The British Journal of Psychiatry (2006) 188: 13-20. doi: 10.1192/bjp.188.1.13
© 2006 The Royal College of Psychiatrists
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REVIEW ARTICLE

Personality disorder and the outcome of depression: meta-analysis of published studies

GILES NEWTON-HOWES, MRCPsych

Department of Psychological Medicine, Division of Neuroscience and Psychological Medicine, Imperial College London, and MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK

PETER TYRER, FRCPsych

Department of Psychological Medicine, Division of Neuroscience and Psychological Medicine, Imperial College London, and MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK

TONY JOHNSON, PhD

Department of Psychological Medicine, Division of Neuroscience and Psychological Medicine, Imperial College London, and MRC Biostatistics Unit, Institute of Public Health, Cambridge, UK

Correspondence: Professor Peter Tyrer, Department of Psychological Medicine, Division of Neuroscience and Mental Health, Imperial College London, St Dunstan's Road, London W6 8RP,UK. E-mail: p.tyrer{at}imperial.ac.uk

Declaration of interest P.T. and T.J. belong to a UK Medical Research Council Cooperative Group (Mencog) evaluating mental health interventions. P.T. is Editor of the British Journal of Psychiatry but had no part in the evaluation of this paper.

Background There is conflicting evidence about the influence of personality disorder on outcome in depressive disorders.

Aims Meta-analysis of studies in which a categorical assessment of personality disorder or no personality disorder was made in people with depressive disorders, and categorical outcome (recovered/not recovered) also determined.

Method Systematic electronic search of the literature for relevant publications. Hand searches of Journal of Affective Disorders and recent reviews, with subsequent meta-analysis of selected studies.

Results Comorbid personality disorder with depression was associated with a doubling of the risk of a poor outcome for depression compared with no personality disorder (random effects model OR=2.18, 95% CI 1.70-2.80), a robust finding maintained with only Hamilton-type depression criteria at outcome (OR=2.20, 95% CI 1.61-3.01). All treatments apart from electroconvulsive therapy (ECT) showed this poor outcome, and the ECT group was small.

Conclusions Combined depression and personality disorder is associated with a poorer outcome than depression alone.


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