Healthcare 2022, 10, 2212. https://doi.org/10.3390/healthcare10112212 www.mdpi.com/journal/healthcare Article Different Effects of Perceived Social Support on the Relationship between Perceived Stress and Depression among University Students with Borderline Personality Disorder Symptoms: A Multigroup Mediation Analysis Narusorn Ingkachotivanich 1 , Tinakon Wongpakaran 1, *, Nahathai Wongpakaran 1 , Awirut Oon-Arom 1 , Nuntaporn Karawekpanyawong 1 , Trustsavin Lohanan 2 and Thanakorn Leesawat 2 1 Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand 2 Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand * Correspondence: tinakon.w@cmu.ac.th Abstract: Background: While perceived social support can mediate the relationship between per- ceived stress and depression, little is known about the differences between individuals with high and low borderline personality disorder symptoms (BPDS). This study aimed to investigate the as- sociations among perceived stress, perceived social support, and depression, and compare low and high levels of BPDS. Methods. This cross-sectional analysis was a secondary analysis of data from the SI-Bord study. University students across Thailand completed a screening instrument for bor- derline personality disorder, the Perceived Stress Scale (PSS), the Revised Thai Multi-dimensional Scales of Perceived Social Support (MSPSS), and the Patient-Health Questionnaire (PHQ)-9. Medi- ation analysis using PROCESS was applied to test the direct and indirect effects of perceived stress on depression. Multigroup mediational analysis was adopted to compare low and high levels of BPDS. Results. The mean age of the 330 participants was 20.27 (SD, 1.4) and 80% were female. Sig- nificant correlations were observed between the PSS, MSPSS, and PHQ scores, with greater magni- tude among the high-level BPDS group (p < 0.001). A significant direct effect on perceived stress and a significant indirect effect on depression through perceived social support were noted. Of all the sources of social support, only the significant others variable significantly differed between the two groups (p < 0.05). Conclusion. Perception of social support had a significant mediating role in perceived stress and depression. The magnitude of associations was remarkably high for individu- als with high BPDS compared to those with low BPDS. Unlike those with low BPDS, all sources of social support were significant mediators between the two groups. Keywords: borderline personality; family support; friends support; depressive symptoms; mediation 1. Introduction Depression is considered an important and commonly found public health problem that leads to suicide. Evidence confirms that depression affects more than 264 million peo- ple worldwide [1]. College and university students are at risk of experiencing stress due to a variety of factors, such as pressure to study, exams, inadequate rest time, inappropri- ate exercise and food intake, competition, coping with family expectations, economic sta- tus, chronic illness, and use of alcohol, cigarettes or other substances [2–5]. Depression causes psychological distress, may negatively affect academic performance [6], and can result in poor quality of life [7–9]. The prevalence of university students reporting depres- sion ranges from 10 to 85%, with a weighted mean of 30.6% [10], and on average, a prev- alence rate of 24.4% is reported in low and middle-income countries [11]. Citation: Ingkachotivanich, N.; Wongpakaran, T.; Wongpakaran, N.; Oon-Arom, A.; Karawekpanyawong, N.; Lohanan, T.; Leesawat, T. Different Effects of Perceived Social Support on the Relationship between Perceived Stress and Depression among University Students with Borderline Personality Disorder Symptoms: A Multigroup Mediation Analysis. Healthcare 2022, 10, 2212. https://doi.org/10.3390/ healthcare10112212 Academic Editors: John H. Foster Received: 18 September 2022 Accepted: 31 October 2022 Published: 3 November 2022 Publisher’s Note: MDPI stays neu- tral with regard to jurisdictional claims in published maps and institu- tional affiliations. Copyright: © 2022 by the authors. Li- censee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and con- ditions of the Creative Commons At- tribution (CC BY) license (https://cre- ativecommons.org/licenses/by/4.0/).