Systematic review and meta-analysis of the role of personality disorder in randomised controlled trials of pharmacological interventions for adults with mood disorders

Bianca E Kavanagh; Melanie M Ashton; Stephanie P Cowdery; Olivia M Dean; Alyna Turner; Michael Berk; Stella M Gwini; Sharon L Brennan-Olsen; Heli Koivumaa-Honkanen; Andrew M Chanen; Lana J Williams

doi:10.1016/j.jad.2020.10.031

Systematic review and meta-analysis of the role of personality disorder in randomised controlled trials of pharmacological interventions for adults with mood disorders

J Affect Disord. 2021 Jan 15:279:711-721. doi: 10.1016/j.jad.2020.10.031. Epub 2020 Oct 16.

Affiliations

¹ Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia. Electronic address: bianca.kavanagh@deakin.edu.au.
² Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia.
³ Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, Parkville, Australia.
⁴ Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; School of Medicine and Public Health, Faculty of Health and Medicine, the University of Newcastle, Callaghan, Australia.
⁵ Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Florey Institute for Neuroscience and Mental Health, University of Melbourne, Kenneth Myer Building, Parkville, Australia; Department of Psychiatry University of Melbourne, The Melbourne Clinic, Professorial Unit, Richmond, Australia; Orygen, Melbourne, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia.
⁶ Deakin University, Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; University Hospital Geelong, Barwon Health, Geelong, Australia.
⁷ Deakin University, School of Health and Social Development, Geelong, Australia; Deakin University, Institute for Health Transformation, Geelong, Australia.
⁸ Institute of Clinical Medicine (Psychiatry), University of Eastern Finland, Kuopio, Finland; Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland; Department of Psychiatry, Oulu University Hospital, Finland.
⁹ Orygen, Melbourne, Australia; Centre for Youth Mental Health, the University of Melbourne, Parkville, Australia.

PMID: 33197840
DOI: 10.1016/j.jad.2020.10.031

Abstract

Background: Personality disorder (PD) may affect the efficacy of pharmacological interventions for mood disorders, but the extent to which this occurs is uncertain. We aimed to examine the available published evidence concerning the role of PD in pharmacological treatment outcomes of randomised controlled trials (RCTs) for adults with mood disorders (i.e. depressive and bipolar spectrum disorders).

Methods: A systematic search of Cochrane Central Register of Controlled Clinical Trials, PubMed, EMBASE, PsycINFO, CINAHL Complete, and Google Scholar databases was undertaken to identify studies of interest. Data were independently extracted by two reviewers. The Cochrane Risk of Bias tool was used to assess methodological quality and risk of bias. A random effects model was utilised and statistical heterogeneity was assessed using the I² statistic. This systematic review was registered with PROSPERO (CRD42018089279) and the protocol is published.

Results: The search yielded 11,640 studies. Subsequent to removing duplicates, 9657 studies were screened at title and abstract stage and 1456 were assessed at full-text stage. Eighteen studies met criteria for inclusion in this review. Meta-analysis did not reveal a significant difference between groups for treatment outcome (standardised mean difference 0.22 [-0.09, 0.54]; I²: 69%, p=0.17) and remission (risk ratio 0.84 [0.64, 1.11]; I²: 51%, p=0.22).

Limitations: This review was limited by lack of studies on bipolar disorder.

Conclusion: PD comorbidity does not appear to affect treatment efficacy of pharmacological interventions for adults with mood disorders.

Keywords: Personality disorders; bipolar disorder; depression; pharmacological interventions; randomized controlled trial.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review
Systematic Review

MeSH terms

Adult
Bipolar Disorder* / drug therapy
Humans
Mood Disorders* / drug therapy
Personality Disorders / drug therapy
Randomized Controlled Trials as Topic
Treatment Outcome