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Search Strategies, Study Selection, and Search Results

Appendix B
The methods for this systematic review follow the Agency for Healthcare Research and Quality (AHRQ) Methods Guide for Effectiveness and Comparative Effectiveness Reviews (available at https://effectivehealthcare.ahrq.gov/products/collections/cer-methods-guide) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist (Moher et al. 2015). The final protocol of this review was registered on PROSPERO (Registration #: CRD42020194098). All methods and analyses were determined a priori.

Literature Searches

Initial searches were conducted on June 7, 2018, by APA staff using MEDLINE (PubMed), EMBASE, the Cochrane Library (Wiley), and PsychInfo (EBSCO). Subsequent searches were conducted by RTI. Searches differed in exact search strings; however, to ensure optimal recall, the RTI searches were reviewed in detail to ensure that the revised search strategy still detected all studies that met inclusion criteria of the original search. These searches were also conducted in MEDLINE, EMBASE, the Cochrane Library, and PsychINFO from January 1, 2018, to June 15, 2020. Additional overlapping update searches of MEDLINE and PsycINFO were run in April and September 2021. Our search strategies used a variety of terms, medical subject headings (MeSH), and major headings, and were limited to English-language and human-only studies.
To minimize retrieval bias, we manually searched reference lists of landmark studies and background articles on this topic for relevant citations that electronic searches might have missed.

Doctor Evidence Original Search Strategy

Search Date: June 7, 2018

PubMed search strategy for borderline personality disorder
Search ID#QueryResults
#1
(“Borderline Personality Disorder”[Mesh]) OR (borderline [tiab] AND personality [tiab])
8,962
#2
(“animals”[MeSH Terms] OR animal [tiab] OR animals [tiab] OR rat [tiab] OR rats [tiab] OR mouse [tiab] OR mice [tiab] OR rodent [tiab] OR rodents [tiab]) NOT (“humans”[MeSH Terms] OR humans [tiab] OR human [tiab])
4,419,530
#3
#1 NOT #2
8,957
 
Limit to English
7,983
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EMBASE search strategy for borderline personality disorder
SearchQueryResults
#1
exp *borderline state/ or (borderline and personality).ti. or (borderline and personality).ab.
11,073
#2
limit #1 to (article or article in press or conference paper)
7,571
#3
#2 not ((exp animal/ or nonhuman/) not exp human/)
7,564
#4
#2 not ((animal or animals or rat or rats or mouse or mice or rodent or rodents) not (humans or human)).ti,ab.
7,548
#5
#3 or #4
7,569
#6
limit #5 to yr = “1883–2002”
2,765
#7
limit #5 to yr = “2002–Current”
4,929
#8
remove duplicates from #6
2,740
#9
remove duplicates from #7
4,739
#10
#8 or #9
7,337
#11
limit #10 to English language
6,356
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Cochrane Library search strategy for borderline personality disorder
SearchQueryResults
#1
MeSH descriptor: [Borderline Personality Disorder] explode all trees
390
#2
borderline and personality:ti,ab,kw (Word variations have been searched)
684
#3
#1 or #2
684
#4
#3 not (pubmed or embase):an
145 in trials; 6 in Cochrane reviews; 9 in other reviews
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PsycINFO search strategy for borderline personality disorder
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RTI Updated Search Strategy

Search Date: June 15, 2020

PubMed search strategy for borderline personality disorder
SearchQueryResults
#1
“Borderline Personality Disorder”[Mesh] OR “Borderline Disorder”[ti] OR “Borderline Personality Disorder”[tiab] OR “borderline-patient”[ti] OR “borderline patient”[ti] OR “borderline-patients”[ti] OR “borderline patients”[ti]
8,693
#2
#1 AND (“2018/01/01”[Date—Publication]: “3000”[Date—Publication])
1,202
#3
#2 AND English[lang]
1,161
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EMBASE search strategy for borderline personality disorder
SearchQueryResults
#1
(‘borderline state’/de OR ‘borderline disorder’:ti OR ‘borderline-patient’:ti OR ‘borderline patient’:ti OR ‘borderline-patients’:ti OR ‘borderline patients’:ti OR ‘borderline personality disorder’:ti,ab,kw) AND [2018-2020]/py AND [english]/lim
1,777
#2
‘borderline personality disorder’:ti,kw AND [english]/lim AND [1-1-2018]/sd
990
#3
#1 OR #2
1,924
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Cochrane Library search strategy for borderline personality disorder
SearchQueryResults
#1
(“Borderline Disorder” OR “Borderline Personality Disorder” OR “borderline-patient” OR “borderline patient” OR “borderline-patients” OR “borderline patients”):ti,ab,kw OR [mh “Borderline Personality Disorder”]
851
#2
#1 with Cochrane Library publication date from Jan 2018 to present, in Cochrane Reviews, Cochrane Protocols, Trials, Clinical Answers, Editorials and Special collections
412
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PsycINFO (via ProQuest) search strategy for borderline personality disorder
SearchQueryResults
S1
if(“Borderline Personality Disorder”) OR mjsub(“Borderline Personality Disorder”) OR mainsubject(“Borderline Personality Disorder”) OR ti(“Borderline Personality Disorder” OR “Borderline Disorder” OR “borderline-patient” OR “borderline patient” OR “borderline-patients” OR “borderline patients”) OR ab(“Borderline Personality Disorder”)
Additional limits—Date: After January 01 2018; Language: English
986
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Search Date: April 6, 2021

PubMed search strategy for borderline personality disorder
SearchQueryResults
#1
“Borderline Personality Disorder”[Mesh] OR “Borderline Disorder*”[ti] OR “Borderline Personality Disorder*”[tiab] OR “borderline patient”[ti] OR “borderline patients”[ti]
9,260
#2
#1 NOT (“Animals”[Mesh] NOT “Humans”[Mesh])
9,258
#3
(#2) AND ((“2020”[Date—Publication]: “3000”[Date—Publication])) Filters: English
744
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PsycINFO (via ProQuest) search strategy for borderline personality disorder
SearchQueryResults
S1
DE “Borderline Personality Disorder”
8,991
S2
borderline W1 (disorder# OR patient#)
13,511
S3
S1 OR S2
13,511
S4
S3 (Limiters – Publication Year 2020 – 2021; Language: English)
510
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Search Date: September 24, 2021

PubMed search strategy for borderline personality disorder
SearchQueryResults
#1
“Borderline Personality Disorder”[Mesh] OR “Borderline Disorder*”[ti] OR “Borderline Personality Disorder*”[tiab] OR “borderline patient”[ti] OR “borderline patients”[ti]
9,488
#2
#1 NOT (“Animals”[Mesh] NOT “Humans”[Mesh])
9,486
#3
(#2) AND ((“2020”[Date—Publication]: “3000”[Date—Publication])) Filters: English
949
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PsycINFO (via ProQuest) search strategy for borderline personality disorder
SearchQueryResults
S1
DE “Borderline Personality Disorder”
9,216
S2
borderline W1 (disorder# OR patient#)
13,784
S3
S1 OR S2
13,784
S4
S3 (Limiters – Publication Year 2020 – 2021; Language: English)
749
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Criteria for Inclusion/Exclusion of Studies in the Review

The criteria for inclusion and exclusion of studies are designed to identify research that can answer the key questions. The criteria are based on the population, intervention/exposure, comparator, outcomes, time frames, country and clinical settings, and study design (PICOTS).
Inclusion and exclusion criteria
BPD = borderline personality disorder; KQ = key question; N = sample size; NA = not applicable; RCT = randomized controlled trial.
*Very high HDI countries: Andorra, Argentina, Australia, Austria, Bahamas, Bahrain, Barbados, Belarus, Belgium, Brunei Darussalam, Bulgaria, Canada, Chile, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hong Kong, China (SAR), Hungary, Iceland, Ireland, Israel, Italy, Japan, Kazakhstan, Korea (Republic of), Kuwait, Latvia, Liechtenstein, Lithuania, Luxembourg, Malaysia, Malta, Montenegro, Netherlands, New Zealand, Norway, Oman, Poland, Portugal, Qatar, Romania, Russian Federation, Saudi Arabia, Singapore, Slovakia, Slovenia, Spain, Sweden, Switzerland, Taiwan**, United Arab Emirates, United Kingdom, United States, Uruguay.
**The United Nations does not recognize Taiwan (i.e., Republic of China) as a sovereign state and does not include it in the HDI report. However, Taiwan’s government calculated its HDI to be 0.885, based on 2014 data and using the same methodology as the United Nations. This HDI value would place Taiwan among countries in the “very high” human development category and will be included in this report.
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Literature Review, Data Abstraction, and Data Management

To ensure accuracy, two reviewers independently reviewed all titles, abstracts, and full-text articles. We used Distiller SR, an online tool to conduct systematic reviews, to screen the literature (DistillerSR, Evidence Partners, Ottawa, Canada). We resolved discrepancies by consensus or by involving a third, senior reviewer.
All results at both title/abstract and full-text review stages were tracked in an EndNote® bibliographic database (Thomson Reuters, New York, NY). Appendix I presents the list of studies excluded (with reasons) at the full-text level.
We designed, pilot tested, and used a structured data abstraction form in DistillerSR to ensure consistency of data abstraction. We abstracted data into categories that included (but were not limited to) the following: study design, eligibility criteria, intervention, methods of outcome assessment, population characteristics, sample size, attrition, results, and adverse event incidence. A second team member verified abstracted study data for accuracy and completeness.

Assessment of Risk of Bias of Individual Studies

To assess the risk of bias of studies, we used the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) (Sterne et al. 2016) for nonrandomized controlled studies, and for randomized controlled trials (RCTs), we used the Cochrane Risk of Bias 2 tool. Two independent reviewers assessed the risk of bias at the study level and also considered rating bias at an outcome level if methodological limitations might affect different outcomes in a different way (e.g., lack of blinding might increase the risk of bias for quality of life but not for overall mortality). We assigned a “high risk of bias” rating to studies that had very serious limitations in design or conduct that might invalidate findings regarding all or individual outcomes. Disagreements between the two reviewers were resolved by discussion and consensus or by consulting a third member of the team. Risk of bias diagrams were generated using the Risk-Of-Bias VISualization (robvis) tool (McGuinness and Higgins 2021; see Appendix E).

Data Synthesis

We summarized all included studies in narrative form and in summary tables that tabulate the important features of the study populations, design, intervention, outcomes, setting, country, and results. If we found three or more similar studies addressing an outcome of interest, we considered quantitative analysis (i.e., meta-analysis) if studies were similar (in population, interventions, comparators, and outcomes). For all analyses, we used random-effects models (restricted maximum likelihood random effects) to estimate pooled effects. To determine whether quantitative analyses were appropriate, we assessed the clinical and methodological heterogeneity of the studies under consideration following established guidance (Gartlehner et al. 2012). If we conducted meta-analyses, we assessed statistical heterogeneity in effects between studies by calculating the chi-squared statistic and the I2 statistic (the proportion of variation in study estimates attributable to heterogeneity). We examined potential sources of heterogeneity using sensitivity analyses. When quantitative analyses were not appropriate (e.g., due to heterogeneity, insufficient numbers of similar studies, or insufficiency or variation in outcome reporting), we synthesized the data qualitatively.

Grading the Certainty of Evidence for Major Comparisons and Outcomes

We graded the certainty of evidence of relevant outcomes based on current Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance (Balshem et al. 2011). Developed to grade the overall certainty of a body of evidence, this approach incorporates five key domains: 1) risk of bias, 2) inconsistency, 3) indirectness, 4) imprecision of the evidence, and 5) reporting bias. It also considers other optional domains that may be relevant for some scenarios. These included plausible confounding that would decrease the observed effect and strength of association (i.e., magnitude of effect) or factors that would increase the strength of association (i.e., dose-response effect). Two reviewers assessed each domain for each selected outcome and resolved differences by consensus discussion. We documented all decisions regarding up- or down-grading the certainty of evidence to ensure transparency. We used GradePro to develop summary of findings tables for the guideline panel.
A2–14 describes the grades of certainty of evidence, which reflect the certainty of the body of evidence regarding a specific outcome.
Definitions of the grades of certainty of evidence
GradeDefinition
High
We are very confident that the estimate of effect lies close to the true effect for this outcome. The body of evidence has few or no deficiencies. We believe that the findings are stable (i.e., another study would not change the conclusions).
Moderate
We are moderately confident that the estimate of effect lies close to the true effect for this outcome. The body of evidence has some deficiencies. We believe that the findings are likely to be stable, but some doubt remains.
Low
We have limited confidence that the estimate of effect lies close to the true effect for this outcome. The body of evidence has major or numerous deficiencies (or both). We believe that additional evidence is needed before concluding either that the findings are stable or that the estimate of effect is close to the true effect.
Very low
We have no evidence, we are unable to estimate an effect, or we have no confidence in the estimate of effect for this outcome. The body of evidence has unacceptable deficiencies, precluding reaching a conclusion.
Source. Adapted from Balshem et al. 2011.
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Results of Literature Search and Literature Screening

We screened 3,321 titles and abstracts from our literature searches. This represents 3,206 records from database and hand searches plus 115 studies previously included by a comparable search conducted by Doctor Evidence, of which we excluded 32 references. Overall, we identified 92 studies reported in 111 publications that met inclusion criteria (A2–1).
PRISMA flow chart.
APA = American Psychiatric Association; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
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Go to The American Psychiatric Association Practice Guideline for the Treatment of                 Patients With Borderline Personality Disorder
The American Psychiatric Association Practice Guideline for the Treatment of Patients With Borderline Personality Disorder
November 2024
©American Psychiatric Association Publishing

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PRISMA flow chart.
APA = American Psychiatric Association; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Tables

PubMed search strategy for borderline personality disorder
EMBASE search strategy for borderline personality disorder
Cochrane Library search strategy for borderline personality disorder
PsycINFO search strategy for borderline personality disorder
PubMed search strategy for borderline personality disorder
EMBASE search strategy for borderline personality disorder
Cochrane Library search strategy for borderline personality disorder
PsycINFO (via ProQuest) search strategy for borderline personality disorder
PubMed search strategy for borderline personality disorder
PsycINFO (via ProQuest) search strategy for borderline personality disorder
PubMed search strategy for borderline personality disorder
PsycINFO (via ProQuest) search strategy for borderline personality disorder
Inclusion and exclusion criteria
Definitions of the grades of certainty of evidence

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View figure
PRISMA flow chart.
APA = American Psychiatric Association; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Table 1
PubMed search strategy for borderline personality disorder
Table 2
EMBASE search strategy for borderline personality disorder
Table 3
Cochrane Library search strategy for borderline personality disorder
Table 4
PsycINFO search strategy for borderline personality disorder
Table 5
PubMed search strategy for borderline personality disorder
Table 6
EMBASE search strategy for borderline personality disorder
Table 7
Cochrane Library search strategy for borderline personality disorder
Table 8
PsycINFO (via ProQuest) search strategy for borderline personality disorder
Table 9
PubMed search strategy for borderline personality disorder
Table 10
PsycINFO (via ProQuest) search strategy for borderline personality disorder
Table 11
PubMed search strategy for borderline personality disorder
Table 12
PsycINFO (via ProQuest) search strategy for borderline personality disorder
Table 13
Inclusion and exclusion criteria
Table 14
Definitions of the grades of certainty of evidence