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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
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
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
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
Adjustment disorder shows a distinct profile as an intermediate category
between no mental disorder and affective disorders (depression and
The World Health Organization (WHO) has stated that the three leading
causes of burden of disease in 2030 are projected to include HIV/AIDS,
unipolar depression and ischaemic heart disease.
To estimate health-related quality of life (HRQoL) and quality-adjusted
life-year (QALY) losses associated with mental disorders and chronic
physical conditions in primary healthcare using data from the diagnosis
and treatment of mental disorders in primary care (DASMAP) study, an
epidemiological survey carried out with primary care patients in
A cross-sectional survey of a representative sample of 3815 primary care
patients. A preference-based measure of health was derived from the
12-item Short Form Health Survey (SF–12): the Short Form–6D (SF–6D)
multi-attribute health-status classification. Each profile generated by
this questionnaire has a utility (or weight) assigned. We used
non-parametric quantile regressions to model the association between both
mental disorders and chronic physical condition and SF–6D scores.
Conditions associated with SF–6D were: mood disorders, β =−0.20 (95% CI
−0.18 to −0.21); pain, β = −0.08 (95%CI −0.06 to −0.09) and anxiety, β
=−0.04 (95% CI −0.03 to −0.06). The top three causes of QALY losses
annually per 100 000 participants were pain (5064), mood disorders (2634)
and anxiety (805).
Estimation of QALY losses showed that mood disorders ranked second behind
pain-related chronic medical conditions.
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