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Risk and Protective Factors for Personality Disorders: An Umbrella Review of Published Meta-Analyses of Case–Control and Cohort Studies

The putative risk/protective factors for several personality disorders remain unclear. The vast majority of published studies has assessed personality characteristics/traits rather than disorders. Thus, the current umbrella review of meta-analyses (MAs) aims to systematically assess risk or protecti...

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Autores principales: Solmi, Marco, Dragioti, Elena, Croatto, Giovanni, Radua, Joaquim, Borgwardt, Stefan, Carvalho, Andre F., Demurtas, Jacopo, Mosina, Anna, Kurotschka, Peter, Thompson, Trevor, Cortese, Samuele, Shin, Jae Il, Fusar-Poli, Paolo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450571/
https://www.ncbi.nlm.nih.gov/pubmed/34552513
http://dx.doi.org/10.3389/fpsyt.2021.679379
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author Solmi, Marco
Dragioti, Elena
Croatto, Giovanni
Radua, Joaquim
Borgwardt, Stefan
Carvalho, Andre F.
Demurtas, Jacopo
Mosina, Anna
Kurotschka, Peter
Thompson, Trevor
Cortese, Samuele
Shin, Jae Il
Fusar-Poli, Paolo
author_facet Solmi, Marco
Dragioti, Elena
Croatto, Giovanni
Radua, Joaquim
Borgwardt, Stefan
Carvalho, Andre F.
Demurtas, Jacopo
Mosina, Anna
Kurotschka, Peter
Thompson, Trevor
Cortese, Samuele
Shin, Jae Il
Fusar-Poli, Paolo
author_sort Solmi, Marco
collection PubMed
description The putative risk/protective factors for several personality disorders remain unclear. The vast majority of published studies has assessed personality characteristics/traits rather than disorders. Thus, the current umbrella review of meta-analyses (MAs) aims to systematically assess risk or protective factors associated with personality disorders. We searched PubMed–MEDLINE/PsycInfo databases, up to August 31, 2020. Quality of MAs was assessed with AMSTAR-2, while the credibility of evidence for each association was assessed through standard quantitative criteria. Out of 571 initial references, five meta-analyses met inclusion criteria, encompassing 56 associations of 26 potential environmental factors for antisocial, dependent, borderline personality disorder, with a median of five studies per association, and median 214 cases per association. Overall, 35 (62.5%) of the associations were nominally significant. Six associations met class II (i.e., highly suggestive) evidence for borderline personality disorder, with large effect sizes involving childhood emotional abuse (OR = 28.15, 95% CI 14.76–53.68), childhood emotional neglect (OR = 22.86, 95% CI 11.55–45.22), childhood any adversities (OR = 14.32, 95% CI 10.80–18.98), childhood physical abuse (OR = 9.30, 95% CI 6.57–13.17), childhood sexual abuse (OR = 7.95, 95% CI 6.21–10.17), and childhood physical neglect (OR = 5.73, 95% CI 3.21–10.21), plus 16 further associations supported by class IV evidence. No risk factor for antisocial or dependent personality disorder was supported by class I, II, and III, but six and seven met class IV evidence, respectively. Quality of included meta-analyses was rated as moderate in two, critically low in three. The large effect sizes found for a broad range of childhood adversities suggest that prevention of personality disorders should target childhood-related risk factors. However, larger cohort studies assessing multidimensional risk factors are needed in the field.
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spelling pubmed-84505712021-09-21 Risk and Protective Factors for Personality Disorders: An Umbrella Review of Published Meta-Analyses of Case–Control and Cohort Studies Solmi, Marco Dragioti, Elena Croatto, Giovanni Radua, Joaquim Borgwardt, Stefan Carvalho, Andre F. Demurtas, Jacopo Mosina, Anna Kurotschka, Peter Thompson, Trevor Cortese, Samuele Shin, Jae Il Fusar-Poli, Paolo Front Psychiatry Psychiatry The putative risk/protective factors for several personality disorders remain unclear. The vast majority of published studies has assessed personality characteristics/traits rather than disorders. Thus, the current umbrella review of meta-analyses (MAs) aims to systematically assess risk or protective factors associated with personality disorders. We searched PubMed–MEDLINE/PsycInfo databases, up to August 31, 2020. Quality of MAs was assessed with AMSTAR-2, while the credibility of evidence for each association was assessed through standard quantitative criteria. Out of 571 initial references, five meta-analyses met inclusion criteria, encompassing 56 associations of 26 potential environmental factors for antisocial, dependent, borderline personality disorder, with a median of five studies per association, and median 214 cases per association. Overall, 35 (62.5%) of the associations were nominally significant. Six associations met class II (i.e., highly suggestive) evidence for borderline personality disorder, with large effect sizes involving childhood emotional abuse (OR = 28.15, 95% CI 14.76–53.68), childhood emotional neglect (OR = 22.86, 95% CI 11.55–45.22), childhood any adversities (OR = 14.32, 95% CI 10.80–18.98), childhood physical abuse (OR = 9.30, 95% CI 6.57–13.17), childhood sexual abuse (OR = 7.95, 95% CI 6.21–10.17), and childhood physical neglect (OR = 5.73, 95% CI 3.21–10.21), plus 16 further associations supported by class IV evidence. No risk factor for antisocial or dependent personality disorder was supported by class I, II, and III, but six and seven met class IV evidence, respectively. Quality of included meta-analyses was rated as moderate in two, critically low in three. The large effect sizes found for a broad range of childhood adversities suggest that prevention of personality disorders should target childhood-related risk factors. However, larger cohort studies assessing multidimensional risk factors are needed in the field. Frontiers Media S.A. 2021-09-06 /pmc/articles/PMC8450571/ /pubmed/34552513 http://dx.doi.org/10.3389/fpsyt.2021.679379 Text en Copyright © 2021 Solmi, Dragioti, Croatto, Radua, Borgwardt, Carvalho, Demurtas, Mosina, Kurotschka, Thompson, Cortese, Shin and Fusar-Poli. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Solmi, Marco
Dragioti, Elena
Croatto, Giovanni
Radua, Joaquim
Borgwardt, Stefan
Carvalho, Andre F.
Demurtas, Jacopo
Mosina, Anna
Kurotschka, Peter
Thompson, Trevor
Cortese, Samuele
Shin, Jae Il
Fusar-Poli, Paolo
Risk and Protective Factors for Personality Disorders: An Umbrella Review of Published Meta-Analyses of Case–Control and Cohort Studies
title Risk and Protective Factors for Personality Disorders: An Umbrella Review of Published Meta-Analyses of Case–Control and Cohort Studies
title_full Risk and Protective Factors for Personality Disorders: An Umbrella Review of Published Meta-Analyses of Case–Control and Cohort Studies
title_fullStr Risk and Protective Factors for Personality Disorders: An Umbrella Review of Published Meta-Analyses of Case–Control and Cohort Studies
title_full_unstemmed Risk and Protective Factors for Personality Disorders: An Umbrella Review of Published Meta-Analyses of Case–Control and Cohort Studies
title_short Risk and Protective Factors for Personality Disorders: An Umbrella Review of Published Meta-Analyses of Case–Control and Cohort Studies
title_sort risk and protective factors for personality disorders: an umbrella review of published meta-analyses of case–control and cohort studies
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8450571/
https://www.ncbi.nlm.nih.gov/pubmed/34552513
http://dx.doi.org/10.3389/fpsyt.2021.679379
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