Borderline Personality Disorder Athens Study (BPDAS): A quasi-experimental pragmatic trial for the assessment of a public, psychodynamic, stepped care service for borderline personality disorder patients

Ioannis Malogiannis¹Lida Anagnostaki²Maria Aspradaki³Panagiotis Aristotelidis⁴Katerina Karambela⁴Maria Amperiadou³Vasiliki Efthymiou⁵Phaithra Kriezi⁶Ioanna Theodoridou⁷PENTAGIOTISSA STEFANATOU⁸George Konstantakopoulos⁹Kyriakos Souliotis¹⁰Lily Evagelia Peppou¹¹Eleni Giannoulis^3*

• ¹Department of Psychoanalytic Psychotherapy & Day Hospital; First Department of Psychiatry, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
• ²Department of Early Childhood Education, National and Kapodistrian University of Athens, Athens, Greece
• ³First Department of Psychiatry, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
• ⁴First Department of Psychiatry, Specific Sector of Personality Disorders, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
• ⁵University Research Institute of Maternal and Child Health & Precision Medicine, National and Kapodistrian University of Athens, Athens, Greece
• ⁶Other
• ⁷2nd Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
• ⁸University of Peloponnese, Tripolis, Peloponnese, Greece
• ⁹Research Department of Clinical, Education and Health Psychology, University College London, London, England, United Kingdom
• ¹⁰Department of Social & Education Policy, University of Peloponnese, Tripolis, Peloponnese, Greece
• ¹¹Neurosciences and Precision Medicine Research Institute “Costas Stefanis”, National and Kapodistrian University of Athens, Athens, Greece

The paper "Borderline Personality Disorder Athens Study (BPDAS): A quasi-experimental pragmatic trial for the assessment of a public, psychodynamic, stepped care service for borderline personality disorder (BPD) patients" is study protocol for a quasi-experimental pragmatic trial for the assessment of a public, psychodynamic, stepped care service for patients with BPD. We believe it falls within the scope of Frontiers in Public Health as it evaluates the effectiveness and cost-effectiveness of a specialized stepped care service for patients with borderline personality disorder (BPD) in a real-world clinical setting. The study aims to assess whether this service leads to greater improvements in clinical outcomes, functioning, and quality of life compared to treatment as usual (TAU), while also examining its cost-effectiveness from a societal perspective. The results will have important implications for the development and implementation of complex, individualized, stepped care interventions for BPD patients in public health services. The quasi-experimental pragmatic trial design allows the service to be evaluated under everyday clinical settings, which is crucial given the complex needs of this patient population. Overall, the study is consistent with the journal's mission to publish research that informs public health policies and practices.