Psychosocial and pharmacological interventions for personality disorders in low- and middle-income countries: A systematic review.

Personality disorders (PDs) have a global prevalence of 7.8% and are associated with increased rates of morbidity and mortality. Most research on PDs has been conducted in High Income Countries (HICs). We conducted a systematic review to investigate the effectiveness of psychosocial and pharmacological interventions for personality disorders (PDs) in individuals from Low- and Middle-Income Countries (LMICs.) We systematically searched MEDLINE, Embase, APA PsycInfo, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and The Cochrane Library from inception to January 5, 2023. Inclusion criteria were quantitative studies and grey literature where participants received a psychosocial or pharmacological intervention for PD. Exclusion criteria were qualitative studies, review articles, studies in which PD was not the primary condition, and articles not available in English. The Cochrane Risk of Bias tool version 2.0 and Joanna Briggs Institute instruments were used to measure risk of bias. Studies were pooled by type of study, PD investigated, type of intervention, assessment methods, and outcomes. Sixteen studies met inclusion criteria and were included. Fifteen were intervention studies related to borderline PD. Only one studied mixed PDs. Twelve studies were of psychotherapy, one pharmacotherapy, one combination of both, and two neurostimulation. Most of the studies showed improvement in symptoms though data was largely collected using self-report measures. There were only six RCTs. There is a dearth of literature on interventions for PDs in LMICs and funding bodies should prioritize research in LMICs. Systematic Review Registration Number: PROSPERO CRD42021233415.

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Copyright: © 2023 Hedemann et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Déclaration de conflit d'intérêts

I have read the journal’s policy and the authors of this manuscript have the following competing interests: Nasim Chaudry has received travel grants from Lundbeck and Pfizer pharmaceutical companies to attend one national and one international academic meeting and conference in the last three years. She is the chief investigator and co-investigator for numerous research projects funded by various grant bodies such as the Medical Research Council, Wellcome Trust, NIH-R, and Global Challenges Research Fund. Usman Arshad has been supported through a grant from the Medical Research Council/DFID/NIHR program YCMAP and the UKRI SAHAR-M program. Muhammad Omair Husain has received grants from the Canadian Institutes of Health Research (CHIR), Miner’s Lamp Innovation Funding in Prevention and Early Detection of Severe Mental Illness, and from the Slaight Centre for Youth in Transition Seed Fund. Muhammad Ishrat Husain reports grants from CIHR, CAMH Foundation, BBRF, University of Toronto, COMPASS Pathways Limited, and the PSI Foundation. He has also received consultation fees from Wake Network Inc. and payments/honoraria from SOBP, APA, ASCP, and WorkSafe BC. He owns shares of MindSet Inc and has received gifts or other services from Filament. The other authors declare no potential conflicts of interest.