Hallahan 2007.

Study characteristics
Methods	12‐week trial with 2 arms: omega‐3 fatty acid placebo Duration of trial: 12 weeks Country: Ireland Setting: outpatient
Participants	Methods of recruitment of patients: "All patients were recruited from the Accident and Emergency (A&E) Department of Beaumont Hospital, an academic teaching hospital in Dublin, Ireland." (Hallahan 2007, p. 118) Overall sample size: 49 Diagnosis of borderline personality disorder: DSM‐IV Means of assessment: SCID‐II Mean age: 30.6 years (SD = no information; range = no information) Sex: 65.31% women Comorbidity: recurrent self‐harm Inclusion criteria: no information Exclusion criteria Current addiction Substance misuse Psychosis Eating disorder Dyslipidaemia Treatment, diet or illness known to interfere with trial drug Weight loss > 10% during previous 3 months Taking supplements containing omega‐3 fatty acids of consuming fish more than once per week Changes to or introduction of psychotropic medication during previous 6 weeks Pregnancy
Interventions	Experimental group Treatment name: omega‐3 fatty acid Number randomised to group: 22 Duration: 12 weeks Control/comparison group Comparison name: placebo Number randomised to group: 27 Duration: 12 weeks Both groups Concomitant psychotherapy: "During the course of the study patients continued to receive standard psychiatric care and had changes to their psychotropic medication as prescribed." (Hallahan 2007, p. 118). Patients with changes to or introduction of psychotropic medication during the 6 weeks prior to screening were not eligible. Concomitant pharmacotherapy: not allowed Proportions of participants taking standing medication during trial observation period: 53.1% of participants continued to receive standard psychiatric care and had changes to their psychotropic medication as prescribed.
Outcomes	Primary outcomes Suicidal behaviour, measured by OAS‐M suicidality subscale. Assessed at baseline and 12 weeks (EOT) Self‐harm: Number of patients with episodes of self‐harm during treatment Secondary outcomes Anger, measured by OAS‐M irritability subscale. Assessed at baseline and 12 weeks (EOT) Impulsivity, measured by OAS‐M aggression subscale. Assessed at baseline and 12 weeks (EOT) Depression, measured by BDI and HRSD. Assessed at baseline and 12 weeks (EOT) Attrition in terms of non‐completers
Notes	Sample calculation: yes Ethics approval: yes Funding source: funded by grants from universities, authorities or research foundations Conflicts of interest: Trial medication was provided by a pharmaceutical company. Comments from trial authors (limitations): "Although 14 patients reported episodes of self‐harm during the study, it was known a priori that the study was insufficiently powered to detect significant differences between groups". (Hallahan 2007, p. 122)
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "computer‐generated list" (Hallahan 2007, p. 119)
Allocation concealment (selection bias)	Low risk	Quote: "An independent colleague dispensed either active or placebo capsules according to a computer‐generated list. The code was only revealed to the researchers once data collection was complete". (Hallahan 2007, p. 119) Comment: Participants and investigators enrolling participants could not foresee assignment because of central allocation.
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Quote: "Participants were prescribed four identical capsules of either active agent or placebo [...] Placebo ensured a degree of equality in the incidence of 'fishy breath', the most frequent side‐effect of taking active treatment." (Hallahan 2007, p. 119)
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Quote: "identical capsules [...] Placebo ensured a degree of equality in the incidence of 'fishy breath' [...] An independent colleague dispensed [...] capsules according to a computer‐generated list. The code was only revealed to the researchers once data collection was complete." (Hallahan 2007, p. 119)
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	Comments: LOCF used, reasons for early termination specified (Hallahan 2007 p. 120): Left district: 1 in active group, 2 in placebo group Lost to follow‐up: 2 in active group, 2 in placebo group Admitted to psychiatric hospital: 0 in active group, 2 in placebo group Refused to continue treatment: 0 in active group, 1 in placebo group Dichotomous outcomes calculated on basis of the ITT sample Of the 49 patients enrolled, 39 completed treatment (19 of the 22 allocated to active treatment, 20 of the 27 allocated to placebo).
Selective reporting (reporting bias)	Unclear risk	Comment: no protocol found
Vested Interest (funding and/or author affiliations)	Low risk	Quotes: "Pronova (now Epax) AS, Lysaker, Norway, provided the active preparation and placebo but were not otherwise involved in the study." (Hallahan 2007, p. 118) "B.H. [i.e. first author] received salary support from the Department of Psychiatry, University of Illinois at Chicago, USA." (Hallahan 2007, p. 122)
Other bias	Low risk	Comment: No apparent other sources of bias found