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

doi:10.1017/S0033291719001247

Meta-Analysis

. 2020 Jun;50(8):1300-1315.

doi: 10.1017/S0033291719001247. Epub 2019 Jun 7.

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

Miquel A Fullana^{1

2}, Miquel Tortella-Feliu³, Lorena Fernández de la Cruz⁴, Jacobo Chamorro⁵, Ana Pérez-Vigil⁴, John P A Ioannidis^{6

7

8

9}, Aleix Solanes^{10

11}, Maria Guardiola¹⁰, Carmen Almodóvar¹⁰, Romina Miranda-Olivos¹⁰, Valentina Ramella-Cravaro^{12

13}, Ana Vilar^{14

15}, Abraham Reichenberg^{16

17

18

19}, David Mataix-Cols^{4

20}, Eduard Vieta²¹, Paolo Fusar-Poli^{12

22}, Mar Fatjó-Vilas^{10

23}, Joaquim Radua^{4

10

12

24}

Affiliations

¹ Institute of Neurosciences, Hospital Clinic, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
² Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
³ University Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Mallorca, Spain.
⁴ Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
⁵ Anxiety Unit, Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Barcelona, Spain.
⁶ Department of Medicine, Stanford Prevention Research Center, Stanford, CA, USA.
⁷ Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA.
⁸ Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, USA.
⁹ Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA.
¹⁰ FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain.
¹¹ Department of Psychiatry and Forensic Medicine, School of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
¹² Early Psychosis: Interventions and Clinical-detection Lab (EPIC), Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹³ Department of Mental Health, Florence Public Health Center, Florence, Italy.
¹⁴ Institut de Neuropsiquiatria i Addiccions, CSMIJ Sant Martí-La Mina, Parc de Salut Mar, Barcelona, Spain.
¹⁵ Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain.
¹⁶ Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹⁷ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁸ Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁹ Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
²⁰ Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
²¹ Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, Barcelona, Spain.
²² Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
²³ 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.
²⁴ Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, Barcelona, Spain.

PMID: 31172897
DOI: 10.1017/S0033291719001247

Free article

Meta-Analysis

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

Miquel A Fullana et al. Psychol Med. 2020 Jun.

Free article

. 2020 Jun;50(8):1300-1315.

doi: 10.1017/S0033291719001247. Epub 2019 Jun 7.

Authors

Affiliations

¹ Institute of Neurosciences, Hospital Clinic, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
² Department of Psychiatry and Forensic Medicine, School of Medicine, Universitat Autònoma de Barcelona, Bellaterra, Spain.
³ University Research Institute on Health Sciences (IUNICS), University of the Balearic Islands, Mallorca, Spain.
⁴ Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.
⁵ Anxiety Unit, Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, Barcelona, Spain.
⁶ Department of Medicine, Stanford Prevention Research Center, Stanford, CA, USA.
⁷ Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, USA.
⁸ Meta-Research Innovation Center at Stanford, Stanford University, Stanford, CA, USA.
⁹ Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, USA.
¹⁰ FIDMAG Germanes Hospitalaries, CIBERSAM, Barcelona, Spain.
¹¹ Department of Psychiatry and Forensic Medicine, School of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
¹² Early Psychosis: Interventions and Clinical-detection Lab (EPIC), Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹³ Department of Mental Health, Florence Public Health Center, Florence, Italy.
¹⁴ Institut de Neuropsiquiatria i Addiccions, CSMIJ Sant Martí-La Mina, Parc de Salut Mar, Barcelona, Spain.
¹⁵ Department of Experimental and Health Sciences, Pompeu Fabra University (UPF), Barcelona, Spain.
¹⁶ Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
¹⁷ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁸ Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁹ Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
²⁰ Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
²¹ Barcelona Bipolar Disorders Program, Institute of Neurosciences, Hospital Clinic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, Barcelona, Spain.
²² Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
²³ 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.
²⁴ Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERSAM, Barcelona, Spain.

PMID: 31172897
DOI: 10.1017/S0033291719001247

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 disorders; meta-analysis; obsessive-compulsive disorder; risk factor; umbrella review.

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

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

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