional outcomes [\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Three of these have focused upon process measures (e.g., emotion dysregulation, post-traumatic stress disorder (PTSD) cognitions and PTSD severity), rather than baseline characteristics [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Data from an RCT of Systems Training for Emotional Predictability and Problem Solving versus Treatment as Usual (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;164) found that baseline global assessment scale (GAS) score was predictive of global functioning at 12-month follow-up, regardless of treatment group [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe current study aimed to investigate baseline correlates of higher psychosocial functioning at 12-month follow-up among young people with \u0026lsquo;first-presentation\u0026rsquo; BPD who had received early intervention for BPD. Psychosocial functioning was defined as a young person\u0026rsquo;s ability to develop and maintain interpersonal relationships and to perform in an age appropriate manner in work, education and social and leisure activities. Given the limited research and heterogeneity of the above findings, this exploratory analysis specifically assessed for inclusion variables found to be associated with improved functional outcomes in longitudinal studies and RCTs among adults with BPD, \u003cem\u003eviz.\u003c/em\u003e BPD severity, sex, PTSD diagnoses, emotion dysregulation and global functioning.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDesign\u003c/h2\u003e \u003cp\u003eThe present study involved a secondary analysis of the Monitoring Outcomes of BPD in Youth (MOBY) RCT, details of which have been published elsewhere [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Briefly, young people with first-presentation BPD were randomised to one of three early intervention treatments for BPD and assessed at baseline and then at 3, 6, 12 and 18 months. The primary outcome, at the 12-month post-randomisation primary endpoint, was psychosocial functioning, which was measured with the Social Adjustment Scale Self-report and the Inventory of Interpersonal Problems Circumplex Version. As treatment group allocation was found not to have a significant effect upon these outcomes [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], the three treatment groups were combined for the purposes of the current analyses.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eNinety-eight participants who had completed the 12-month outcome measures were included in the current study. Upon entry to the study, participants were aged 15 to 25 years, had recently-diagnosed BPD and had never received evidence-based BPD treatment (i.e., first-presentation BPD).\u003c/p\u003e \u003cp\u003eKey exclusion criteria were (1) DSM-IV psychotic disorder within the past 12 months; (2) lifetime diagnosis of a schizophrenia spectrum or bipolar I or II disorder; and (3) prior evidence-based treatment for BPD. All participants (and a parent/legal guardian for minors) gave written informed consent. The study was approved by the Melbourne Health Human Research Ethics Committee (HREC2010.055).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eMeasures\u003c/h2\u003e \u003cp\u003eInterpersonal functioning was measured by the 64-item, self-report Inventory of Interpersonal Problems Circumplex Version [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Scale scores range from 0\u0026ndash;264. Social adjustment was assessed with the 54-item, self-report Social Adjustment Scale-Self Report [SAS-SR; 23], which rates functioning over the previous two weeks in three main domains: work, social and leisure activities, and relationships.\u003c/p\u003e \u003cp\u003eDemographic variables collected at baseline are listed in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Social disadvantage was measured using the Australian Bureau of Statistics Index of Relative Social Disadvantage and was divided into tertiles (Low, Medium, High).\u003c/p\u003e \u003cp\u003eDSM diagnoses were derived using the Structured Clinical Interview for DSM-IV Axis I \u0026ndash; Patient Edition [SCID-I/P; 24] and SCID-II [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In keeping with previous practice, criterion B for Antisocial personality disorder was ignored for participants aged under 18 years [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBPD severity was derived from the BPD severity index (BPDSI-IV), which assesses for the nine DSM-IV-TR BPD criteria (identical to DSM-5) over the previous 3 months [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Total scores range from 0\u0026ndash;90.\u003c/p\u003e \u003cp\u003eEmotion regulation was measured via the 36-item, self-report Difficulties in Emotion Regulation Scale [DERS; 27], with higher scores indicating higher levels of emotion dysregulation.\u003c/p\u003e \u003cp\u003eOther measures included the 10-item Montgomery\u0026ndash;\u0026Aring;sberg Depression Rating Scale [MADRS; 28], the clinician-rated Social and Occupational Functioning Assessment Scale [SOFAS; 29]. The classes and number of substances used over the past month was identified via Opiate Treatment Index [OTI; 30]. The total number and classes of medications was assessed with a questionnaire which identified all medications used by participants at baseline. Client satisfaction with the service was assessed via an 8-item questionnaire [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Satisfaction scores were averaged across all time points (baseline, 3, 6, and 12 months) to provide a final score.\u003c/p\u003e \u003cp\u003eA number of other variables were identified but eliminated prior to the final regression analysis due to multicollinearity with other independent variables or insufficient correlation with the dependent variables (see Supplementary Table\u0026nbsp;1 and statistical analysis section for details).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analyses\u003c/h2\u003e \u003cp\u003eTwo hierarchical multiple regression models were conducted to determine the symptom, behavioural (measured at baseline) and treatment characteristics (measured across a 12 month period) that predict social adjustment (Block 1; see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) or interpersonal functioning (Block 2; see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) at 12 months. Demographic characteristics were entered into the model first (Block 1a, 2a), followed by symptom/behavioural characteristics (Block 1b, 2b) and finally treatment characteristics (Block 1c, 2c) to assess whether the addition of each group of variables explained a significant variation in the dependent variable. Preliminary analyses were completed to ensure all assumptions were met.\u003c/p\u003e \u003cp\u003eTo reduce the number of dependent variables entered into the final models, variables were removed if not feasibly related to the outcome or if there was an insufficient rate of responses (less than 10%), dichotomous variables were removed where similar continuous variables existed, and overlapping numeric variables were recoded into one variable or the least relevant variable was removed. A correlation analysis (Pearsons or Point Biserial) was then completed to identify multicollinearity between independent variables, with duplicate variables removed if their correlation was \u0026gt;\u0026thinsp;0.7 [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Variables not correlated with the independent variables at a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.15 were also removed (see Supplementary Table\u0026nbsp;1). All assumptions relating to hierarchical regression were assessed for each model [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. From these models, variance (R\u0026sup2;), change in variance (ΔR\u0026sup2;) and the F statistic (ΔF) are presented along with the standardised regression values (\u0026#120573;) and squared semipartial values (sri\u003csup\u003e2\u003c/sup\u003e). Cohen\u0026rsquo;s f\u003csup\u003e2\u003c/sup\u003e was used to identify effect sizes with f\u003csup\u003e2\u003c/sup\u003e \u0026ge; 0.02, f\u003csup\u003e2\u003c/sup\u003e \u0026ge; 0.15, and f\u003csup\u003e2\u003c/sup\u003e \u0026ge; 0.35 representing small, medium, and large effect sizes, respectively [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. All statistical analyses were completed using IBM\u003csup\u003e\u0026reg;\u003c/sup\u003e SPSS\u003csup\u003e\u0026reg;\u003c/sup\u003e Statistics 27.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows that the majority of participants were female, identified as medium or high social disadvantage status, and had a co-occurring mood or anxiety disorder. They had, on average, two co-occurring mental state disorders and one co-occurring personality disorder, in addition to BPD. The three most commonly co-occurring personality disorders were antisocial (29%), avoidant (26%), paranoid (21%).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline demographic and clinical characteristics of participants who completed 12 month outcome measures\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eTotal sample (N\u0026thinsp;=\u0026thinsp;98)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e78 (79.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge,\u0026nbsp; \u003cem\u003e\u0026micro;\u003c/em\u003e(σ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e18.8 (2.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial disadvantage rank\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (17.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (31.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStability of accommodation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e5 (5.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e26 (26.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e66 (67.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaregiver completed secondary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e38 (38.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAchieved age-appropriate secondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e63 (64.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParent(s) born in Australia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e40 (40.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEnglish as main language spoken at home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e94 (95.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot living with a biological parent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e64 (65.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn a relationship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e38 (38.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChildren\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e5 (5.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent mental state diagnoses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber,\u0026nbsp; \u003cem\u003e\u0026micro;\u003c/em\u003e(σ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2.5 (1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny mood disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e80 (81.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny anxiety disorder\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e73 (74.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny eating disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e4 (4.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny somatoform disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e7 (7.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-traumatic stress disorder\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e31 (31.6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eCurrent personality disorder diagnoses\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber, including BPD, \u003cem\u003e\u0026micro;\u003c/em\u003e(σ)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e2.3 (1.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNote. NEET\u003c/em\u003e, not in education, employment or training; \u003cem\u003eSOFAS\u003c/em\u003e Social and Occupational Functioning Assessment Scale. \u003cem\u003eBPD\u003c/em\u003e Borderline Personality Disorder; \u003csup\u003ea\u003c/sup\u003eExcludes specific phobia and post-traumatic stress disorder.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eHierarchical regression model 1: predictors of social adjustment at 12 months.\u003c/b\u003e The full model of demographic, symptom and behavioural and treatment characteristics to predict social adjustment at 12 months (SAS-SR) was statistically significant at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.008, with a large effect size \u003cem\u003eF\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.412 (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). After adjusting for demographic variables, symptom and behavioural characteristics, having at least one caregiver in employment at baseline was the only variable to predict less severe difficulties in social adjustment at 12 months. Having at least one caregiver in employment was the strongest predictor, uniquely contributing 6.0% of the variance in social adjustment at 12 months (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e\u003cb\u003eHierarchical regression model 2: predictors of interpersonal functioning at 12 months.\u003c/b\u003e The full model of demographic, symptom and behavioural and treatment characteristics predicting interpersonal functioning (IIP-C) at 12 months was statistically significant at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.004 with a large effect size \u003cem\u003eF\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.522 (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). An assessment of coefficients showed that, after adjusting for demographic variables, symptom and behavioural characteristics, higher ratings of interpersonal functioning, lower ratings of BPD severity and a lower number of personality disorder diagnoses at baseline predicted less severe interpersonal problems at 12 months. BPD severity was the strongest predictor, uniquely contributing 8.0% of the variance, followed by baseline values of interpersonal function which uniquely contributed 7.0% of the variance, followed by the number of personality disorders at baseline which uniquely contributed 6.0% of the variance in interpersonal problems at 12 months (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eModel 1. Hierarchical Multiple Regression Model predicting social adjustment from demographic, symptom and behavioural, and treatment characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003eSocial Adjustment/Role Function\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBlock 1a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eBlock 1b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eBlock 1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eBlock 1d\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003cp\u003e(at Baseline)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esr\u003csub\u003ei\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003esr\u003csub\u003ei\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003esr\u003csub\u003ei\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esr\u003csub\u003ei\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSAS-SR at Baseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.35***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.36***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn relationship (Y/N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.27*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.25*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial disadvantage status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaregiver working (Y/N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.25*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.26*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.25*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNEET (Y/N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of PD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBPDSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSOFAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.21\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of Medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking Alliance Inventory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.68***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.70***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.94**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.77**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eΔR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eΔF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.68***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.37**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003e\u003cem\u003eNote. NEET\u003c/em\u003e Not in education, employment or training; \u003cem\u003ePD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;Personality disorders; \u003cem\u003eBPDSI\u003c/em\u003e Borderline Personality Disorder Severity index; \u003cem\u003eSOFAS\u003c/em\u003e Social and Occupational Functioning Assessment Scale. *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;=\u0026thinsp;0.01, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.005\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eModel 2. Hierarchical Multiple Regression Model predicting interpersonal problems from demographic, symptom and behavioural and treatment characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003eInterpersonal Functioning\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eBlock 2a\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eBlock 2b\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003eBlock 2c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003eBlock 2d\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables (at Baseline)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003esr\u003csub\u003ei\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003esr\u003csub\u003ei\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003esr\u003csub\u003ei\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003esr\u003csub\u003ei\u003c/sub\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInterpersonal Functioning at Baseline\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.38**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.39**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.42*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.41*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn relationship (Y/N)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHighest education reached by caregiver\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of MSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of PD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.32*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.31*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBPDSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.38*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.39*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMADRS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDERS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSOFAS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.25\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of substances\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of medications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorking Alliance Inventory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e-0.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.22***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.70**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.20***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e2.96***\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eΔR\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eΔF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.22***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.30*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eNote. MSD\u003c/em\u003e Mental State Disorder; \u003cem\u003ePD\u003c/em\u003e Personality disorders; \u003cem\u003eBPD\u003c/em\u003e Borderline Personality Disorder; \u003cem\u003eMADRS\u003c/em\u003e Montgomery\u0026ndash;\u0026Aring;sberg Depression Rating Scale; \u003cem\u003eBPD-SI\u003c/em\u003e Borderline Personality Disorder Severity index; \u003cem\u003eDERS\u003c/em\u003e Difficulties in Emotion Regulation Scale; \u003cem\u003eSOFAS\u003c/em\u003e Social and Occupational Functioning Assessment Scale. *p\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **p\u0026thinsp;\u0026lt;\u0026thinsp;=\u0026thinsp;0.01, ***p\u0026thinsp;\u0026lt;\u0026thinsp;0.005\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is the first study to investigate the baseline demographic, clinical, and treatment characteristics that predict improved functioning at 12-month follow up among young people receiving early intervention for BPD. Three main findings emerged from this study. First, having at least one caregiver in employment at baseline uniquely predicted better social adjustment at 12 months. Second, each of lower BPD severity, fewer co-occurring personality disorder diagnoses, and fewer interpersonal problems at baseline uniquely predicted fewer interpersonal problems at 12 months. Third, suicide attempts (SA) and non-suicidal self-injury (NSSI) over the previous 12 months did not seem to be influential upon functional outcomes and were not included in the final model.\u003c/p\u003e \u003cp\u003eWhile better overall social adjustment (including occupational, leisure, social and relationships) at 12 months was uniquely predicted by having at least one caregiver in employment, it is noteworthy that this was not predicted by commonly used selection criteria for clinical service provision, i.e., general indicators of clinical severity, or the level of social adjustment. This supports findings from a large epidemiological study (N\u0026thinsp;=\u0026thinsp;2281), which found that the lower levels of exposure to parental joblessness during childhood was associated with improved wage outcomes in early adulthood, even after adjusting for demographic and socioeconomic factors [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Although these findings are associations, two mechanisms might explain how caregiver employment might lead to improved long-term occupational functioning in their offspring. First, the \u0026lsquo;resource-based framework\u0026rsquo; [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] suggests that parental employment increases a caregiver\u0026rsquo;s ability to gain access to resources that might be beneficial to the child\u0026rsquo;s development, including food, housing, and the capacity to invest in early educational environments conducive to growth and learning. In turn, this might enhance the formation of skills required for future labour force attachment [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Second, the \u0026lsquo;socialisation framework\u0026rsquo; [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] suggests that the presence of work role models and positive parental attitudes toward employment might increase a child\u0026rsquo;s self-efficacy and motivation for employment [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. The current findings highlight the importance of further research designed to investigate the potential roles of caregiver educational and occupational attainment in treatment outcome.\u003c/p\u003e \u003cp\u003eThe baseline characteristics that predict fewer interpersonal problems at 12 months (BPD severity, number of co-occurring PD diagnoses, severity of interpersonal problems) fall under the rubric of indicators of PD severity. The finding that lower BPD severity at baseline uniquely predicted fewer interpersonal problems following treatment is supported by previous epidemiological research showing that children and adolescents from the community with lower levels of BPD severity experienced improved peer relationships at two, four, nine and twenty year follow-up [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. These findings are also supported by a cross-sectional study of adolescents (N\u0026thinsp;=\u0026thinsp;177; aged 15\u0026ndash;18 years) receiving outpatient treatment for BPD, which found that poorer peer relationships were predicted by a diagnosis of a PD (BPD or other PD), when adjusting for disruptive behaviour disorders, mood disorders, substance use disorders and anxiety disorders [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe finding that SA and NSSI over the previous 12 months do not seem to be influential in 12-month functional outcomes reinforces the case to reconsider entry criteria for early intervention treatment programs. In many clinical settings, recent SA and NSSI garner much of the short-term focus of care and are highly influential in clinical decision-making, especially with regard to offering treatment [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Evidence supports SA and NSSI as a population level transdiagnostic marker of psychopathology and suicide risk among young people [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. However, the current finding adds weight to the argument that, among clinical populations, where SA and NSSI are ubiquitous [99% lifetime history among the MOBY sample; 43], and have limited utility as a test for later suicide because of their modest sensitivity and low positive predictive value [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e], SA and NSSI should not exert disproportionate influence upon who is selected for treatment.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThis is the first study to investigate predictors of functional outcomes among young people receiving early intervention for BPD. Strengths of this study include the intentional recruitment of a \u0026lsquo;real-world\u0026rsquo; sample of young people, typical of frontline clinical services, who had never received a diagnosis of or specialised treatment for BPD. Also, the methodological process of eliminating variables prior to the final regression analysis, along with the relatively large sample size, meant that a large number of predictor variables could be examined, without compromising the power of the study. Despite the large number of variables measured, there remains a substantial amount of unexplained variance, suggesting that there might be important variables not usually measured in clinical trials for personality disorder that might influence functional outcomes.\u003c/p\u003e \u003cp\u003eLimitations include that the method for defining social disadvantage rank was based upon postcode, rather than individual or household variables. It is possible that the relationship between having at least one caregiver in employment and better functional outcomes might be explained by other individual or household indicators of social disadvantage. It is also possible that participants with poor outcomes are under-represented at the 12-month time point, as the presence and number of mental disorders at follow-up, rather than baseline, has been found to be significantly associated with follow-up contact difficulty in longitudinal studies among young people [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThere were few baseline predictors of outcome identified in this clinical trial of early intervention for young people with first-presentation BPD. Of those that were identified, perhaps unsurprisingly, young people who presented with indicators of lower BPD severity were more likely to have better interpersonal functioning at 12-month outcome. The finding in regard to caregiver employment and better social adjustment suggests that future research should focus upon individual or household indicators of social disadvantage as moderators of outcome in early intervention for BPD. Finally, the lack of support for commonly used selection criteria for clinical service provision as predictors of functional outcome suggests the need for a reconsideration of these criteria and further studies to guide appropriate resource allocation.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe authors would like to acknowledge the clinicians, young people and their families involved in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe author(s) declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData supporting results is available upon request to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors made substantial contributions to either the conception, design, collection of data, analysis or interpretation of data. All authors were involved in drafting the manuscript and approved the final version. A.C, H.J, L.M, J.B, and J.G were involved in the conception and design of project. S.P, V.R and J.B made substantial contributions to the collection of data. A.C, H.A, J.B and K.N wrote the main manuscript text. H.A completed the data analysis with support from S.C and prepared all tables. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e\u0026Aacute;lvarez-Tom\u0026aacute;s I, Ruiz J, Guilera G, Bados A (2019) Long-term clinical and functional course of borderline personality disorder: A meta-analysis of prospective studies. Eur Psychiatry 56:75\u0026ndash;83\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRo E, Clark LA (2009) Psychosocial functioning in the context of diagnosis: assessment and theoretical issues. 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J Couns Psychol 36:223\u0026ndash;233\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"european-child-and-adolescent-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ecap","sideBox":"Learn more about [European Child \u0026 Adolescent Psychiatry](http://link.springer.com/journal/787)","snPcode":"787","submissionUrl":"https://submission.nature.com/new-submission/787/3","title":"European Child \u0026 Adolescent Psychiatry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Psychiatry, Youth, Adolescence, Employment, Early Intervention, Functioning","lastPublishedDoi":"10.21203/rs.3.rs-4410142/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4410142/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eNo studies have investigated baseline predictors of improved functioning among young people receiving treatment for BPD. The current study aimed to identify the baseline demographic, psychopathological and treatment correlates of improved functioning at 12 months among young people with BPD, who received early intervention in the Monitoring Outcomes of BPD in Youth (MOBY) randomised controlled trial. Of 139 randomised young people (aged 15 to 25 years) who completed interview and self-report measures at baseline (pre-treatment), 98 (M\u003csub\u003eage\u003c/sub\u003e = 18.7, \u003cem\u003eSD\u003c/em\u003e\u0026thinsp;=\u0026thinsp;2.7) provided data on the same measures at 12 months (primary endpoint). Adjusting for other demographic, clinical and treatment characteristics, hierarchical regression analyses revealed that better social adjustment at 12 months was predicted by having at least one caregiver engaged in employment at baseline (β = -0.25, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04, \u003cem\u003eF\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.41). Higher levels of interpersonal functioning at 12 months were predicted by fewer interpersonal problems (β\u0026thinsp;=\u0026thinsp;0.41, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.02), fewer co-occurring personality disorder diagnoses (β = -0.31, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04), and lower BPD severity (β = -0.31, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.04) at baseline (\u003cem\u003eF\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.52). These findings suggest that young people presenting with lower severity of BPD, better interpersonal functioning at baseline, and at least one caregiver in employment are more likely to have better functional outcomes following early intervention. The findings did not support suicide attempts and self-harm as predictors of functional outcome. Future research should focus upon individual or household indicators of social disadvantage as moderators of outcome in early intervention for BPD.\u003c/p\u003e","manuscriptTitle":"Baseline correlates of functional impairment at 12 months in young people with borderline personality disorder: Findings from the MOBY randomised controlled trial ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-30 06:11:46","doi":"10.21203/rs.3.rs-4410142/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-24T16:20:56+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-24T09:56:15+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211356472650517311791353081525531393425","date":"2024-10-01T08:24:03+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-10T16:31:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"30420543615517922384440943434148154463","date":"2024-06-09T19:15:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"117844356059995084409832849613988246019","date":"2024-06-05T12:58:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-05T10:21:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-13T10:30:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-13T10:30:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"European Child \u0026 Adolescent Psychiatry","date":"2024-05-13T01:57:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"european-child-and-adolescent-psychiatry","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ecap","sideBox":"Learn more about [European Child \u0026 Adolescent Psychiatry](http://link.springer.com/journal/787)","snPcode":"787","submissionUrl":"https://submission.nature.com/new-submission/787/3","title":"European Child \u0026 Adolescent Psychiatry","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"142bdfe9-2d10-4883-9c8b-2be23e8993ae","owner":[],"postedDate":"May 30th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-06-02T16:01:32+00:00","versionOfRecord":{"articleIdentity":"rs-4410142","link":"https://doi.org/10.1007/s00787-025-02742-5","journal":{"identity":"european-child-and-adolescent-psychiatry","isVorOnly":false,"title":"European Child \u0026 Adolescent Psychiatry"},"publishedOn":"2025-05-28 15:57:33","publishedOnDateReadable":"May 28th, 2025"},"versionCreatedAt":"2024-05-30 06:11:46","video":"","vorDoi":"10.1007/s00787-025-02742-5","vorDoiUrl":"https://doi.org/10.1007/s00787-025-02742-5","workflowStages":[]},"version":"v1","identity":"rs-4410142","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4410142","identity":"rs-4410142","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}