Table 1 Characteristics of included studies
Authors | Sample with ‘personality disorder’ diagnosis | Population | Subgroup with PD diagnosis Y/N | Subtype of ‘personality disorder’ | Age (mean) | Gender % female | Ethnicity or Country of Birth | Country | Study design | Intervention | Intervention duration | Control/Comparison | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Andreoli 2016 [28] | 170 | Participants all met the DSM-IV criteria for BPD and MDD, presenting to ER after suicide attempt or self-harm | N | BPD | 31.9 | 84.1 | NR | Switzerland | RCT | Abandonment psychotherapy | 3 months | TAU | |
Barbato 2011 [29] | 36 | All patients admitted or discharged from 262 General Hospital Psychiatric Units in May 2004 during 12 day index period | Y | All subtypes | 41.2a | 43.2a | NR | Italy | Cohort study with pre post outcomes reporting change over time | Brief admission | Up to 12 days | NA | |
Berrino A 2011 [30] | 200 | Adults (18–65) referred to the emergency department of large teaching hospital who met DSM-IV criteria for BPD + presence of severe deliberate self harm | N | BPD | Intervention: 32.6 Control: 31.5 | Intervention: 87, Control: 83 | NR | Switzerland | Non randomised controlled study with historical controls | Crisis intervention in the general hospital | Mean 4.6 days | Participants presenting to same service environment before crisis hospitalisation was implemented | |
Booth 2014 [31] | 70 | Adults must be over 18 yrs, hospital inpatients, have a history of NSSI or strong ideation, study welcomed people with BPD. Final sample 61.4% people with BPD | Total sample > 50% | BPD | 35.22 | 80.7 | NR | Ireland | Cohort study with pre post outcomes reporting change over time | DBT skills group | NR | NA | |
Borschmann 2013 [11] | 88 | Adults accessing community mental health teams in south east london who met diagnostic criteria for borderline personality disorder, had self harmed in the previous 12 months, were under the care of a CMHT and did not have a psychotic illness | N | BPD | 35.8 | 83 | 1.1% Asian, 10.2% Black 73.9% White 8.0% white 6.8% other | UK | Pilot RCT | Joint crisis planning | 1 week | TAU | |
Branjerdporn 2021 [32] | 25 | Young adults (age 18 to 25 years) admitted to a specialised acute psychiatric unit for young adults | Y | All subtypes | 20.63 | 20 | Country of birth: 7% outside Australia 1st nation status 0% | Australia | Cohort study with pre post outcomes reporting change over time | Acute admission to Young Adult mental health unit | Mean 13.44 days | NA | |
Breslow 1993 [33] | 69 | Adults admitted to crisis beds at a psychiatric emergency service- those judged as likely to significantly improve within a 72 h timeframe | Total sample > 50% BPD | BPD | Study 1: 36.3 Study 2: 35.6a | Study 1: 45% Study 2: 49%a | NR | USA | Cohort study with pre post outcomes reporting change over time, replicated 1 year apart | Crisis beds | 3 days | NA | |
Damsa 2003 [34] | 507 | Adults > 16 yrs presenting to ER in crisis | Y | All subtypes | Pre: hospitalised 45, OP 41 Post: Hospitalised: 48 OP 41a | NR | NR | Luxembourg | Non randomised controlled study with historical controls | Crisis intervention in psychiatric emergencies service | Up to a few weeks | Use of psychiatric emergency service before crisis intervention introduced | |
Damsa 2005 [35] | 190 | Compared adults (> 16yrs) who consulted the psychiatric emergency department over a period of 8 months in 2002 with those who consulted over the same period in 2003 after crisis intervention was implemented | Y | BPD | Control group: Hospitalised mean age 48.7, Not hospitalised 44.4, Intervention group: hospitalised 49.3, not hospitalised 43.9a | 56a | NR | Luxembourg | Non randomised controlled study with historical controls | Crisis intervention in psychiatric emergencies service | Up to a few weeks | Use of psychiatric emergency service before crisis intervention introduced | |
Eckerstrom 2022 [36] | 63 | Patients of 2 OP units and 2 psychiatric hospital wards in Stockholm specialised in BPD and anxiety disorders. Participants needed to have a clinical history and current symptoms of emotional instability and a history of self-harm, and at least one previous period of inpatient care | Total sample > 50% BPD | BPD | 33.7a | 78a | NR | Sweden | Cohort study with pre post outcomes reporting change over time | Patient-initiated brief admission | 1–3 days, max 3 uses per month | NA | |
Gebhardt 2016 [37] | 18 | Inpatients of a general psychiatric hospital | Y | Mixed (8), Dependent (3), EUPD (2), histrionic (2), narcissistic (2), NOS (1) | 48.3 | 66 | NR | Germany | Cohort study with pre post outcomes reporting change over time | Acute psychiatric hospitalisation | Mean 1.4 months | NA | |
Giese 1990 [38] | 9 | Patients aged 18–45 yrs admitted to a psychiatric ward over a 3 month period. Must meet DSM-II criteria for axis II diagnosis and have an axis I diagnosis of an affective disorder | Y (and total sample > 50% BPD) | BPD | 30a | 88a | NR | USA | Cohort study with pre post outcomes reporting change over time | Acute psychiatric hospitalisation | Mean 22.8 days | NA | |
Grenyer 2018 [39] | 642 | Patients presenting to the hospital inpatient unit or emergency department: aged over 12 yrs, at least one inpatient admission during baseline 18 months, had a primary diagnosis of a personality disorder based on ICD10 | N | All subtypes | 36.85 | Intervention group: 46 Treatment group: 55.4 | NR | Australia | Cluster RCT | Brief crisis focused psychological intervention | One month of weekly contact | Usual medical care and community treatment by health care professionals, waitlist for psychological treatments | |
Huxley 2019 [40] | 67 | Aged > 18yrs, presenting with suicidal thoughts or plans, recent episodes of self harm behaviour, emotional dysregulation and/or personality disorder | N | All subtypes | 31.54 | 75 | NR | Australia | Cohort study with pre post outcomes reporting change over time | Brief crisis focused psychological intervention | 1 month | NA | |
Koekkoek 2010 [41] | 11 | Adults 18–60 yrs, received treatment in a day hospital with a formal DSM-IV diagnosis of BPD and history of repeated or long-term admissions | N | BPD | 43.55 | 100 | NR | Netherlands | Cohort study with pre post outcomes reporting change over time | Preventative brief psychiatric admissions | Variable length of stay over 6 months | ||
Laddis 2010 [42] | 58 | Consecutive admissions to a crisis stabilisation unit with a diagnosis of BPD or CPTSD | N | BPD | Control group 33.2 experimental group 37.2 | Control group 96 Intervention group 75 | NR | USA | Non randomised controlled trial with contemporaneous controls | Psychotherapeutic crisis intervention according to the Cape Cod Model | 2–3 days | TAU- medication, supportive psychotherapy, problem solving, occasional analysis of the transference and elements of DBT | |
Lariviere 2010 [43] | 20 | Adults > 18 yrs who were treated in a psychiatric day hospital and were diagnosed as having 1) psychotic disorders, 2) mood and anxiety disorders 3) cluster B personality disorders | Y | Cluster B personality disorders | 38.4 | 90 | 100% Caucasian | Canada | Cohort study with pre post outcomes reporting change over time | Acute day hospital | mean 8 weeks | NA | |
McQuillan 2005 [44] | 87 | Patients whose main problems are recent suicidal or parasuicidal behaviour, severe impulsive disorders, anger problems or multiple therapeutic failures. 92% of participants screened positive for BPD | N | BPD | 37 | 81 | NR | Switzerland | Cohort study with pre post outcomes reporting change over time | 3 week intensive DBT program aimed at crisis support, with optional initial stay in crisis centre of up to 2 nights | 3 weeks | ||
Mellsop 1987 [45] | 57 | Adults (aged 20–60 yrs) admitted to a general hospital psychiatric unit over a 12 month period | Y | All subtypes | 35a | 58 | NR | New Zealand | Cohort study with pre post outcomes reporting change over time | Acute psychiatric hospitalisation | NR | NA | |
Nehls 1994 [46] | 5 | Clients of a designated community mental health centre, meeting the DSM-III criteria for BPD and involved in brief hospital treatment program for at least 1 year | N | BPD | NR | NR | NR | USA | Cohort study with pre post outcomes reporting change over time | Brief hospital treatment plan | Brief admissions 48–72 h | NA | |
Pavan 2003 [47] | 22 | Young adults in emotional crisis. Referrals received from GPs, emergency room psychiatrists, community mental health facilities or self-referrals | Y (and total sample > 50% PD) | Depressive (20.9%), OPD (18.6%) BPD (16.3%), avoidant (9.3%), dependent (9.3%) and schizotypal (9.3%) | 30.9a | 76 | NR | Italy | Cohort study with pre post outcomes reporting change over time | Crisis psychotherapy | 10 weeks | NA | |
Savard 2019 [48] | 270 | 260 patients with a DSM-IV personality disorder diagnosis who were experiencing a crisis episode, and who completed the day hospital treatment program | N | 68% BPD, Cluster B 14%, narcissistic 7.4%, mixed 5.8%, dependent and histrionic (1.6%) OCPD (1.2%), schizotypal (0.4%) | 18 to 24 years = 23.8%, 25–30 years = 22.7%, 31 to 40 years = 26.2%, 41 to 50 years = 17.7% and 51 + years = 9.6% | 78a | NR | Canada | Cohort study with pre post outcomes reporting change over time | Time limited day hospital crisis treatment for personality disorders | 6 weeks | NA | |
Shergill 1997 [49] | 8 | All admissions to an acute day unit over a one year period | Y | All subtypes | 37.3 | 54a | NR | UK | Cohort study with pre post outcomes reporting change over time | Acute day hospital | Mean 157.5 days | NA | |
Springer 1995 [50] | 31 | Adults admitted to a general inpatient psychiatry ward at a university hospital who met criteria for a diagnosis of a personality disorder diagnosis using the MCMI-II | N | BPD | 31.4 | 68 | 87.1% White 6.5% African American 3.2% Hispanic 3.2% Asian | USA | RCT | Creative coping' skills training groups on short term inpatient ward | Mean 2 weeks | Wellness and lifestyles groups- discuss items of interest to patients but not in a psychotherapeutic manner | |
Turhan 2016 [51] | 27 | All patients who had primary ICD10 diagnosis of BPD taken on by the Edinburgh Intensive Home treatment team between 2010 and 2013 | N | BPD | 39 (median) | 100 | NR | UK (Scotland) | Cohort study with pre post outcomes reporting change over time | Intensive home treatment team | NR | NA | |
Tyrer 1994 [52] | 50 | Adults (aged 16-65yrs) presenting in psychiatric emergeny at a general hospital over a 14 month period.. Subgroup analysed with a personality disorder diagnosis based on ICD classification | Y | All subtypes | EIS group: 35 HS group: 30 (median)a | 55 | Caucasian 63% Other 25% (PD group only) | UK | RCT | Early intervention service | 12 weeks | Conventional hospital based psychiatric services | |
Uhlmann 2008 [53] | 63 | All admissions in the area with an acute crisis and the main diagnosis of F6 or F4 according to ICD10 without a comorbid schizophrenic disorder. If the main diagnosis was F4 then a personality disorder had to be present as a secondary diagnosis. Acute crises had to involve suicidal or violent behaviour | N | All subtypes | Before group: 32.6 After group: 31.5 | Before: 55 After: 78 | NR | Germany | Non randomised controlled study with historical controls | Specialised hospital admission ward for patients with personality disorder diagnoses in acute crisis | Before group: mean 32.5 days After group 43 days | Admission to general acute psychiatric ward without a disorder specific psychotherapeutic ward concept | |
Unger 2013 [54] | 68 | Adults (> 18 yrs) recruited from psychiatric unit in a clinic in Berlin with a major depressive episode or recurrent depression as the principal diagnosis. Analysed a subgroup with comorbid personality disorder diagnosis | Y | OCPD (13.1%), avoidant (12.5%), BPD (9.5%), depressive 9.5%), narcissistic (5.4%), dependent (4.2%), paranoid (3.6%), histrionic (3%), schizoid (1.2%), antisocial (1.2%), passive-aggressive (1.2%), schizotypal (0.6%) | 48.17 | 57.4 | NR | Germany | Cohort study with pre post outcomes reporting change over time | Acute psychiatric hospitalisation for depression | Mean 60.31 days | NA | |
Van Kessel 2002 [55] | 21 | Clients of an inpatient mental health facility who had a DSM-IV diagnosis of borderline personality disorder | N | BPD | 30 | 100 | BPA group: 90% Caucasian, 10% Pacific Island Control group: 64% Caucasian 27% pacific islander 9% other | New Zealand | Non randomised controlled trial with matched contemporaneous controls | Brief planned admission | NR | Standard care through community and inpatient services | |
Vazquez-Bourgon 2021 [56] | 27 | Adults (> 18 yrs) admitted to an acute psychiatric day hospital between January 2015 and January 2017. Inclusion criteria: 1) main DSM-IV diagnosis of non affective psychotic disorder, bipolar disorder, mood and anxiety disorder, personality disorder 2) present acute symptomatology for which the patient needed acute intensive treatment 3) voluntarily admitted to the day hospital | Y | All subtypes | 37.3 | 74 | NR | Spain | Cohort study with pre post outcomes reporting change over time | Acute day hospital | 20.0 days | NA | |
Westling 2019 [9] | 125 | Adults (18–60 yrs) attending 4 psychiatric inpatient services with a current episodes of self harm and recurrent suicidal behaviour, 3 or more diagnostic criteria for BPD, 7 or more days of hospital admission or presenting to ER 3 or more times in the last 6 months. 63.4% had diagnosis of BPD and 19.2% had diagnosis of other personality disorder | N | BPD | 32 | 85 | NR | Sweden | RCT | Brief admission | Maximum 3 nights | TAU, including general psychiatric admission | |
Wright 2020 [57] | 18 | All English speaking mother infant pairs who had an inpatient stay of 4 or more days in a 3-bed MBU. Personality disorder was a comorbid diagnosis | Y | All subtypes | 32.2 | 100 | 64% NZ European | New Zealand | Cohort study with pre post outcomes reporting change over time | Mother and baby unit | Approximately 3 weeks | NA | |
Yen 2009 [58] | 50 | Participants recruited consecutively from a 5 day DBT partial hospitalisation program for women. Participants had to be between 18 and 65 years of age and meet full criteria for BPD. Exclusion: schizophrenia, bipolar, cyclothymic disorder, substance dependence or mental retardation | N | BPD | NR | 100 | NR | USA | Cohort study with pre post outcomes reporting change over time | 5 day DBT partial hospitalisation program | 5 days | NA | |
Yoshimatsu 2015 [59] | 64 | A sample of 245 psychiatric inpatients divided into 2 groups based on whether they screened positive on the Mclean screening instrument for BPD | Y | BPD | 38 | 73 | 92.2% White | USA | Cohort study with pre post outcomes reporting change over time | Acute psychiatric hospitalisation in a mood disorders unit | 6.5 days | NA | |
Zimmerman 2022 [60] | 182 | Diagnosis of BPD. To take part in the virtual program they were required to have a computer, tablet or smartphone with access to the internet (those who did not have these had a kindle tablet and internet provided short term). Excluded if had a primary substance use disorder or imminent suicidal or homicidal ideation with plan and intent | N | BPD | In person group: 33.82, Telehealth: 34.86 | In person group: 74.4 Telehealth: 73.4 | In person group: 62.4% White 17.1% Hispanic 6.8% Black 3.4% Asian 9.4% other Telehealth group: 73.4% White 10.9% Hispanic 12.5% black 0% Asian 3.1% other | USA | Non randomised controlled study with historical controls | In person partial hospitalisation program | Mean 13.2 days in telehealth group 9.6 days in in person group | Telehealth version of the program | |