Effectiveness of outpatient and community treatments for people with a diagnosis of ‘personality disorder’: systematic review and meta-analysis
Abstract Background Quality of care and access to effective interventions have been widely criticised as limited for people diagnosed with ‘personality disorder’ or who have comparable needs (described in some recent papers as “Complex Emotional Needs” (CEN). It is important to identify effective in...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-01-01
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| Series: | BMC Psychiatry |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12888-022-04483-0 |
| _version_ | 1797945775987097600 |
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| author | Panos Katakis Merle Schlief Phoebe Barnett Luke Sheridan Rains Sarah Rowe Steve Pilling Sonia Johnson |
| author_facet | Panos Katakis Merle Schlief Phoebe Barnett Luke Sheridan Rains Sarah Rowe Steve Pilling Sonia Johnson |
| author_sort | Panos Katakis |
| collection | DOAJ |
| description | Abstract Background Quality of care and access to effective interventions have been widely criticised as limited for people diagnosed with ‘personality disorder’ or who have comparable needs (described in some recent papers as “Complex Emotional Needs” (CEN). It is important to identify effective interventions and the optimal context and mode of delivery for people with CEN. We aimed to investigate the effectiveness of psychosocial interventions delivered in community and outpatient settings in treating symptoms associated with ‘personality disorder’, and the moderating effects of treatment-related variables. Methods We systematically searched MEDLINE, EMBASE, PsycINFO, CINAHL, HMIC, ASSIA for articles published in English, from inception to November 23, 2020. We included randomized controlled trials examining interventions provided in community or outpatient settings for CEN. The primary outcome was ‘personality disorder’ symptoms, while secondary outcomes included anxiety symptoms, depressive symptoms, and global psychiatric symptoms. Random-effects meta-analysis was conducted for each outcome, and meta-regression analysis was performed to assess the moderating effects of treatment characteristics. The quality of the studies and the degree of publication bias was assessed. Results We included 54 trials (n = 3716 participants) in the meta-analysis. We found a large effect size (g = 0.78, 95% CI: 0.56 to 1.01, p < 0.0001) favoring interventions for ‘borderline personality disorder’ (BPD) symptoms over Treatment as Usual or Waitlist (TAU/WL), and the efficacy was maintained at follow-up (g = 1.01, 95% CI: 0.37 to 1.65, p = 0.002). Interventions effectively reduced anxiety symptoms (g = 0.58, 95% CI: 0.21 to 0.95, p = 0.002), depressive symptoms (g = 0.57, 95% CI: 0.32 to 0.83, p < 0.0001), and global psychiatric symptoms (g = 0.50, 95% CI: 0.35 to 0.66, p < 0.0001) compared to TAU/WL. The intervention types were equally effective in treating all symptom categories assessed. Treatment duration and treatment intensity did not moderate the effectiveness of the interventions for any outcome. Conclusions People with a ‘personality disorder’ diagnosis benefited from psychological and psychosocial interventions delivered in community or outpatient settings, with all therapeutic approaches showing similar effectiveness. Mental health services should provide people with CEN with specialised treatments in accordance with the availability and the patients’ preferences. |
| first_indexed | 2024-04-10T21:01:32Z |
| format | Article |
| id | doaj.art-e97e4525ea5249e6916d37e524b95084 |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-04-10T21:01:32Z |
| publishDate | 2023-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-e97e4525ea5249e6916d37e524b950842023-01-22T12:21:16ZengBMCBMC Psychiatry1471-244X2023-01-0123112910.1186/s12888-022-04483-0Effectiveness of outpatient and community treatments for people with a diagnosis of ‘personality disorder’: systematic review and meta-analysisPanos Katakis0Merle Schlief1Phoebe Barnett2Luke Sheridan Rains3Sarah Rowe4Steve Pilling5Sonia Johnson6Division of Psychiatry, University College LondonNIHR Mental Health Policy Research Unit, Division of Psychiatry, University College LondonNIHR Mental Health Policy Research Unit, Division of Psychiatry, University College LondonNIHR Mental Health Policy Research Unit, Division of Psychiatry, University College LondonDivision of Psychiatry, University College LondonCentre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College LondonNIHR Mental Health Policy Research Unit, Division of Psychiatry, University College LondonAbstract Background Quality of care and access to effective interventions have been widely criticised as limited for people diagnosed with ‘personality disorder’ or who have comparable needs (described in some recent papers as “Complex Emotional Needs” (CEN). It is important to identify effective interventions and the optimal context and mode of delivery for people with CEN. We aimed to investigate the effectiveness of psychosocial interventions delivered in community and outpatient settings in treating symptoms associated with ‘personality disorder’, and the moderating effects of treatment-related variables. Methods We systematically searched MEDLINE, EMBASE, PsycINFO, CINAHL, HMIC, ASSIA for articles published in English, from inception to November 23, 2020. We included randomized controlled trials examining interventions provided in community or outpatient settings for CEN. The primary outcome was ‘personality disorder’ symptoms, while secondary outcomes included anxiety symptoms, depressive symptoms, and global psychiatric symptoms. Random-effects meta-analysis was conducted for each outcome, and meta-regression analysis was performed to assess the moderating effects of treatment characteristics. The quality of the studies and the degree of publication bias was assessed. Results We included 54 trials (n = 3716 participants) in the meta-analysis. We found a large effect size (g = 0.78, 95% CI: 0.56 to 1.01, p < 0.0001) favoring interventions for ‘borderline personality disorder’ (BPD) symptoms over Treatment as Usual or Waitlist (TAU/WL), and the efficacy was maintained at follow-up (g = 1.01, 95% CI: 0.37 to 1.65, p = 0.002). Interventions effectively reduced anxiety symptoms (g = 0.58, 95% CI: 0.21 to 0.95, p = 0.002), depressive symptoms (g = 0.57, 95% CI: 0.32 to 0.83, p < 0.0001), and global psychiatric symptoms (g = 0.50, 95% CI: 0.35 to 0.66, p < 0.0001) compared to TAU/WL. The intervention types were equally effective in treating all symptom categories assessed. Treatment duration and treatment intensity did not moderate the effectiveness of the interventions for any outcome. Conclusions People with a ‘personality disorder’ diagnosis benefited from psychological and psychosocial interventions delivered in community or outpatient settings, with all therapeutic approaches showing similar effectiveness. Mental health services should provide people with CEN with specialised treatments in accordance with the availability and the patients’ preferences.https://doi.org/10.1186/s12888-022-04483-0Personality disorderPsychotherapyPsychological interventionsCommunity treatmentsSystematic reviewmeta-analysis |
| spellingShingle | Panos Katakis Merle Schlief Phoebe Barnett Luke Sheridan Rains Sarah Rowe Steve Pilling Sonia Johnson Effectiveness of outpatient and community treatments for people with a diagnosis of ‘personality disorder’: systematic review and meta-analysis BMC Psychiatry Personality disorder Psychotherapy Psychological interventions Community treatments Systematic review meta-analysis |
| title | Effectiveness of outpatient and community treatments for people with a diagnosis of ‘personality disorder’: systematic review and meta-analysis |
| title_full | Effectiveness of outpatient and community treatments for people with a diagnosis of ‘personality disorder’: systematic review and meta-analysis |
| title_fullStr | Effectiveness of outpatient and community treatments for people with a diagnosis of ‘personality disorder’: systematic review and meta-analysis |
| title_full_unstemmed | Effectiveness of outpatient and community treatments for people with a diagnosis of ‘personality disorder’: systematic review and meta-analysis |
| title_short | Effectiveness of outpatient and community treatments for people with a diagnosis of ‘personality disorder’: systematic review and meta-analysis |
| title_sort | effectiveness of outpatient and community treatments for people with a diagnosis of personality disorder systematic review and meta analysis |
| topic | Personality disorder Psychotherapy Psychological interventions Community treatments Systematic review meta-analysis |
| url | https://doi.org/10.1186/s12888-022-04483-0 |
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