Is Brief Admission Effective for Individuals With Lived Experience of Borderline Personality Disorder (BPD) When Experiencing Crisis? A Mixed Systematic Review

Brief admission has been widely used to support individuals with lived experience of borderline personality disorder (BPD) who are experiencing crisis. This study updates a previous 2014 systematic review of the effectiveness of brief admission for individuals with BPD. Following PRISMA guidelines, four databases (MEDLINE, CINAHL, PsychINFO and Cochrane library) were searched from 2011. Two independent reviewers screened titles and abstracts followed by full texts against predefined inclusion criteria. Risk of bias was evaluated using the Mixed Methods Appraisal Tool (MMAT). Due to heterogeneity of studies, meta-analysis was not conducted. Instead, a convergent segregated mixed method was used for data analysis. A total of 4465 studies were screened. Six studies were included in this review: one randomised controlled trial (RCT), two non-RCT quantitative studies and three qualitative studies. All the studies were conducted in European countries; all were adjunctive to community treatment. All the eligible qualitative and RCT studies met the full MMAT criterion, whereas the eligible non-RCT quantitative studies met four of the five criteria. Objective outcomes in terms of rehospitalisation rates showed conflicting evidence. Data integration indicated that the improvement in symptoms and quality of life can be explained by the qualitative findings of positive self-impact. Brief admission as a crisis management tool is acceptable and can be effective. The quality of inpatient care and preplanning appear important in achieving good outcomes. More rigorous evidence is needed to understand the effect on subsequent admission frequency. The effectiveness of admissions unplanned or unlinked to community treatment remains under-investigated.