Psychotherapies for borderline personality disorder : a focused systematic review and meta-analysis

Background: A recently updated Cochrane review supports the efficacy of psychotherapy for borderline personality disorder (BPD). Aims: To evaluate the effects of standalone and add-on psychotherapeutic treatments more concisely. Method: We applied the same methods as the 2020 Cochrane review, but focused on adult samples and comparisons of active treatments and unspecific control conditions. Standalone treatments (i.e. necessarily including individual psychotherapy as either the sole or one of several treatment components) and add-on interventions (i.e. complementing any ongoing individual BPD treatment) were analysed separately. Primary outcomes were BPD severity, self-harm, suicide-related outcomes and psychosocial functioning. Secondary outcomes were remaining BPD diagnostic criteria, depression and attrition. Results: Thirty-one randomised controlled trials totalling 1870 participants were identified. Among standalone treatments, statistically significant effects of low overall certainty were observed for dialectical behaviour therapy (self-harm: standardised mean difference (SMD) −0.54, P = 0.006; psychosocial functioning: SMD −0.51, P = 0.01) and mentalisation-based treatment (self-harm: risk ratio 0.51, P < 0.0007; suicide-related outcomes: risk ratio 0.10, P < 0.0001). For adjunctive interventions, moderate-quality evidence of beneficial effects was observed for DBT skills training (BPD severity: SMD −0.66, P = 0.002; psychosocial functioning: SMD −0.45, P = 0.002), and statistically significant low-certainty evidence was observed for the emotion regulation group (BPD severity: mean difference −8.49, P < 0.00001), manual-assisted cognitive therapy (self-harm: mean difference −3.03, P = 0.03; suicide-related outcomes: SMD −0.96, P = 0.005) and the systems training for emotional predictability and problem-solving (BPD severity: SMD −0.48, P = 0.002). Conclusions: There is reasonable evidence to conclude that psychotherapeutic interventions are helpful for individuals with BPD. Replication studies are needed to enhance the certainty of findings

Pharmacological interventions for people with borderline personality disorder

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the beneficial and harmful effects of pharmacological treatment for adolescents and adults with borderline personality disorder (BPD)

Psychological therapies for people with borderline personality disorder

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the beneficial and harmful effects of psychological therapies for people with borderline personality disorder (BPD)

Pharmacotherapy for Borderline Personality Disorder: an Update of Published, Unpublished and Ongoing Studies

Purpose of the review!#!We aim to identify the most recent evidence of randomised controlled trials evaluating continued drug treatments in people with a diagnosis of BPD, review the most recent findings, highlight trends in terms of currently ongoing studies and comment on the overall body of evidence.!##!Recent findings!#!We identified seven new RCTs, plus newly available data for an older RCT. Only three of these RCTs have been published in full text, while we found study data posted at trial registry platforms for the others. The new findings do not support fluoxetine as a treatment option for suicide and self-harm prevention. A large effectiveness study did not detect beneficial effects of lamotrigine in routine care. The prevalent use of medications in BPD is still not reflected or supported by the current evidence. More research is needed regarding the most commonly used substances and substance classes, i.e. SSRIs, and quetiapine, but also with respect to people presenting with distinct comorbid conditions

Promoting Well-Being, Quality of Life, and Health Care Utilization in Caregivers of Chronically Ill and Disabled Children and Adolescents Through Case Management: A Systematic Review Protocol

In recent decades, an increase in the prevalence of chronic health problems among children and adolescents has been observed (Barrio Cortes et al., 2020; Compas et al., 2012; Davis et al., 2014). Chronic health problems (both chronic illnesses and chronic physical disabilities) are generally defined as those conditions that last &gt; 12 months and are severe enough to create limitations in usual activity. Examples of chronic illnesses include cystic fibrosis, congenital heart disease, and diabetes mellitus. Examples of chronic physical disabilities include meningomyelocele, hearing or visual impairments, cerebral palsy, and a loss of limb function. These health problems can be so severe that children and adolescents may require extensive care and support to manage their conditions effectively. The primary caregivers for those children and adolescents are typically family members, with the mother assuming this responsibility in most cases (Oetting-Roß, 2022). These parents or caregivers often confront distinctive challenges, experiencing considerable stress associated with their caregiving role (Keller &amp; Honig, 2004; Majnemer et al., 2012; B. F. Page et al., 2020). These challenges encompass financial strains as well as emotional and physical exhaustion (Caicedo, 2014). Other burdens arise from the limited availability and accessibility of support services and difficulties in navigating the complex healthcare system (Kofahl et al., 2017; Oetting-Roß, 2022). The burden of caring for a child living with a disability or chronic illness increases the risk of health, social and economic harm, and often leads to poorer living and care conditions (B. F. Page et al., 2020). The wellbeing and overall quality of life of carers are significantly compromised (Cohn et al., 2020), underscoring the need for interventions aimed at promoting their health and wellbeing. Case management is a collaborative process that facilitates assessing, planning, coordinating, and advocating for individuals and families to access health care and support services (Mullahy, 2016). Caregivers of disabled or chronically ill children and adolescents often encounter multiple healthcare providers, specialists, and services. This can lead to fragmentation and confusion in care (Boyden et al., 2022). Case management helps to streamline communication and coordination between different healthcare professionals, ensuring continuity and coherence in children's treatment plans (Mullahy, 2016). Case management also provides emotional support, counselling and coping skills to help parents manage stress and anxiety associated with caring responsibilities (Bromer &amp; Korfmacher, 2017). In this way, the well-being of families could be enhanced. There have been few reviews of the impact of case management on well-being and health care utilization. One problem is the considerable variation in terminology between studies of case management, which leads to role confusion and ambiguity and hinders comparability across health conditions and contexts (Lukersmith et al., 2016). Published reviews have shown that case management can reduce the number and duration of hospital stays for mental illnesses (Dieterich et al., 2017) and has the potential to improve mental health and well-being in older people (You et al., 2012). The largest review to date by Joo &amp; Huber (2019) summarized several English-language reviews on case management. The evidence presented in this review suggests that case management has a positive effect on health care utilization in the management of chronic diseases. The use of case management has been shown to result in fewer hospital admissions, shorter lengths of stay, and lower costs. Thus far, there has been no comprehensive overview of case management interventions tailored for caregivers of disabled or chronically ill children and adolescents. A comprehensive review of case management for caregivers of disabled or chronically ill children and adolescents is important for several reasons. First, it provides a comprehensive synthesis of existing evidence, enabling health professionals, policy makers and researchers to understand the potentially favorable effects of case management in supporting parents and carers. Second, such a review can identify gaps in current knowledge, guide future research, and inform the development of evidence-based interventions tailored to the specific needs of this population. The review project will specially target home-based interventions, with clinical settings being excluded. By focusing on home-based interventions, the review aims to capture strategies and support mechanisms that can be seamlessly integrated into caregivers' daily lives, promoting sustainable and practical approaches to caregiving

Conflicts of interest and spin in reviews of psychological therapies: a systematic review

OBJECTIVE: To explore conflicts of interest (COI) and their reporting in systematic reviews of psychological therapies, and to evaluate spin in the conclusions of the reviews. METHODS: MEDLINE and PsycINFO databases were searched for systematic reviews published between 2010 and 2013 that assessed effects of psychological therapies for anxiety, depressive or personality disorders, and included at least one randomised controlled trial. Required COI disclosure by journal, disclosed COI by review authors, and the inclusion of own primary studies by review authors were extracted. Researcher allegiance, that is, that researchers concluded favourably about the interventions they have studied, as well as spin, that is, differences between results and conclusions of the reviews, were rated by 2 independent raters. RESULTS: 936 references were retrieved, 95 reviews fulfilled eligibility criteria. 59 compared psychological therapies with other forms of psychological therapies, and 36 psychological therapies with pharmacological interventions. Financial, non-financial, and personal COI were disclosed in 22, 4 and 1 review, respectively. 2 of 86 own primary studies of review authors included in 34 reviews were disclosed by review authors. In 15 of the reviews, authors showed an allegiance effect to the evaluated psychological therapy that was never disclosed. Spin in review conclusions was found in 27 of 95 reviews. Reviews with a conclusion in favour of psychological therapies (vs pharmacological interventions) were at high risk for a spin in conclusions (OR=8.31 (1.41 to 49.05)). Spin was related in trend to the inclusion of own primary studies in the systematic review (OR=2.08 (CI 0.83 to 5.18) p=0.11) and researcher allegiance (OR=2.63 (0.84 to 8.16) p=0.16). CONCLUSIONS: Non-financial COI, especially the inclusion of own primary studies into reviews and researcher allegiance, are frequently seen in systematic reviews of psychological therapies and need more transparency and better management

Psychological therapies for adolescents with borderline personality disorder (BPD) or BPD features-A systematic review of randomized clinical trials with meta-analysis and Trial Sequential Analysis.

ObjectivesTo review the effectiveness of psychological therapies for adolescents with borderline personality disorder (BPD) or BPD features.MethodsWe included randomized clinical trials on psychological therapies for adolescents with BPD and BPD features. Data were extracted and assessed for quality according to Cochrane guidelines, and summarized as mean difference (MD) with 95% confidence intervals (CI) for continuous data and as Odds ratios (OR) with 95% CI for dichotomous data. Risk of bias was assessed using Cochrane's risk of bias tool for each domain. When possible, we pooled trials into meta-analyses, and used Trial Sequential Analysis (TSA) to control for random errors. Quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE).Results10 trials on adolescents with BPD or BPD features were included. All trials were considered at high risk of bias, and the quality of the evidence was rated as "very low". We did TSA on the primary outcome and found that the required information size was reached. The risk of random error was thus discarded.ConclusionOnly 10 trials have been conducted on adolescents with BPD or BPD features. Of these only few showed superior outcomes of the experimental intervention compared to the control intervention. No adverse effects of the interventions were mentioned. Attrition rates varied from 15-75% in experimental interventions. The overall quality was very low due to high risk of bias, imprecision and inconsistency, which limits the confidence in effect estimates. Due to the high risk of bias, high attrition rates and underpowered studies in this area, it is difficult to derive any conclusions on the efficacy of psychological therapies for BPD in adolescence. There is a need for more high quality trials with larger samples to identify effective psychological therapies for this specific age group with BPD or BPD features

Co-RESPOND: An ongoing IPD Meta-Analyses of European Cohorts on Mental Health and Resilience During the COVID-19 Pandemic

Background The COVID-19 pandemic has put both individuals as well as  health care systems under stress. However, it is not yet clear which  factors influence mental health, and the identification of vulnerable  groups is still a research priority (Ahrens et al., 2021; Riehm et al.,  2021). RESPOND is an EU Horizon 2020-funded project with the aim prepare  the European mental health care system for future pandemics.   Aims Utilizing mental health data from before the pandemic until mid-2022,  this project has several aims. Firstly, to identify groups that are  vulnerable to mental health problems and understand their trajectories.  Secondly, to identify protective factors to mental health during the pandemic. Thirdly, to investigate resilience operationalized as stressor  reactivity and determine psychological resilience factors.   Methods Rather than utilising summary data, individual participant data (IPD)  meta-analyses will be done that allow for the use of advanced  statistical methods as compared to conventional meta-analyses of  aggregated data. For the assessment of data harmonization potential, the  Maelstrom guidelines (Bergeron et al., 2018) are used.  Results:  Nine cohorts from five different European countries (Belgium, France,  Germany, Spain, the Netherlands) have been identified that will  contribute to joint analyses. Datasets are currently transformed in  accordance to jointly agreed rules for data 1harmonization and  anonymization.    Discussion and outlook Retrospective data  harmonization requires meticulous efforts, and thoughtful deliberation  to ensure that GDPR requirements are met. However, this project will  help to make optimal use of existing datasets and allow for more general  conclusions on the trajectories of mental health and resilience across Europe.</p

Transdiagnostic psychosocial interventions to promote mental health in forcibly displaced persons: a systematic review and meta-analysis

Background: People forced to leave their homes, such as refugees and internally displaced persons, are exposed to various stressors during their forced displacement, putting them at risk for mental disorders. Objective: To summarize evidence on the efficacy of psychosocial interventions aiming to promote mental health and/or to prevent mental symptoms by fostering transdiagnostic skills in forcibly displaced persons of all ages. Method: Four databases and reference lists were searched for randomized controlled trials on interventions in this population on 11 March 2022. Thirty-six studies were eligible, 32 studies (comprising 5299 participants) were included in random-effects multilevel meta-analyses examining the effects of interventions on mental symptoms and positive mental health (e.g. wellbeing) as well as moderators to account for heterogeneity. OSF Preregistration-ID: 10.17605/OSF.IO/XPMU3 Results: Our search resulted in 32 eligible studies, with 10 reporting on children/adolescents and 27 on adult populations. There was no evidence for favourable intervention effects in children/adolescents, with 44.4% of the effect sizes pointing to potentially negative effects yet remaining non-significant. For adult populations, our meta-analyses showed a close-to-significant favourable effect for mental symptoms, M(SMD) = 0.33, 95% CI [–0.03, 0.69], which was significant when analyses were limited to high-quality studies and larger for clinical compared to non-clinical populations. No effects emerged for positive mental health. Heterogeneity was considerable and could not be explained by various moderators (e.g. type of control, duration, setting, theoretical basis). Certainty of evidence was very low across all outcomes limiting the generalizability of our findings. Conclusion: The present review provides at most weak evidence for an effect favouring transdiagnostic psychosocial interventions over control conditions for adult populations but not for children and adolescents. Future research should combine the imperative of humanitarian aid in face of major crises with studying the diverse needs of forcibly displaced persons to improve and tailor future interventions