Solmi, Marco, Dragioti, Elena, Croatto, Giovanni, Radua, Joaquim, Borgwardt, Stefan, Carvalho, Andre F., Demurtas, Jacopo, Mosina, Anna, Kurotschka, Peter, Thompson, Trevor ORCID: https://orcid.org/0000-0001-9880-782X, Cortese, Samuele, Shin, Jae Il and Fusar-Poli, Paolo (2021) Risk and protective factors for personality disorders: an umbrella review of published meta-analyses of case-control and cohort studies. Frontiers in Psychiatry, 12:679379. ISSN 1664-0640 (Print), 1664-0640 (Online) (doi:10.3389/fpsyt.2021.679379)

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Abstract

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.

Item Type:	Article
Additional Information:	© 2021 Solmi, Dragioti, Croatto, Radua, Borgwardt, Carvalho, Demurtas, Mosina, Kurotschka, Thompson, Cortese, Shin and Fusar-Poli. 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.
Uncontrolled Keywords:	umbrella review, personality disorder, prevention, meta-analysis, risk factor, systematic review, psychiatry, mental health
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development Faculty of Education, Health & Human Sciences > Institute for Lifecourse Development > Centre for Chronic Illness and Ageing Faculty of Education, Health & Human Sciences > School of Human Sciences (HUM)
Related URLs:	Publisher
Last Modified:	12 Nov 2021 13:29
URI:	http://gala.gre.ac.uk/id/eprint/33763

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