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Risk and protective factors for anxiety and obsessive-compulsive disorders: an umbrella review of systematic reviews and meta-analyses

Published online by Cambridge University Press:  07 June 2019

Miquel A. Fullana Open the ORCID record for Miquel A. Fullana [Opens in a new window] ,
Miquel Tortella-Feliu ,
Lorena Fernández de la Cruz ,
Jacobo Chamorro ,
Ana Pérez-Vigil ,
John P. A. Ioannidis ,
Aleix Solanes ,
Maria Guardiola ,
Carmen Almodóvar  and
Romina Miranda-Olivos
...Show all authors
Miquel A. Fullana*
Affiliation:
Institute of Neurosciences, Hospital Clinic, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain
Miquel Tortella-Feliu
Affiliation:
University Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Mallorca, Spain
Lorena Fernández de la Cruz
Affiliation:
Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
Jacobo Chamorro
Affiliation:
Anxiety Unit, Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Barcelona, Spain
Ana Pérez-Vigil
Affiliation:
Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
John P. A. Ioannidis
Affiliation:
Department of Medicine, Stanford Prevention Research Center, Stanford, CA, USA Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, USA Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA
Aleix Solanes
Affiliation:
FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain Department of Psychiatry and Forensic Medicine, School of Medicine, Autonomous University of Barcelona, Barcelona, Spain
Maria Guardiola
Affiliation:
FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain
Carmen Almodóvar
Affiliation:
FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain
Romina Miranda-Olivos
Affiliation:
FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain
Valentina Ramella-Cravaro
Affiliation:
Early Psychosis: Interventions and Clinical-detection Lab (EPIC), Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK Department of Mental Health, Florence Public Health Center, Florence, Italy
Ana Vilar
Affiliation:
Institut de Neuropsiquiatria i Addiccions, CSMIJ Sant Martí-La Mina, Parc de Salut Mar, Barcelona, Spain Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain
Abraham Reichenberg
Affiliation:
Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
David Mataix-Cols
Affiliation:
Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
Eduard Vieta
Affiliation:
Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, Barcelona, Spain
Paolo Fusar-Poli
Affiliation:
Early Psychosis: Interventions and Clinical-detection Lab (EPIC), Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
Mar Fatjó-Vilas
Affiliation:
FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain Department of Evolutionary Biology, Ecology and Environmental Sciences, Faculty of Biology, University of Barcelona, Institute of Biomedicine of the University of Barcelona (IBUB), Barcelona, Spain
Joaquim Radua
Affiliation:
Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain Early Psychosis: Interventions and Clinical-detection Lab (EPIC), Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, Barcelona, Spain
*
Author for correspondence: Miquel A. Fullana, E-mail: [email protected]
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Abstract

Background

A multitude of risk/protective factors for anxiety and obsessive-compulsive disorders have been proposed. We conducted an umbrella review to summarize the evidence of the associations between risk/protective factors and each of the following disorders: specific phobia, social anxiety disorder, generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder, and to assess the strength of this evidence whilst controlling for several biases.

Methods

Publication databases were searched for systematic reviews and meta-analyses examining associations between potential risk/protective factors and each of the disorders investigated. The evidence of the association between each factor and disorder was graded into convincing, highly suggestive, suggestive, weak, or non-significant according to a standardized classification based on: number of cases (>1000), random-effects p-values, 95% prediction intervals, confidence interval of the largest study, heterogeneity between studies, study effects, and excess of significance.

Results

Nineteen systematic reviews and meta-analyses were included, corresponding to 216 individual studies covering 427 potential risk/protective factors. Only one factor association (early physical trauma as a risk factor for social anxiety disorder, OR 2.59, 95% CI 2.17–3.1) met all the criteria for convincing evidence. When excluding the requirement for more than 1000 cases, five factor associations met the other criteria for convincing evidence and 22 met the remaining criteria for highly suggestive evidence.

Conclusions

Although the amount and quality of the evidence for most risk/protective factors for anxiety and obsessive-compulsive disorders is limited, a number of factors significantly increase the risk for these disorders, may have potential prognostic ability and inform prevention.

Keywords

Anxiety disordersmeta-analysisobsessive-compulsive disorderrisk factorumbrella review
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 8 , June 2020 , pp. 1300 - 1315
Copyright
Copyright © Cambridge University Press 2019

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References

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