M Fornaro1, L Orsolini2, S Marini3, D De Berardis4, G Perna5, A Valchera6, L Ganança7, M Solmi8, N Veronese9, B Stubbs10. 1. New York State Psychiatric Institute, Columbia University, NY, USA. Electronic address: mf3000@cumc.columbia.edu. 2. School of Life and Medical Sciences, University of Hertfordshire, Hatfield, Herts, UK; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands; Hermanas Hospitalarias - Villa San Giuseppe, Ascoli Piceno, Italy. Electronic address: laura.orsolini@hotmail.it. 3. Department of Neuroscience & Imaging, "G. D'Annunzio" University, Chieti, Italy. Electronic address: sfnmarini@gmail.com. 4. National Health Service, Department of Mental Health, Psychiatric Service of Diagnosis and Treatment, Hospital "G. Mazzini", ASL 4, Teramo, Italy. Electronic address: dodebera@aliceposta.it. 5. Hermanas Hospitalarias-Villa San Benedetto Menni Hospital, Department of Clinical Neurosciences, FoRiPsi, Italy. Electronic address: pernagp@gmail.com. 6. Hermanas Hospitalarias - Villa San Giuseppe, Ascoli Piceno, Italy. Electronic address: a.valchera@ospedaliere.it. 7. New York State Psychiatric Institute, Columbia University, NY, USA; Departamento de Psiquiatria e Saúde Mental, Faculdade de Medicina, Universidade de Lisboa, PT. Electronic address: lg2733@cumc.columbia.edu. 8. Department of Neuroscience, University of Padova, Padua, Italy; National Health Care System, Padua Local Unit ULSS 17, Italy. Electronic address: marco.solmi83@gmail.com. 9. Department of Medicine, DIMED, Geriatrics Section, University of Padua, Italy. Electronic address: ilmannato@gmail.com. 10. Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK; Health Service and Population Research Department, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. Electronic address: brendon.stubbs@kcl.ac.uk.
Abstract
INTRODUCTION: Data about the prevalence of borderline personality (BPD) and bipolar (BD) disorders comorbidity are scarce and the boundaries remain controversial. We conducted a systematic review and meta-analysis investigating the prevalence of BPD in BD and BD in people with BPD. METHODS: Two independent authors searched MEDLINE, Embase, PsycINFO and the Cochrane Library from inception till November 4, 2015. Articles reporting the prevalence of BPD and BD were included. A random effects meta-analysis and meta-regression were conducted. RESULTS: Overall, 42 papers were included: 28 considering BPD in BD and 14 considering BD in BPD. The trim and fill adjusted analysis demonstrated the prevalence of BPD among 5273 people with BD (39.94 ± 11.78 years, 44% males) was 21.6% (95% CI 17.0-27.1). Higher comorbid BPD in BD were noted in BD II participants (37.7%, 95% CI 21.9-56.6, studies=6) and North American studies (26.2%, 95% CI 18.7-35.3, studies=11). Meta regression established that a higher percentage of males and higher mean age significantly (p<0.05) predicted a lower prevalence of comorbid BPD in BD participants. The trim and fill adjusted prevalence of BD among 1814 people with BPD (32.22 ± 7.35 years, 21.5% male) was 18.5% (95% CI 12.7-26.1). LIMITATIONS: Paucity of longitudinal/control group studies and accurate treatment records. CONCLUSIONS: BPD-BD comorbidity is common, with approximately one in five people experiencing a comorbid diagnosis. Based on current diagnostic constructs, and a critical interpretation of results, both qualitative and quantitative syntheses of the evidence prompt out the relevance of differences rather similarities between BD and BPD.
INTRODUCTION: Data about the prevalence of borderline personality (BPD) and bipolar (BD) disorders comorbidity are scarce and the boundaries remain controversial. We conducted a systematic review and meta-analysis investigating the prevalence of BPD in BD and BD in people with BPD. METHODS: Two independent authors searched MEDLINE, Embase, PsycINFO and the Cochrane Library from inception till November 4, 2015. Articles reporting the prevalence of BPD and BD were included. A random effects meta-analysis and meta-regression were conducted. RESULTS: Overall, 42 papers were included: 28 considering BPD in BD and 14 considering BD in BPD. The trim and fill adjusted analysis demonstrated the prevalence of BPD among 5273 people with BD (39.94 ± 11.78 years, 44% males) was 21.6% (95% CI 17.0-27.1). Higher comorbid BPD in BD were noted in BD II participants (37.7%, 95% CI 21.9-56.6, studies=6) and North American studies (26.2%, 95% CI 18.7-35.3, studies=11). Meta regression established that a higher percentage of males and higher mean age significantly (p<0.05) predicted a lower prevalence of comorbid BPD in BD participants. The trim and fill adjusted prevalence of BD among 1814 people with BPD (32.22 ± 7.35 years, 21.5% male) was 18.5% (95% CI 12.7-26.1). LIMITATIONS: Paucity of longitudinal/control group studies and accurate treatment records. CONCLUSIONS: BPD-BD comorbidity is common, with approximately one in five people experiencing a comorbid diagnosis. Based on current diagnostic constructs, and a critical interpretation of results, both qualitative and quantitative syntheses of the evidence prompt out the relevance of differences rather similarities between BD and BPD.
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