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Adjustment disorders in primary care: prevalence, recognition and use of services

  • Anna Fernández (a1), Juan M. Mendive (a2), Luis Salvador-Carulla (a3), María Rubio-Valera (a4), Juan Vicente Luciano (a3), Alejandra Pinto-Meza (a3), Josep Maria Haro (a5), Diego J. Palao (a6), Juan A. Bellón (a7), Antoni Serrano-Blanco (a8) and the DASMAP investigators...

Abstract

Background

Within the ICD and DSM review processes there is growing debate on the future classification and status of adjustment disorders, even though evidence on this clinical entity is scant, particularly outside specialised care.

Aims

To estimate the prevalence of adjustment disorders in primary care; to explore whether there are differences between primary care patients with adjustment disorders and those with other mental disorders; and to describe the recognition and treatment of adjustment disorders by general practitioners (GPs).

Method

Participants were drawn from a cross-sectional survey of a representative sample of 3815 patients from 77 primary healthcare centres in Catalonia. The prevalence of current adjustment disorders and subtypes were assessed face to face using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Multilevel logistic regressions were conducted to assess differences between adjustment disorders and other mental disorders. Recognition and treatment of adjustment disorders by GPs were assessed through a review of patients' computerised clinical histories.

Results

The prevalence of adjustment disorders was 2.94%. Patients with adjustment disorders had higher mental quality-of-life scores than patients with major depressive disorder but lower than patients without mental disorder. Self-perceived stress was also higher in adjustment disorders compared with those with anxiety disorders and those without mental disorder. Recognition of adjustment disorders by GPs was low: only 2 of the 110 cases identified using the SCID-I were detected by the GP. Among those with adjustment disorders, 37% had at least one psychotropic prescription.

Conclusions

Adjustment disorder shows a distinct profile as an intermediate category between no mental disorder and affective disorders (depression and anxiety disorders).

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Copyright

Corresponding author

Dr Anna Fernández, Parc Sanitari Sant Joan de Déu, Research and Development Unit, Fundació Sant Joan de Déu, Dr Antoni Pujadas 42, 08830 Sant Boi de Llobregat, Barcelona, Spain. Email: afernandez@pssjd.org

Footnotes

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See editorial, pp. 90–92, this issue.

Declaration of interest

None.

Footnotes

References

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Adjustment disorders in primary care: prevalence, recognition and use of services

  • Anna Fernández (a1), Juan M. Mendive (a2), Luis Salvador-Carulla (a3), María Rubio-Valera (a4), Juan Vicente Luciano (a3), Alejandra Pinto-Meza (a3), Josep Maria Haro (a5), Diego J. Palao (a6), Juan A. Bellón (a7), Antoni Serrano-Blanco (a8) and the DASMAP investigators...
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