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)

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

Non-Pharmacologic Multicomponent Interventions Preventing Delirium in Hospitalized People

BACKGROUND/OBJECTIVES: Delirium is a common neurobehavioral complication in hospitalized patients with a high prevalence in various clinical settings. Prevention of delirium is critical due to its common occurrence and associated poor outcomes. Our objective was to evaluate the efficacy of multicomponent interventions in preventing incident delirium in hospitalized patients at risk. DESIGN: Systematic review and meta-analysis. SETTING: Hospital. PARTICIPANTS: We included a study if it was a randomized controlled trial and was evaluating effects of coordinated non-pharmacologic multicomponent interventions in the prevention of delirium. MEASUREMENTS We performed a systematic literature search in PubMed and CENTRAL (PROSPERO: CRD42019138981; last update May 24, 2019). We assessed the quality of included studies by using the criteria established by the Cochrane Collaboration. We extracted the measured outcomes for delirium incidence, duration of delirium, length of hospital stay, falls during hospital stay, discharge to institutional care, and inpatient mortality. RESULTS: In total, we screened 1,027 eligible records and included eight studies with 2,105 patients in the review. We found evidence of an effect (ie, reduction) of multicomponent interventions on the incidence of delirium (risk ratio?=?.53; 95% confidence interval?=?.41-.69; I2 =?0). We detected no clear evidence of an effect for delirium duration, length of hospital stay, accidental falls, and mortality. Subgroup analyses did not result in findings of substantial effect modifiers, which can be explained by the high homogeneity within studies. CONCLUSION: Our findings confirm the current guidelines that multicomponent interventions are effective in preventing delirium. Data are still lacking to reach evidence-based conclusions concerning potential benefits for hard outcomes such as length of hospital stay, return to independent living, and mortality

Non‐Pharmacologic Multicomponent Interventions Preventing Delirium in Hospitalized People

BACKGROUND/OBJECTIVES: Delirium is a common neurobehavioral complication in hospitalized patients with a high prevalence in various clinical settings. Prevention of delirium is critical due to its common occurrence and associated poor outcomes. Our objective was to evaluate the efficacy of multicomponent interventions in preventing incident delirium in hospitalized patients at risk. DESIGN: Systematic review and meta-analysis. SETTING: Hospital. PARTICIPANTS: We included a study if it was a randomized controlled trial and was evaluating effects of coordinated non-pharmacologic multicomponent interventions in the prevention of delirium. MEASUREMENTS We performed a systematic literature search in PubMed and CENTRAL (PROSPERO: CRD42019138981; last update May 24, 2019). We assessed the quality of included studies by using the criteria established by the Cochrane Collaboration. We extracted the measured outcomes for delirium incidence, duration of delirium, length of hospital stay, falls during hospital stay, discharge to institutional care, and inpatient mortality. RESULTS: In total, we screened 1,027 eligible records and included eight studies with 2,105 patients in the review. We found evidence of an effect (ie, reduction) of multicomponent interventions on the incidence of delirium (risk ratio?=?.53; 95% confidence interval?=?.41-.69; I2 =?0). We detected no clear evidence of an effect for delirium duration, length of hospital stay, accidental falls, and mortality. Subgroup analyses did not result in findings of substantial effect modifiers, which can be explained by the high homogeneity within studies. CONCLUSION: Our findings confirm the current guidelines that multicomponent interventions are effective in preventing delirium. Data are still lacking to reach evidence-based conclusions concerning potential benefits for hard outcomes such as length of hospital stay, return to independent living, and mortality

Implementation of a federated database infrastructure for individual participant data meta-analyses - the RESPOND OBiBa-network

Background The EU HORIZON 2020-sponsored RESPOND project aims to  prepare the European mental health care system for future pandemics  (https://respond-project.eu/). Within RESPOND, the Leibniz Institute for  Resilience Research (LIR) heads a project that aims to pool existing  longitudinal cohort data of RESPOND partners collected during the  COVID-19 pandemic and conduct a meta-analysis on the individual  participant data level. Objectives The aim was to find a  technical solution that would meet several requirements. First and  foremost, it must enable the pooled analysis of individual participant  data while complying with the GDPR. Second, it should provide tools that  simplify harmonization e. g. standardized description of study designs  and collected datasets. Third, the solution should be sustainable so  that future projects can build on this resource. Results We  identified a federated database infrastructure built with open-source  software from OBiBa (www.obiba.org) as a suitable technical solution.  OBiBa provides modular applications e. g. for building a web portal  based on a study catalogue (Mica), and for storing and managing data  (Opal).   Discussion and outlook Whilst some advanced IT skills  are required for installation, OBiBa software is an excellent tool for  conducting individual participant meta-analyses and easy to maintain. At  this point, an access-restricted network consisting of servers behind  the firewalls of the participating institutes is operational. The next  step is that each partner uploads their data to their respective Opal  server. Subsequently, remote analyses can be performed. After completion  of the project, the Mica web portal will be made publicly available to  the scientific community to stimulate future research projects of  RESPOND consortium partners and beyond.</p