Sabine Kaiser

Comorbidity of personality disorders in anxiety disorders: A meta-analysis of 30 years of research

BACKGROUND A comprehensive meta-analysis to identify the proportions of comorbid personality disorders (PD) across the major subtypes of anxiety disorders (AD) has not previously been published. METHODS A literature search identified 125 empirical papers from the period 1980-2010 on patients with panic disorders, social phobia, generalised anxiety, obsessive-compulsive (OCD) and post-traumatic stress disorder (PTSD). Several moderators were coded. RESULTS The rate of any comorbid PD was high across all ADs, ranging from .35 for PTSD to .52 for OCD. Cluster C PDs occurred more than twice as often as cluster A or B PDs. Within cluster C the avoidant PD occurred most frequently, followed by the obsessive-compulsive and the dependent PD. PTSD showed the most heterogeneous clinical picture and social phobia was highly comorbid with avoidant PD. A range of moderators were examined, but most were non-significant or of small effects, except an early age of onset, which in social phobia increased the risk of an avoidant PD considerably. Gender or duration of an AD was not related to variation in PD comorbidity. LIMITATIONS Blind rating of diagnoses was recorded from the papers as an indication of diagnostic validity. However, as too few studies reported it the validity of the comorbid estimates of PD was less strong. CONCLUSIONS The findings provided support to several of the proposed changes in the forthcoming DSM-5. Further comorbidity studies are needed in view of the substantial changes in how PDs will be diagnosed in the DSM-5.

Comorbidity of personality disorders in mood disorders: A meta-analytic review of 122 studies from 1988 to 2010

BACKGROUND A meta-analysis was conducted to identify the proportions of comorbid personality disorders (PD) in mood disorders. METHODS We found 122 empirical papers published in the period 1980-2010 on participants having mood disorders in addition to a comorbid PD. Mood disorders were classified as bipolar disorders (BD), major depressive disorders (MDD) and dysthymic disorders (DYS). Several moderators were coded as well. RESULTS The risk of having at least one comorbid PD (any PD) was high across all three mood disorders (BD=.42, MDD=.45), but highest in DYS (.60). Cluster B and C PDs were most frequent in BD, while cluster C PDs dominated in MDD and DYS. Among the specific PDs, the paranoid (.11 versus .07/.05), borderline (.16 versus .14/.13), histrionic (.10 versus .06/.06) and obsessive-compulsive (.18 versus .09/.12) PDs occurred more frequently in BD versus MDD/DYS, whereas the avoidant PD (.22 versus .12/.16) was most frequent in DYS versus BD/MDD. Moderator analyses showed higher comorbidity when diagnoses were based on questionnaires versus clinical interviews, DSM-III-R versus DSM-IV, more women were included or the duration of the disorder was longer. Age of onset yielded mixed results. LIMITATIONS Blind rating of diagnoses was recorded, but was employed in too few studies to be usable as an indication of diagnostic validity. CONCLUSIONS Personality disorders are common in mood disorders. Implications of the identified moderators as well as the new DSM-5 diagnostic system are considered.

Effectiveness of school-based preventive interventions on adolescent alcohol use: a meta-analysis of randomized controlled trials.

BackgroundPreventive interventions for adolescents are an important priority within school systems. Several interventions have been developed, but the effectiveness of such interventions varies considerably between studies. The purpose of this study was to assess the effectiveness of universal school-based prevention programs on alcohol use among adolescents by using meta-analytic techniques.MethodA systematic literature search in the databases, PubMed (Medline), PsycINFO (Ovid), EMBASE (Ovid) and WEB of Science (ISI) was conducted to search for empirical articles published in the period January 1990 to August 2014.ResultsIn total, 28 randomized controlled studies with 39,289 participants at baseline were included. Of these 28 articles, 12 studies (N = 16279) reported continuous outcomes (frequency of alcohol use and quantity of alcohol use), and 16 studies (N = 23010) reported categorical data (proportion of students who drank alcohol). The results of the random effects analyses showed that the overall effect size among studies reporting continuous outcomes was small and demonstrated a favorable effect from the preventive interventions (Hedges’ g¯ = 0.22, p < .01). The effect size among studies reporting categorical outcomes was not significant (OR¯ = 0.94, p = .25). The level of heterogeneity between studies was found to be significant in most analyses. Moderator analyses conducted to explore the heterogeneity showed neither significant difference between the different school levels (junior high schools and high schools), nor between the varied program intensities (low, medium and high intensity programs). The meta-regression analyses examining continuous moderators showed no significant effects for age or gender.ConclusionsThe findings from this meta-analysis showed that, overall, the effects of school-based preventive alcohol interventions on adolescent alcohol use were small but positive among studies reporting the continuous measures, whereas no effect was found among studies reporting the categorical outcomes. Possible population health outcomes, with recommendations for policy and practice, are discussed further in this paper.

Personality disorders in eating disorder not otherwise specified and binge eating disorder: a meta-analysis of comorbidity studies.

Abstract A meta-analysis was conducted to identify the proportion of comorbid personality disorders (PDs) in patients with eating disorder not otherwise specified (EDNOS) and binge eating disorder (BED). A search identified 20 articles in the period of 1987 to 2010. For EDNOS and BED, the comorbid proportions for any PD were 0.38 and 0.29, respectively; for cluster C PDs, 0.38 and 0.30, respectively (avoidant PD, 0.18 and 0.12, and obsessive-compulsive PD, 0.11 and 0.10, respectively); and for cluster B PDs, 0.25 and 0.11, respectively (borderline, 0.12 and 0.10). This pattern converged with findings on anorexia nervosa and bulimia nervosa, except being lower. Because the comorbidity profiles for EDNOS and BED were highly similar, their underlying PD pathology seems similar. Few moderators were significant, except for interviews yielding lower estimates than that of questionnaires. The variance statistic for any PD comorbidity was wide for EDNOS and narrow for BED, thus partly supporting BED as a distinct eating disorder category and EDNOS as a potentially more severe condition than BED.

The comorbidity of personality disorders in eating disorders: a meta-analysis

PurposeThe present meta-analysis summarized the proportion of comorbid personality disorders (PDs) in patients with anorexia (AN) and bulimia nervosa (BN), respectively, and examined possible moderating variables.MethodsA search of the databases PsychINFO, Embase, and Medline for the period 1980–2016 identified 87 studies from 18 different countries.ResultsThe mean proportion of PDs among patients with any type of eating disorder (ED) was .52 compared to .09 in healthy controls. There were no statistically significant differences between AN (.49) and BN (.54) in proportions of any PD or PD clusters except for obsessive-compulsive PD (.23 vs .12 in AN and BN, respectively).ConclusionsBoth ED diagnoses had a similar comorbidity profile with a high prevalence of borderline and avoidant PDs. Moderator analyses conducted for any ED and any PD yielded significant differences for diagnostic systems with respect to EDs, method for assessing PD as well as patient weight and age.

Catching the moving target of adolescent personality and its disorders. A commentary on the article (doi:10.1007/s40519-017-0368-y) by Gaudio and Dakanalis: What about the assessment of personality disturbance in adolescents with eating disorders?

Our meta-analysis of 87 studies summarized the proportion of comorbid personality disorders (PDs) in patients with anorexia (AN) and bulimia nervosa (BN). The mean proportion of PDs among patients with any type of eating disorder (ED) was .52 compared to .09 in healthy controls. Patients with AN and BN had a quite comparable comorbidity profile, and with the borderline and avoidant PDs as the most prevalent [1]. Studies from 1980 to January 2016, published in English or German, were analyzed if the ED (and not the PD) was the primary diagnosis, and if the studies provided comorbidity proportions or data convertible to a proportion. Of particular interest here is that studies of patients below 18 years of age were excluded from the meta-analysis. We are aware of at least two studies [2, 3] comprising adolescents below this age limit. Using structured [2] or self-report plus structured clinical [3] interviews, these studies reported very similar findings as in our meta-analysis. Similar results in only two additional studies would, however, have had a negligible impact on the ‘‘big picture’’ provided by this meta-analysis. The general argument in these studies [2, 3] as well as in the commentary article by Gaudio and Dakanalis [4] is that an early identification of a PD may bring about treatment arrangements that may prevent a poor prognosis of the ED, and that such arrangements are possible because a PD among younger ED patients can be reliably assessed. The argument for the reliability of a PD assessment [4] seems to rest on an assumption that the personality of young people below the age of 18 is fully developed. One should not be negligent about personality problems causing clinical impairment. Hence, the DSM-5 accepts a PD diagnosis (except an antisocial PD) as tentatively valid in adolescents below 18 years of age if personality traits appear as maladaptive, pervasive, and persistent within at least one year, and not limited to a particular developmental stage or another mental disorder. The exclusion criterion in our meta-analysis [1] adheres, however, to the general principle in the literature and in the DSM-5 that a PD diagnosis in adolescents below 18 years is probably invalid because their personality is far from fully developed and because many traits in younger people will not persist unchanged into adulthood. Obviously, individual differences in the development of personality and its disorders make the 18-year limit somewhat arbitrary, and the lowest true age limit for a valid PD diagnosis seems almost impossible to define exactly. Nevertheless, when used consistently, the 18-year limit may serve to prevent falsepositive PD diagnoses in clinical work and it leads to few excluded studies in meta-analyses like in our study [1]. What does it mean that the personality in young people is not fully developed? This is a complicated question and attempts to study the personality of children and adolescents has been aptly described as trying to catch a moving target [5] in the crossfire between evidence of trait continuity versus change across the life span. Personality development can be viewed as the psychological processing of interpersonal experiences in a complex interaction between biological temperaments and the nature and quality of adult–child attachments, and where the processing and accommodation of experiences are & Jan H. Rosenvinge jan.rosenvinge@uit.no

Linking interprofessional work to outcomes for employees: A meta-analysis

The aim of this meta-analysis of studies of workers in the health and social care sector was to examine the relationship between interprofessional work and employee outcomes of job stress, autonomy, burnout, engagement, job satisfaction, turnover intention, and perceived service quality, and to examine the influence of different moderators on those relationships. A systematic literature search of the PsycInfo, Embase, Medline, and the Cumulative Index to Nursing and Allied Health Literature databases was conducted to identify relevant articles. A total of 45 articles with results for 53 independent samples was included in the meta-analysis. A random effects model was used to estimate the mean effect sizes (correlations). Most employees were nurses working in hospitals. Interprofessional work was weakly negatively associated with job stress, burnout, and turnover intention (range mean r = -.13 to -.22); and was moderately positively associated with autonomy, engagement, job satisfaction, and perceived service quality (range mean r =.33 to .46). When feasible, interprofessional work was categorized as teamwork (most intensive), collaboration, or cooperation. Teamwork, the most intense of three forms of interprofessional work, promoted lower burnout and turnover intention. The results of this meta-analysis suggest that interprofessional work is linked to better well-being for employees in health and social care.

Reorganisation of healthcare services for children and families: Improving collaboration, service quality, and worker well-being

ABSTRACT This study is an evaluation of a reorganisation of different services for children and their families in a Norwegian municipality. The main aim of the reorganisation was to improve interprofessional collaboration through integrating different social services for children and their parents. The evaluation was guided by the Job Demands-Resources Model with a focus on social and healthcare workers’ experiences of their work, including job demands and resources, service quality, and well-being at work. The survey of the employees was conducted at three measurement points: before (T1) and after (T2, T3) the reorganisation took place, and included between 87 and 122 employees. A secondary aim was to examine the impact of different job resources and job demands on well-being (burnout, engagement, job satisfaction), and service quality. A one-way ANOVA indicated a positive development on many scales, such as collaboration, work conflict, leadership, and perceived service quality, especially from T1 to T2. No changes were detected in burnout, engagement, or job satisfaction over time. Moderated regression analyses (at T3) indicated that job demands were particularly associated with burnout, and job resources with engagement and job satisfaction. Perceived service quality was predicted by both job demands and resources, in addition to the interaction between workload and collaboration. The reorganisation seems to have contributed to a positive development in how collaboration, work conflict, leadership, and service quality were evaluated, but that other changes are needed to increase worker well-being. The value of the study rests on the findings that support co-locating and merging services for children and their families, and that collaboration is an important resource for healthcare professionals.