Interventions benefit those with personality disorder in community, outpatient setting

Individuals diagnosed with a personality disorder benefited from interventions delivered in community or outpatient settings, with all therapeutic approaches demonstrating similar efficacy, according to a study published in BMC Psychiatry.

“People diagnosed with ‘personality disorder’ experience severe impairment and distress from adolescence or early adulthood onwards, affecting various aspects of their life, including social and vocational functioning as well as mental and physical health,” Panos Katakis, MS, of the division of psychiatry at University College London, and colleagues wrote.

Katakis and colleagues sought to examine the effectiveness of psychosocial interventions provided in community and outpatient settings for treatment of personality disorder, as well as any moderating effects of treatment-related variables.

Their database search included MEDLINE, EMBASE, PsycINFO, CINAHL, HMIC, ASSIA for articles published in English, from inception to Nov. 23, 2020. From an initial pool of more than 12,000 studies suitable for screening, 54 studies featuring randomized controlled trials involving 3,716 participants with personality disorder were found to be suitable for meta-analysis. An additional 57 studies that featured comparisons between intervention and control groups were analyzed.

Secondary outcomes included symptoms of anxiety, depression and global psychiatric disorders. Random-effects meta-analysis was conducted for each outcome, and meta-regression analysis was performed to assess the moderating effects of treatment characteristics.

Results were significantly in favor of interventions (0.78, 95% CI: 0.56-1.01) for borderline personality disorder symptoms compared with treatment as usual or waitlist (TAU/WL), whose efficacy was maintained at a given follow-up interval (1.01, 95% CI: 0.37-1.65). These interventions additionally reduced anxiety (0.58, 95% CI: 0.21-0.95), depression (0.57, 95% CI: 0.32-0.83), and global psychiatric symptoms (0.5, 95% CI: 0.35-0.66) compared with TAU/WL.

Researchers also found that intervention types were equally effective in treating all assessed symptom categories, however, they found no moderating effectiveness for either treatment duration or intensity across interventions for any outcome.

“Mental health guidelines need to highlight the effectiveness of treatments provided in the community for this population,” Katakis and colleagues wrote. “While stepped-care interventions should be developed and delivered in community settings.”