Abstract
BackgroundAlthough psychoses and ethnicity are well researched, the importance of culture, race and ethnicity has been overlooked in Personality Disorders (PD) research. This study aimed to review the published literature on ethnic variations of prevalence, aetiology and treatment of PD.MethodA systematic review of studies of PD and race, culture and ethnicity including a narrative synthesis of observational data and meta-analyses of prevalence data with tests for heterogeneity.ResultsThere were few studies with original data on personality disorder and ethnicity. Studies varied in their classification of ethnic group, and few studies defined a specific type of personality disorder. Overall, meta-analyses revealed significant differences in prevalence between black and white groups (OR 0.476, CIs 0.248 - 0.915, p = 0.026) but no differences between Asian or Hispanic groups compared with white groups. Meta-regression analyses found that heterogeneity was explained by some study characteristics: a lower prevalence of PD was reported among black compared with white patients in UK studies, studies using case-note diagnoses rather than structured diagnostic interviews, studies of borderline PD compared with the other PD, studies in secure and inpatient compared with community settings, and among subjects with co-morbid disorders compared to the rest. The evidence base on aetiology and treatment was small.ConclusionThere is some evidence of ethnic variations in prevalence of personality disorder but methodological characteristics are likely to account for some of the variation. The findings may indicate neglect of PD diagnosis among ethnic groups, or a true lower prevalence amongst black patients. Further studies are required using more precise cultural and ethnic groups.
Highlights
Psychoses and ethnicity are well researched, the importance of culture, race and ethnicity has been overlooked in Personality Disorders (PD) research
Black and minority ethnic groups are known to be over-represented in mental health services, especially in forensic and secure settings and inpatient care
Defining PD Interview schedules were used to establish PD prevalence in three studies; the schedules included the NIMH Diagnostic Interview Schedule Version III-R [8], the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM IV version [9], the Structured Clinical Interview for DSM-IV Axis II [10], and the Structured Clinical Interview for DSM-IV, Patient Version[10] The other four studies relied on case-notes
Summary
Psychoses and ethnicity are well researched, the importance of culture, race and ethnicity has been overlooked in Personality Disorders (PD) research. This study aimed to review the published literature on ethnic variations of prevalence, aetiology and treatment of PD. One aspect that has been overlooked that may reveal a better understanding about the aetiology and treatment of personality disorder is the impact of culture, race and ethnicity on PD [2]. Black and minority ethnic groups are known to be over-represented in mental health services, especially in forensic and secure settings and inpatient care. This study aimed to systematically review all available published literature that addresses PD prevalence, aetiology and treatment in relation to race and ethnicity
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