Adjustment disorders in primary care: prevalence, recognition and use of services
Open accessAbstract
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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Adjustment disorder with anxiety (ADA) is the most frequent and best characterized stress-related psychiatric disorder.
“Adjustment disorder with anxiety (ADA) is the most frequent and best characterized stress-related psychiatric disorder [2].”
From Efficacy of Seren@ctif, a computer-based stress management program for patients with adjustment disorder with anxiety: Protocol for a controlled trial (2017) · cites this paper as [2]
In the 'Prevalence of adjustment disorder' section (page unavailable), the anxiety subtype was the most frequent adjustment-disorder subtype in this primary-care sample: 50 cases, versus 29 with depressed mood and 31 with other subtypes. That does not establish that it is the most frequent stress-related psychiatric disorder generally. The paper also does not call it the best characterized; its introduction describes evidence on adjustment disorders as scant. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOne of the consequences of the lack of attention to adjustment disorder in mental health research is that the condition is underrecognised and may be mistaken for major depression and treated accordingly.
“One of the consequences of the lack of attention to adjustment disorder in mental health research is that the condition is underrecognised and may be mistaken for major depression 11 and treated accordingly.”
From Adjustment disorder: Implications for ICD-11 and DSM-5 (2012) · cites this paper as [11]
The Results and Recognition sections report that GPs recorded an adjustment-disorder diagnosis in only 2 of 110 identified cases, supporting underrecognition. The paper compares adjustment disorder with major depression and reports psychotropic prescriptions, but it does not establish that GPs mistook these cases for major depression or treated them on that basis. Nor does it establish that lack of research attention caused the underrecognition. (LLM, conf=0.85)
Experimental — accuracy not yet measured
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MODERN APPROACHES TO THE STUDY OF ADJUSTMENT DISORDERS (LITERATURE REVIEW)
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- Authors
- Fernández, A., Mendive, J. M., Salvador-Carulla, L., Rubio-Valera, M., Luciano, J. V., Pinto-Meza, A., Haro, J. M., Palao, D. J., Bellón, J. A., Serrano-Blanco, A., & the DASMAP investigators
- Affiliations
- Institut Català de la Salut (ES)
- Instituto de Salud Carlos III (ES)
- Universitat Autònoma de Barcelona (ES)
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2012-08
- Volume
- 201
- Issue
- 2
- Pages
- 137-142
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2155568829
- Cited by
- 90
- References
- 32
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 2 · 2023: 4 · 2022: 8 · 2021: 4 · 2020: 11 · 2019: 5 · 2018: 13 · 2017: 7 · 2016: 6 · 2015: 5 · 2014: 5 · 2013: 9 · 2012: 3
- FWCI
- 10.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- adjustment disorder, primary care, prevalence, general practitioners, treatment, mental illness, major depressive disorder, anxiety disorders, psychological quality of life, perceived stress, psychotropic prescribing, DSM-IV classification, ICD classification
- MeSH terms
- Adjustment Disorders, Adolescent, Adult, Aged, Community Mental Health Services, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Primary Health Care, Spain, Prevalence, Young Adult
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