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Shi X, Zhao Y, Wan Q, Chai P, Ma Y. Curative care expenditure of outpatient anxiety disorder in Liaoning Province, 2015-2020-based on "System of Health Accounts 2011". Front Public Health 2024; 12:1329596. [PMID: 39022419 PMCID: PMC11251961 DOI: 10.3389/fpubh.2024.1329596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Anxiety disorders are the most common mental disorder, experienced by more than a quarter of the population. This study examines total outpatient curative care expenditures (CCE) for anxiety disorders and changes in their composition based on the System of Health Accounts 2011 (SHA 2011). Methods This study used multi-stage stratified random from a total of 9,318,513 outpatient sample data by 920 healthcare organizations, a total of 109,703 cases of anxiety disorders from 53 sample organizations (5.76%) from 2015 to 2020. Univariate analysis, multifactor analysis and structural equation modeling (SEM) were used to explore the influential factors affecting outpatient CCE for anxiety disorders. Results Anxiety disorder outpatient CCE from 2015 to 2020 continued to increase from CNY 99.39million in 2015 to CNY 233.84 million in 2020, mainly concentrated in western medicine costs, 15-64 years, general hospital, generalized anxiety disorder and public financing. The results of univariate analysis showed statistically significant differences in all subgroups, and the results of multivariate analysis and SEM showed that the choice to purchase western drugs, purchase prepared Chinese drugs, choice to have a checkup, urban employees' basic medical insurance, and 0-14 years old were associated with high anxiety disorder outpatient CCE. Conclusion Initiatives to improve the essential drug system, reduce the out-of-pocket (OOP) ratio, and strengthen primary health care to effectively reduce the medical burden on patients.
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Affiliation(s)
- Xiaoxia Shi
- Department of Traditional Chinese Medicine, School of Graduate Students, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Yue Zhao
- Department of Traditional Chinese Medicine, School of Graduate Students, Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Quan Wan
- China National Health Development Research Center, Beijing, China
| | - Peipei Chai
- China National Health Development Research Center, Beijing, China
| | - Yuedan Ma
- Department of Public Management, School of Economics and Management, Liaoning University of Traditional Chinese Medicine, Shenyang, China
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Sáenz-Herrero M, Recio-Barbero M, López-Atanes M, Santorcuato A, Bacigalupe A, Segarra R. Gender differences in the management of acute psychiatric episodes in the emergency department: a cross-sectional analysis of the 2017-2019 triennium. Arch Womens Ment Health 2023; 26:777-783. [PMID: 37620657 DOI: 10.1007/s00737-023-01360-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 08/02/2023] [Indexed: 08/26/2023]
Abstract
There is growing evidence that gender is an important determinant of mental health and well-being. In this sense, both biological and socio-economic factors play a key role in how people experience psychological disturbances. This study examine whether there were sex- and gender-based differences in the management of psychiatric disorders in the emergency department (ED). A cross-sectional retrospective study was conducted in the ED over the 2017-2019 period. Sex was codified as female/male and socio-economic deprivation index was compiled to address the impact of social determinants. Episodes were reclassified according to four major clusters. Psychotropic drug prescription was categorized according to the ATC classification. Poisson regression models, adjusted for age and socioeconomic status, were used. A total of 9789 episodes (53.9% females) of individuals who required an acute-related psychiatric intervention were retrieved. Age distribution and socioeconomic quintiles revealed gender differences. Anxiety-related consultations accounted for up to 50% of all episodes. Female gender was found to be overrepresented in anxiety and stress-related disorders, mood disorders, and personality disorders. In contrast, Males accounted for 70% of all psychoactive substance use disorders. Considering main clinical syndromic clusters, analysis showed that female patients were more likely to be prescribed with anxiolytic treatment in ED treatment than men in the categories of "Common mental disorders" (PR = 1.122 [1.014-1.242; p = 0.025), "Severe Mental Disorders" (PR = 1.217[1.054-1.406] p = 0.007) and "Personality disorders" (PR = 1.398 (1.038 - 1.884); p = 0.028). This study highlights the relevance of considering sex and gender as potential determinants in both the clinical presentation and management of psychiatric emergencies.
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Affiliation(s)
- Margarita Sáenz-Herrero
- Department of Psychiatry, Cruces University Hospital, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain
- Department of Psychiatry, University of the Basque Country, UPV/EHU, Leioa, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Leioa, Spain
| | - María Recio-Barbero
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain.
- Department of Psychiatry, University of the Basque Country, UPV/EHU, Leioa, Spain.
| | - Mayte López-Atanes
- Department of Psychiatry, University of the Basque Country, UPV/EHU, Leioa, Spain
- Universitätsklinikum Hamburg-Eppendorf - Koordinierendes Zentrum Für Traumatisierte Geflüchtete, Hamburg, Germany
| | - Ana Santorcuato
- Emergency Department, Cruces University Hospital, Barakaldo, Spain
| | - Amaia Bacigalupe
- Department of Sociology and Social Work, Social Determinants of Health and Demographic Change-OPIK Research Group, University of the Basque Country, UPV/EHU, Leioa, Spain
| | - Rafael Segarra
- Department of Psychiatry, Cruces University Hospital, Barakaldo, Spain
- Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Barakaldo, Spain
- Department of Psychiatry, University of the Basque Country, UPV/EHU, Leioa, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Leioa, Spain
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Shafierizi S, Basirat Z, Nasiri-Amiri F, Kheirkhah F, Chehrazi M, Pasha H, Faramarzi M. The prevalence of adjustment disorder and predisposing factors in infertile women. BMC Psychol 2023; 11:142. [PMID: 37131228 PMCID: PMC10152011 DOI: 10.1186/s40359-023-01193-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 04/27/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Infertility is a stressful life event that increases the risk of developing mental disorders, particularly adjustment disorder (AD). Given the paucity of data on the prevalence of AD symptoms in infertility, the purpose of this study was to ascertain the prevalence, clinical presentation, and risk factors for AD symptoms in infertile women. METHOD In a cross-sectional study, 386 infertile women completed questionnaires including the Adjustment Disorder New Module-20 (ADNM), the Fertility Problem Inventory (FPI), the Coronavirus Anxiety Scale (CAS), and the Primary Care Posttraumatic Stress Disorder (PC-PTSD-5) at an infertility center between September 2020 and January 2022. RESULT The results indicated that 60.1% of infertile women exhibited AD symptoms (based on ADNM > 47.5). In terms of clinical presentation, impulsive behavior was more common. No significant relationship was observed between prevalence and women's age or duration of infertility. Infertility stress (β = 0.27, p < 0.001), coronavirus anxiety (β = 0.59, p = 0.13), and a history of unsuccessful assisted reproductive therapies (β = 2.72, p = 0.008) were several predisposing factors for AD symptoms in infertile women. CONCLUSIONS The findings suggest that all infertile women be screened from the start of infertility treatment. Additionally, the study suggests that infertility specialists should focus on combining medical and psychological treatments for individuals predisposed to AD, particularly infertile women who exhibit impulsive behaviors.
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Affiliation(s)
- Shiva Shafierizi
- Counselling in Midwifery, Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Zahra Basirat
- Department of Obstetrics and Gynecology, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Fatemeh Nasiri-Amiri
- Department of Reproductive Health, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Farzan Kheirkhah
- Department of Psychiatry, Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Chehrazi
- Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran
| | - Hajar Pasha
- Department of Reproductive Health, Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Mahbobeh Faramarzi
- Department of Psychology, Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
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Morgan MA, O'Gallagher K, Kelber MS, Garvey Wilson AL, Evatt DP. Diagnostic and functional outcomes of adjustment disorder in U.S. active duty service members. J Affect Disord 2023; 323:185-192. [PMID: 36455712 DOI: 10.1016/j.jad.2022.11.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adjustment disorder (AD) is a commonly diagnosed psychiatric disorder. However, little is known about its course, predictors of its diagnostic outcomes, or its association with functional impairment. Our primary aim was to examine diagnostic transitions of service members with an incident AD diagnosis (IADx) to one of three states: 1) another psychiatric diagnosis, 2) chronic AD, or 3) no psychiatric diagnosis. Secondary outcomes included predictors of diagnostic course and functional outcomes associated with follow-up diagnoses. METHODS Health records of a random sample of 10,720 service members with an IADx were analyzed using multinomial logit regression and hazard rate model with competing risks. RESULTS IADx transitions were 24.3 % to another psychiatric diagnosis, 8.9 % with chronic AD, and 43.7 % without a diagnosis. Nearly a quarter (23.1 %) separated from service. Deployment was the strongest predictor of transitioning to another diagnosis. Those who transitioned to another diagnosis separated at an increased rate and with more adverse outcomes. LIMITATIONS Diagnostic findings are based on data in the electronic health record, and we could not specifically identify the stressor that precipitated an AD diagnosis. These findings describe the course of AD in military personnel and may not generalize to civilians. CONCLUSIONS AD, as initially diagnosed, represents a heterogeneous disorder with an enduring impact across the military career for a considerable proportion of service members. As an early indicator of more severe psychiatric outcomes, an IADx may signal an opportunity for early intervention and screening, particularly in service members with a history of deployment.
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Affiliation(s)
- Maria A Morgan
- Psychological Health Center of Excellence (PHCoE), Defense Health Agency, USA.
| | - Kevin O'Gallagher
- Psychological Health Center of Excellence (PHCoE), Defense Health Agency, USA
| | | | | | - Daniel P Evatt
- Psychological Health Center of Excellence (PHCoE), Defense Health Agency, USA
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Ramamurthy P, Alexander A, Solomon S, Thilakan P. Prescription Pattern and Follow-up Pattern in Psychiatric Outpatients with Adjustment Disorder. Indian J Psychol Med 2022; 44:530-531. [PMID: 36157011 PMCID: PMC9460020 DOI: 10.1177/02537176211015098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Parthasarathy Ramamurthy
- Dept. of Psychiatry, Pondicherry Institute of Medical Science (A Unit of Madras Medical Mission), Kalapet, Puducherry, India
| | - Aneesh Alexander
- Dept. of Psychiatry, Pondicherry Institute of Medical Science (A Unit of Madras Medical Mission), Kalapet, Puducherry, India
| | - Susan Solomon
- Dept. of Psychiatry, Pondicherry Institute of Medical Science (A Unit of Madras Medical Mission), Kalapet, Puducherry, India
| | - Pradeep Thilakan
- Dept. of Psychiatry, Pondicherry Institute of Medical Science (A Unit of Madras Medical Mission), Kalapet, Puducherry, India
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Gabet M, Gentil L, Lesage A, Fleury MJ. Investigating characteristics of patients with mental disorders to predict out-patient physician follow-up within 30 days of emergency department discharge. BJPsych Open 2022; 8:e95. [PMID: 35579032 PMCID: PMC9169501 DOI: 10.1192/bjo.2022.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prompt follow-up at emergency department discharge is a key indicator of healthcare quality and patient recovery. To improve services, better knowledge of predictors for out-patient physician follow-up within 30 days after discharge is needed. AIMS We investigated clinical and sociodemographic characteristics and service use to predict patients with mental disorders with or without physician follow-up after emergency department use. METHOD This study used data extracted from clinical administrative databases for 9514 patients who attended an emergency department in Quebec (Canada) in 2014-2015 (index visit) for mental health reasons. Patient clinical and sociodemographic characteristics from 2012-2013 to 2014-2015, and service use 12 months before the index visit, were investigated as predictors for patients with or without prompt follow-up, using hierarchical logistic regression. RESULTS Two-thirds of patients did not receive prompt physician follow-up. Patients with level 1-2 illness acuity at emergency department triage (needing immediate or urgent care); those with adjustment or bipolar disorders, but without alcohol-related disorders (clinical characteristics); and patients with higher continuity of physician care, more psychosocial interventions in community healthcare centres and prior hospital admission (service use characteristics) were more likely to receive prompt out-patient follow-up. CONCLUSIONS Access to medical care was poor, considering the high needs of this population. The role of the emergency department as a gateway for accessing out-patient care may be strengthened by strategies like screening, brief intervention including motivational treatments, brief case management offered by emergency department staff, timely referral to services and better post-discharge planning. Collaborative care for patients attending emergency departments should also be improved.
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Affiliation(s)
- Morgane Gabet
- Department of Health Administration, School of Public Health, Université de Montréal, Canada; and Douglas Hospital Research Center, Canada
| | - Lia Gentil
- Douglas Hospital Research Center, Canada; and Department of Psychiatry, McGill University, Canada
| | - Alain Lesage
- Department of Psychiatry, Université de Montréal, Canada; and Centre de recherche Fernand-Séguin, Institut universitaire en santé mentale de Montréal, Canada
| | - Marie-Josée Fleury
- Department of Health Administration, School of Public Health, Université de Montréal, Canada; Douglas Hospital Research Center, Canada; and Department of Psychiatry, McGill University, Canada
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Kelber MS, Morgan MA, Beech EH, Smolenski DJ, Bellanti D, Galloway L, Ojha S, Otto JL, Wilson ALG, Bush N, Belsher BE. Systematic review and meta-analysis of predictors of adjustment disorders in adults. J Affect Disord 2022; 304:43-58. [PMID: 35176345 DOI: 10.1016/j.jad.2022.02.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/22/2021] [Accepted: 02/13/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The diagnosis of adjustment disorder is common in clinical practice, yet there is lack of research on the etiology and epidemiology of adjustment disorders. The goal of this systematic review was to evaluate predictors of adjustment disorders in adults. METHODS We conducted systematic searches in MEDLINE, EMBASE, and PsycINFO. We included 70 studies that examined thirteen theoretically-derived and predefined predictors of adjustment disorders with a total of 3,449,374 participants. RESULTS We found that female gender, younger age, unemployed status, stress, physical illness and injury, low social support, and a history of mental health disorders predicted adjustment disorders. Most of these predictors differentiated individuals with adjustment disorders from individuals with no mental health disorders. Participants with adjustment disorders were more likely to have experienced accidents than were those with posttraumatic stress disorder but were less likely to have experienced assaults and abuse, neglect, and maltreatment. More research is needed to identify factors that differentiate adjustment disorders from other mental health disorders. LIMITATIONS Because very few studies adjusted for confounders (e.g., demographic variables, mental health histories, and a variety of stressors), it was not possible to identify independent associations between predictors and adjustment disorders. CONCLUSIONS We identified a number of factors that predicted adjustment disorders compared to no mental health diagnosis. The majority of studies were rated as moderate or high in risk of bias, suggesting that more rigorous research is needed to confirm the relationships we detected.
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Affiliation(s)
- Marija Spanovic Kelber
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA.
| | - Maria A Morgan
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Erin H Beech
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Derek J Smolenski
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Dawn Bellanti
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Lindsay Galloway
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Suman Ojha
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Jean Lin Otto
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Abigail L Garvey Wilson
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA; Department of Epidemiology, George Washington University, Washington, DC, USA
| | - Nigel Bush
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Bradley E Belsher
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA; Carl T Hayden Veterans Medical Center, Phoenix, AZ, USA
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8
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Abstract
After participating in this activity, learners should be better able to:• Assess strategies for diagnosing depressive disorders in patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)• Identify factors that contribute to the development of depressive disorders in HIV/AIDS• Evaluate strategies for managing depressive disorders in HIV/AIDS ABSTRACT: Depressive disorders and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are associated with major socioeconomic burdens. The negative impact of depressive disorders on HIV/AIDS is well known, including on treatment outcomes. Unfortunately, depressive disorders are underdiagnosed and undertreated in seropositive persons. This review summarizes clinically useful information on depressive disorders in HIV/AIDS. More specifically, we address assessment, differential diagnosis, contributing factors, management, and common challenges in the treatment of depressive disorders in seropositive individuals. Assessment and diagnosis of depression may be challenging in seropositive persons because of several biopsychosocial particularities associated with HIV/AIDS. One of the difficulties is the overlap between depression and HIV/AIDS symptoms, particularly in individuals with advanced AIDS, requiring consideration of a broad differential diagnosis. Several factors related to HIV/AIDS status contribute to the higher rates of depressive disorders, including infectious-immunological, psychosocial, and exogenous factors. The treatment of depressive disorders in HIV/AIDS involves three groups of interventions: (1) pharmacological interventions, (2) psychotherapeutic interventions, and (3) management of other contributing factors. Challenges in management include poor adherence to treatment and the risk of suicide. We provide evidence-based recommendations to improve assessment and management of depressive disorders in seropositive persons.
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Wilfong KM, Goodie JL, Curry JC, Hunter CL, Kroke PC. The Impact of Brief Interventions on Functioning Among those Demonstrating Anxiety, Depressive, and Adjustment Disorder Symptoms in Primary Care: The Effectiveness of the Primary Care Behavioral Health (PCBH) Model. J Clin Psychol Med Settings 2021; 29:318-331. [PMID: 34626278 DOI: 10.1007/s10880-021-09826-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Abstract
Limited scalability combined with limited opportunities for patients to receive evidence-based interventions in traditional behavioral health treatment models for anxiety and depression creates a gap in access to adequate care. Primary Care Behavioral Health (PCBH) is one model of treatment in which behavioral health consultants (BHC) work directly within primary care settings, but there is limited evidence regarding the effectiveness of this model of care. The functional outcomes and appointment characteristics of Beneficiaries (N = 5402) within the military healthcare system were assessed. The study sample was predominately Caucasian, female, military dependents seen for 2 to 4 appointments. A reliable change index revealed that 17.2% showed reliable improvement and 2.4% showed reliable deterioration (p < .05). Of individuals with a severe Behavioral Health Measure-20 score at baseline, 81.5% showed some improvement at their final appointment, with 33% demonstrating reliable improvement. A mixed model analysis was used to determine the predictive value of appointment characteristics. All relations were significant (p < .001), except the between-subjects effect of appointment duration. Appointment duration revealed individuals reported worse functioning at the start of atypically long appointments. Individuals with generally longer intervals between appointments reported worse functioning, but an atypically long interval predicted better functioning at the following appointment. As it relates to number of appointments, individuals with more total appointments reported worse functioning outcomes, with generally better functioning across appointments. Overall, these data support the effectiveness of time-limited care provided through the PCBH model.
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Affiliation(s)
- Kevin M Wilfong
- Uniformed Service University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA.
| | - Jeffrey L Goodie
- Uniformed Service University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
| | - Justin C Curry
- Defense Health Agency, Clinical Support Division, Patient Centered Medical Home Branch, 7700 Arlington Boulevard, Suite 5101, Falls Church, VA, 22042, USA
| | - Christopher L Hunter
- Defense Health Agency, Clinical Support Division, Patient Centered Medical Home Branch, 7700 Arlington Boulevard, Suite 5101, Falls Church, VA, 22042, USA
| | - Phillip C Kroke
- Uniformed Service University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA
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Bajjani-Gebara J, Wilcox SL, Williams JW, Kosinski AS, Allard RJ, Wilson C, Landoll R. Adjustment Disorders in U.S. Active Duty Military Women: A Scoping Review for the Years 2000 to 2018. Womens Health Issues 2021; 31 Suppl 1:S33-S42. [PMID: 34454702 DOI: 10.1016/j.whi.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/20/2020] [Accepted: 12/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adjustment disorder (AD) is the most common mental health diagnosis in the U.S. military and is more than twice as likely to be diagnosed in active duty servicewomen as compared with male servicemembers. The literature on ADs, particularly in female servicemembers, has not been reviewed yet. We conducted a scoping review of the literature to explore the degree of research activity and summarize current literature gaps. METHODS We created a PRISMA-ScR checklist and prospectively registered it in Open Science Framework. The literature search included articles (including studies and reports) published between 2000 and 2018 in either the grey literature or the following databases: Ovid Medline, CINAHL, Embase, PsycINFO, Web of Science, and Ovid Cochrane. We used DistillerSR to conduct title and abstracts screening, full-text screening, and data charting. The social ecological model for military women's health framework was used to organize the results. RESULTS After screening 1,304 records, 29 were included for data charting. Most frequently, studies were descriptive (cross-sectional) (25%), with no randomized controlled studies. The studies primarily focused on ADs' risk factors in servicewomen (76%), followed by military readiness (38%). Only 14% addressed recommendations for treatments based on expert opinion, although they did not directly test interventions, and 7% focused on health outcomes. CONCLUSIONS ADs affect the health of U.S. military women and military readiness, yet little is known about their successful treatment or health outcomes. Additional research in those areas is warranted.
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Affiliation(s)
- Jouhayna Bajjani-Gebara
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, Maryland.
| | - Sherrie L Wilcox
- Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Department of Preventive Medicine and Biostatistics, Bethesda, Maryland
| | - John W Williams
- Duke University Medical Center, Duke University School of Medicine, Durham, North Carolina
| | - Andrzej S Kosinski
- Duke University School of Medicine, Department of Biostatistics and Bioinformatics, Durham, North Carolina
| | - Rhonda J Allard
- Uniformed Services University of the Health Sciences, James A. Zimble Learning Resource Center, Bethesda, Maryland
| | - Candy Wilson
- Uniformed Services University of the Health Sciences, Daniel K. Inouye Graduate School of Nursing, Bethesda, Maryland
| | - Ryan Landoll
- Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine, Bethesda, Maryland
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Abstract
BACKGROUND Adjustment disorder requires therapeutic intervention because of its complications, which include a significant risk of suicide, but evidence-based therapeutic guidelines are not available. AREAS OF UNCERTAINTY The main problem is related to answer to the following question: What is the optimal therapeutic approach to adjustment disorder? In this respect we review all randomized controlled trials that aimed to investigate therapeutic interventions for adjustment disorder in adult populations. DATA SOURCES Comprehensive search of the electronic database PubMed (January 1980-June 2019). The review included clinical trials that aimed to investigate a psychological or pharmacological treatment for adjustment disorder in adult population and reported outcome data for therapeutic interventions. RESULTS The search identified 23 studies that fulfilled the inclusion criteria for this review. Pharmacotherapy interventions were the focus of 11 studies that used various medications and dosages including viloxazine, lormetazepam, S-adenosylmethionine, pivagabine, trazodone, clorazepate, etifoxine, lorazepam, diazepam, afobazole, and plant extracts (Kava-kava, Euphytose, and Ginkgo biloba) on a total number of 1020 patients. Psychotherapy interventions were identified in 12 studies that used mirror therapy, short-term dynamic psychotherapy, yoga meditation, body-mind-spirit technique, mindfulness, bibliotherapy (self-help manual), humor training, and cognitive behavioral therapy. CONCLUSIONS Psychotherapy seems indicated for mildly symptomatic adjustment disorder. Given the fact that adjustment disorder with severe symptoms is associated with a high risk of suicidal ideation and suicide attempts, clinicians must consider the potential benefit of using psychotropic agents such as benzodiazepines, antidepressants, or etifoxine.
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12
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Oh DJ, Kim SR, Kim EY, Baik MJ. Comparison of Autonomic Reactivity to the Stress between Adjustment Disorder and Major Depressive Disorder. Psychiatry Investig 2020; 17:1175-1181. [PMID: 33301669 PMCID: PMC8560334 DOI: 10.30773/pi.2020.0209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Adjustment disorder (AD) remains an ambiguous diagnosis that overlaps with major depressive disorder (MDD). This study compared autonomic reactivity to the stress between AD and MDD to test for biological differences. METHODS Physically healthy Korean male soldiers admitted to a psychiatric ward were recruited for participation. Clinical diagnoses indicated that 62 patients with AD and 47 with MDD were selected. Procedures consisted of electrocardiogram measurements according to three consecutive phases lasting five minutes each [i.e., resting, stress (including a mental arithmetic task and Stroop color word test), and recovery]. RESULTS The reactive trends of all heart rate variability (HRV) parameters related to the stress tasks in participants with AD did not differ from those with MDD. High-frequency HRV (a proxy of parasympathetic activity) increased during times of stress for participants with AD and MDD. Despite similar reactive trends, AD participants had higher HRV values than participants with MDD during whole phases, particularly for variables reflecting overall autonomic activity. CONCLUSION AD is associated with higher basal activity in the autonomous nervous system when compared to MDD. However, both are associated with pathophysiology indicating an altered autonomic reactivity to stress.
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Affiliation(s)
- Dae Jong Oh
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Sae Rom Kim
- Department of Psychiatry, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Eun Young Kim
- Mental Health Center, Seoul National University Health Care Center, Seoul, Republic of Korea.,Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myung Jae Baik
- Gyeonggi Provincial Mental Health Center, Suwon, Republic of Korea
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Zapata-Ospina JP, Sierra-Muñoz JS, Cardeño-Castro CA. [Diagnosis and treatment of adjusment disorder in primary care]. Semergen 2020; 47:197-206. [PMID: 33214076 DOI: 10.1016/j.semerg.2020.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/22/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Abstract
Adjustment disorder (AD) corresponds to the combination of affective, cognitive and behavioral symptoms that appear after a stressful event. It is a frequent reason for consultation in primary care and is one of the most common diagnoses in suicide attempts attended in the emergency department. Its essential feature is that the symptoms must appear in direct relation to an event perceived as stressful, so it tends to be transitory if the event ceases or the patient adapts. The mainstay of treatment are psychosocial interventions, aimed at modifying the event or its consequences, supporting adaptation and optimizing resources to cope with the event. However, prescription of psychotropic drugs is favored in practice, when its use should be limited to symptomatic relief. This highlights the need to properly identify and treat it. This article presents the strategies for diagnosis and treatment of AD in primary care.
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Affiliation(s)
- J P Zapata-Ospina
- Instituto de Investigaciones Médicas, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
| | - J S Sierra-Muñoz
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia
| | - C A Cardeño-Castro
- Servicio de Psiquiatría de Enlace, Hospital Universitario San Vicente Fundación, Medellín, Colombia
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14
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Rachyla I, Mor S, Cuijpers P, Botella C, Castilla D, Quero S. A guided Internet-delivered intervention for adjustment disorders: A randomized controlled trial. Clin Psychol Psychother 2020; 28:313-324. [PMID: 32959481 DOI: 10.1002/cpp.2518] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 12/11/2022]
Abstract
Evidence of self-help interventions for adjustment disorder (AjD) is limited. This study aims at testing in a randomized controlled trial (RCT) the effectiveness of a disorder-specific, Internet-delivered cognitive-behavioural therapy (ICBT) intervention for AjD. Participants were randomly allocated to either an ICBT with brief weekly telephone support (n = 34) or a waiting list group (n = 34). Beck's inventories for depression and anxiety were used as primary outcomes. The secondary outcomes were AjD symptoms, post-traumatic growth, positive and negative affect, and quality of life. In all, 76.5% of the participants completed the intervention. Compared with the control group, participants in the intervention condition showed significantly greater improvement in all outcomes (Cohen's d ranged from 0.54 to 1.21) except in anxiety symptoms measured by Beck Anxiety Inventory (d = 0.27). Only ICBT group showed a significant improvement in post-traumatic growth, positive and negative affect, and quality of life. The number of cases that achieved clinically meaningful change in all outcome measures was also higher in the ICBT group. All therapeutic gains were maintained at 3-, 6- and 12-month follow-ups. The current study provides evidence on the effectiveness of ICBT interventions to reduce the impact of AjD. Results suggest that brief self-help intervention with minimal therapist support is more effective than the mere passage of time in reducing the distress symptoms associated to the disorder and also can confer additional benefits.
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Affiliation(s)
- Iryna Rachyla
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Sonia Mor
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health research institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cristina Botella
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain.,CIBER of Physiopathology of Obesity and Nutrition (CIBERObn), Madrid, Spain
| | - Diana Castilla
- CIBER of Physiopathology of Obesity and Nutrition (CIBERObn), Madrid, Spain.,Department of Personality, Evaluation and Psychological Treatment, Universidad de Valencia, Valencia, Spain
| | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain.,CIBER of Physiopathology of Obesity and Nutrition (CIBERObn), Madrid, Spain
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15
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The 12-month course of ICD-11 adjustment disorder in the context of involuntary job loss. CLINICAL PSYCHOLOGY IN EUROPE 2020; 2:e3027. [DOI: 10.32872/cpe.v2i3.3027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/18/2020] [Indexed: 11/25/2022] Open
Abstract
Background
After its redefinition in ICD-11, adjustment disorder (AjD) comprises two core symptom clusters of preoccupations and failure to adapt to the stressor. Only a few studies investigate the course of AjD over time and the definition of six months until the remission of the disorder is based on little to no empirical evidence. The aim of the present study was to investigate the course of AjD symptoms and symptom clusters over time and to longitudinally evaluate predictors of AjD symptom severity.
Method
A selective sample of the Zurich Adjustment Disorder Study, N = 105 individuals who experienced involuntary job loss and reported either high or low symptom severity at first assessment (t1), were assessed M = 3.4 (SD = 2.1) months after the last day at work, and followed up six (t2) and twelve months (t3) later. They completed a fully structured diagnostic interview for AjD and self-report questionnaires.
Results
The prevalence of AjD was 21.9% at t1, 6.7% at t2, and dropped to 2.9% at t3. All individual symptoms and symptom clusters showed declines in prevalence rates across the three assessments. A hierarchical regression analysis of symptoms at t3 revealed that more symptoms at the first assessment (β = 0.32, p = .002) and the number of new life events between the first assessment and t3 (β = 0.29, p = .004) significantly predicted the number of AjD symptoms at t3.
Conclusion
Although prevalence rates of AjD declined over time, a significant proportion of individuals still experienced AjD symptoms after six months. Future research should focus on the specific mechanisms underlying the course of AjD.
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16
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Casey P, Pillay D, Wilson L, Maercker A, Rice A, Kelly B. Pharmacological interventions for adjustment disorders in adults. Hippokratia 2020. [DOI: 10.1002/14651858.cd010530.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Patricia Casey
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
| | - Divina Pillay
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
| | - Lorna Wilson
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
| | - Andreas Maercker
- Department of Psychology; University of Zurich; Zurich Switzerland
| | - Angela Rice
- Library and Information Service; Mater Misericordiae University Hospital; Dublin Ireland
| | - Brendan Kelly
- Department of Psychiatry; University College Dublin; Dublin Ireland
- Mater Misericordiae University Hospital; Dublin Ireland
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17
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Marco JH, Alonso S, Baños R. Meaning-making as a mediator of anxiety and depression reduction during cognitive behavioral therapy intervention in participants with adjustment disorders. Clin Psychol Psychother 2020; 28:325-333. [PMID: 32881109 DOI: 10.1002/cpp.2506] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 08/23/2020] [Accepted: 08/24/2020] [Indexed: 11/11/2022]
Abstract
There is a consensus among researchers about the link between low meaning in life and anxiety and depressive symptoms. One unanswered question is whether meaning-making is a mediator of the change in anxiety and depression symptoms in participants with adjustment disorders during cognitive behavioural therapy (CBT) treatment. The aims of this study were (a) to analyse whether there was meaning-making during the application of the CBT, (b) to analyse whether meaning-making was a mediator of anxiety psychopathology and (c) to analyse whether meaning-making was a mediator of depressive symptoms. The sample was composed of 115 patients who satisfied the full Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria for adjustment disorder as their primary diagnosis and completed CBT treatment in a primary care mental health service: 74.78% women, n = 86, and 25.22% men, n = 29, with a mean age of 41.89 (standard deviation [SD] = 10.39) years. The diagnosis was established using the Structured Clinical Interview for DSM-5 (SCID-5), and participants filled out the Beck Anxiety Inventory, the Beck Depression Inventory and Purpose in Life questionnaires. The therapists were clinical psychologists with experience in clinical assessment. A repeated-measures analysis of variance (ANOVA) and two mediation analyses using the bootstrap method were performed. The results indicated that (a) There was meaning-making during the CBT because the treated sample showed a statistically significant improvement in meaning in life, and (b) meaning-making during the CBT was a partial mediator between anxiety symptoms and depressive symptoms before and after the treatment. The present study suggests that meaning in life could be an important variable in the psychopathology of adjustment disorders.
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Affiliation(s)
- José H Marco
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Valencia, Spain
| | - Sandra Alonso
- Catedra UMIVALE Innovación e Investigación en la Patologia del Trabajo, Valencia, Spain.,Escuela de Doctorado, Universidad Católica de Valencia, San Vicente Mártir, Valencia, Spain
| | - Rosa Baños
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Valencia, Spain.,Ciber Fisiopatologia Obesidad y Nutrición (CB06/03), Instituto Salud Carlos III, Madrid, Spain
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18
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Bellón JA, Conejo-Cerón S, Rodríguez-Bayón A, Ballesta-Rodríguez MI, Mendive JM, Moreno-Peral P. [Common mental disorders in primary care: diagnostic and therapeutic difficulties, and new challenges in prediction and prevention. SESPAS Report 2020]. GACETA SANITARIA 2020; 34 Suppl 1:20-26. [PMID: 32843196 DOI: 10.1016/j.gaceta.2020.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 11/28/2022]
Abstract
In primary health care only chronic pain surpass depression and anxiety in loss of quality-adjusted life years. More than 70% of people suffering from common mental disorders consulted their GPs for this reason. However, 'the declining halves rule' is a reality: less than 50% of primary care attendees with common mental disorders were correctly diagnosed, of these less than 50% received adequate treatment (pharmacological or psychological) and of these less than 50% patients were adherent. Collaborative models of common mental disorders care in primary health care have demonstrated their effectiveness through clinical trials; however, its implementation in a more general and real context is difficult and its effectiveness remains unclear. Risk algorithms have been developed and validated in primary health care to predict the onset and prognosis of common mental disorders; which are useful for their treatment and prevention. There is evidence that psychological and psychoeducational interventions (and possibly those of physical exercise) are effective for the primary prevention of common mental disorders, even in primary health care; although their effects are small or moderate. These interventions have a high potential to be scalable in schools, workplace and primary health care; in addition, when they are administered through information and communication technologies (e.g. by App), in self-guided or minimally guided programs, they have demonstrated their effectiveness for the treatment and prevention of common mental disorders. They are also very accessible, have low cost and contribute to the massive implementation of these interventions in different settings.
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Affiliation(s)
- Juan Angel Bellón
- Centro de Salud El Palo, Distrito Sanitario Málaga-Guadalhorce, Servicio Andaluz de Salud, Málaga, España; Departamento de Salud Pública y Psiquiatría, Universidad de Málaga, Málaga, España; Red de Actividades Preventivas y Promoción de la Salud (redIAPP), Instituto de Salud Carlos III, Madrid, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España.
| | - Sonia Conejo-Cerón
- Red de Actividades Preventivas y Promoción de la Salud (redIAPP), Instituto de Salud Carlos III, Madrid, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
| | - Antonina Rodríguez-Bayón
- Red de Actividades Preventivas y Promoción de la Salud (redIAPP), Instituto de Salud Carlos III, Madrid, España; Centro de Salud San José, Distrito Sanitario Jaén Norte, Servicio Andaluz de Salud, Linares (Jaén), España
| | - María Isabel Ballesta-Rodríguez
- Red de Actividades Preventivas y Promoción de la Salud (redIAPP), Instituto de Salud Carlos III, Madrid, España; Centro de Salud Federico del Castillo, Distrito Sanitario Jaén, Servicio Andaluz de Salud, Jaén, España
| | - Juan Manuel Mendive
- Red de Actividades Preventivas y Promoción de la Salud (redIAPP), Instituto de Salud Carlos III, Madrid, España; Centro de Atención Primaria La Mina, Institut Català de la Salut, IDIAP Jordi Gol, Barcelona, España
| | - Patricia Moreno-Peral
- Red de Actividades Preventivas y Promoción de la Salud (redIAPP), Instituto de Salud Carlos III, Madrid, España; Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
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19
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Smith ML, Farkas DK, Sumner JA, Jiang T, Lash TL, Galea S, Sørensen HT, Gradus JL. Associations between adjustment disorder and hospital-based infections in the Danish population. J Psychosom Res 2020; 132:109976. [PMID: 32142971 DOI: 10.1016/j.jpsychores.2020.109976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is some evidence that posttraumatic stress disorder (PTSD) is associated with increased risk of infections, and it is unknown whether adjustment disorder is as well. We assessed the association between adjustment disorder and subsequent infections, and assessed additive interaction with sex. METHODS The study population included a nationwide cohort of all Danish-born residents of Denmark diagnosed with adjustment disorder between 1995 and 2011, and an age- and sex-matched general population comparison cohort. We compared rates of infections requiring inpatient or outpatient hospitalization in the two cohorts. We fit Cox proportional hazards models to compute adjusted hazard ratios (aHR) for the associations between adjustment disorder and 32 types of infections, and calculated interaction contrasts to assess interaction between adjustment disorder and sex. RESULTS Adjustment disorder was associated with increased rates of infections overall (n = 19,838 infections, aHR = 1.8, 95% confidence interval = 1.8. 1.9), and increased rates of each individual infection type (aHRs for 30 infections ranged from 1.5 to 2.3), adjusting for baseline psychiatric and somatic comorbidities and marital status. For many infection types (e.g., skin infections, pneumonia), interaction contrasts indicated rate differences were greater among men than women, while for two (urinary tract infections and sexually transmitted infections), rate differences were greater for women. CONCLUSIONS These findings are consistent with studies examining the relationship between psychological stress and infections, and between PTSD and infections. They may be explained by a combination of the triggering of unhealthy behaviors as well as immune responses to stress.
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Affiliation(s)
- Meghan L Smith
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | | | - Jennifer A Sumner
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Tammy Jiang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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20
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Arbus C, Hergueta T, Duburcq A, Saleh A, Le Guern ME, Robert P, Camus V. Adjustment disorder with anxiety in old age: Comparing prevalence and clinical management in primary care and mental health care. Eur Psychiatry 2020; 29:233-8. [DOI: 10.1016/j.eurpsy.2013.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 03/18/2013] [Accepted: 04/17/2013] [Indexed: 10/26/2022] Open
Abstract
AbstractPurpose:Adjustment disorder with anxiety (AjD-A) is a common cause of severe anxiety symptoms, but little is known about its prevalence in old age.Methods:This cross-sectional study examined the prevalence of AjD-A in outpatients over the age of 60 who consecutively consulted 34 general practitioners and 22 psychiatrists during a 2-week period. The diagnosis of AjD-A was obtained using the optional module for diagnostic of adjustment disorder of the Mini International Neuropsychiatric Interview (MINI). The study procedure also explored comorbid psychiatric conditions and documented recent past stressful life events, as well as social disability and current pharmacological and non-pharmacological management.Results:Overall, 3651 consecutive subjects were screened (2937 in primary care and 714 in mental health care). The prevalence rate of AjD-A was 3.7% (n = 136). Up to 39% (n = 53) of AjD-A subjects had a comorbid psychiatric condition, mostly of the anxious type. The most frequently stressful life event reported to be associated with the onset of AjD-A was personal illness or health problem (29%). More than 50% of the AjD-A patients were markedly to extremely disabled by their symptoms. Compared to patients who consulted psychiatrists, patients who were seen by primary care physicians were older, had obtained lower scores at the Hamilton Anxiety Rating Scale, benefited less frequently from non-pharmacological management and received benzodiazepines more frequently.Conclusions:AjD-A appears to be a significantly disabling cause of anxiety symptoms in community dwelling elderly persons, in particular those presenting personal health related problems. Improvement of early diagnosis and non-pharmacological management of AjD-A would contribute to limit risks of benzodiazepine overuse, particularly in primary care settings.
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21
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Jacob L, Bohlken J, Kostev K. Incidence of and factors associated with manic episodes and bipolar disorder in the decade following depression onset in Germany. J Affect Disord 2020; 266:534-539. [PMID: 32056923 DOI: 10.1016/j.jad.2020.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/20/2020] [Accepted: 02/01/2020] [Indexed: 11/18/2022]
Abstract
AIM The goal of this retrospective cohort study was to analyze the incidence of and factors associated with manic episodes and bipolar disorder in the decade following a depression diagnosis in patients from Germany. METHODS This study included adults who were diagnosed with depression for the first time in one of 199 neuropsychiatric practices in Germany between 2007 and 2017 (index date). The cumulative incidence of a manic episode or bipolar disorder was estimated for up to 10 years after the index date using Kaplan-Meier curves. Multivariate Cox regression models were further used to investigate the association between demographic, clinical, and pharmaceutical variables and the incidence of manic episodes and bipolar disorder. RESULTS This study included 162,689 patients [mean (standard deviation) age 51.6 (14.9) years; 63.2% women]. Ten years after a depression diagnosis, the incidence of manic episodes and bipolar disorder ranged from 2.9% to 5.1%. Young age, severe depression, and the prescription of venlafaxine were identified as variables positively associated with manic episodes and bipolar disorder, while several clinical (e.g., somatoform disorders, extrapyramidal and movement disorders) and pharmaceutical variables (e.g., hypericum perforatum, amitriptyline) were negatively associated with bipolarity. CONCLUSIONS The incidence of manic episodes and bipolar disorder was relatively low in the decade following a depression diagnosis in Germany. Young age, depression severity, and several clinical and pharmaceutical variables were significantly associated with bipolarity in patients with depression.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-le-Bretonneux, France; Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain
| | - Jens Bohlken
- Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät der Universität 01403, Leipzig, Germany
| | - Karel Kostev
- Epidemiology, IQVIA, Main Airport Center, Unterschweinstiege 2-14, 60549 Frankfurt, Germany.
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22
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Salomonsson S, Santoft F, Lindsäter E, Ejeby K, Ingvar M, Öst LG, Lekander M, Ljótsson B, Hedman-Lagerlöf E. Predictors of outcome in guided self-help cognitive behavioural therapy for common mental disorders in primary care. Cogn Behav Ther 2019; 49:455-474. [PMID: 31638472 DOI: 10.1080/16506073.2019.1669701] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cognitive behavioural therapy (CBT) can effectively treat common mental disorders (CMDs), but access to treatment is insufficient. Guided self-help (GSH) CBT has shown effects comparable to face-to-face CBT and may be a resource-efficient treatment alternative. However, not all patients respond to GSH. Learning more about predictors of outcome may increase knowledge regarding which patients respond to GSH. The aim of this study was to investigate predictors of outcome for GSH CBT for patients with CMDs in primary care. Consecutive patients (N = 396) with a principal disorder of depression, anxiety, insomnia or stress-related disorders were included. All patients received GSH CBT. Outcomes were remission status, reliable change and post-treatment depression ratings. Predictors investigated were clinical, demographic and therapy-related variables. Analyses were conducted using logistic and linear regression. Higher educational level predicted remission, higher quality of life ratings predicted remission and decreased depression, and higher age at onset predicted reliable change. Therapy-related variables, i.e. patient adherence to treatment and patients' and clinicians' estimation of treatment response, were all related to outcome. More large-scale studies are needed, but the present study points at the importance of therapy-related variables such as monitoring and supporting treatment adherence for an increased chance of remission.
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Affiliation(s)
- Sigrid Salomonsson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet , Stockholm, Sweden
| | - Fredrik Santoft
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet , Stockholm, Sweden
| | - Elin Lindsäter
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet , Stockholm, Sweden
| | - Kersti Ejeby
- Department of Neurobiology, Care Sciences and Society (NVS), H1, Division of Family medicine, Karolinska Institutet , Stockholm, Sweden
| | - Martin Ingvar
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet , Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital , Stockholm, Sweden
| | - Lars-Göran Öst
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet , Stockholm, Sweden.,Department of Psychology, Stockholm University , Stockholm, Sweden
| | - Mats Lekander
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet , Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital , Stockholm, Sweden.,Stress Research Institute, Stockholm University , Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet , Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet , Stockholm, Sweden.,Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet , Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital , Stockholm, Sweden
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23
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Quero S, Rachyla I, Molés M, Mor S, Tur C, Cuijpers P, López-Montoyo A, Botella C. Can Between-Session Homework Be Delivered Digitally? A Pilot Randomized Clinical Trial of CBT for Adjustment Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3842. [PMID: 31614596 PMCID: PMC6843437 DOI: 10.3390/ijerph16203842] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/28/2019] [Accepted: 10/08/2019] [Indexed: 12/20/2022]
Abstract
Adjustment disorder (AjD) is one of the most common disorders in clinical practice, and its symptoms are severe enough to cause great distress and functional impairment. The AjD CBT protocol specifically developed for this disorder has shown positive results when delivered face to face and through virtual reality. Despite existing evidence supporting the benefits of therapeutic homework as part of a psychological intervention, little is known about how to increase homework engagement in psychotherapy. This study examines the feasibility (doability, initial efficacy and acceptability) of a digital support system to deliver homework via the Internet in the treatment of AjD. Participants were randomly assigned to a traditional homework condition or a digital support system condition. Both interventions resulted in statistically significant improvements, with large effect sizes, in all the outcome measures at post-treatment, with no significant differences between groups. At 12-month follow-up, these therapeutic gains were maintained, and an improvement was even observed in both conditions, with no significant differences between groups. Additionally, treatment satisfaction predicted efficacy in both groups separately and when the whole group was considered. This is the first study to explore the feasibility an initial efficacy of delivering a therapeutic homework component for AjD through the Internet.
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Affiliation(s)
- Soledad Quero
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, 12006 Castellón, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERON), Instituto Salud Carlos III, 28029 Madrid, Spain.
| | - Iryna Rachyla
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, 12006 Castellón, Spain.
| | - Mar Molés
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, 12006 Castellón, Spain.
| | - Sonia Mor
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, 12006 Castellón, Spain.
| | - Cintia Tur
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, 12006 Castellón, Spain.
| | - Pim Cuijpers
- Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, 1081BT Amsterdam, The Netherlands.
| | - Alba López-Montoyo
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, 12006 Castellón, Spain.
| | - Cristina Botella
- Department of Basic, Clinical Psychology, and Psychobiology, Universitat Jaume I, 12006 Castellón, Spain.
- CIBER Fisiopatología de la Obesidad y Nutrición (CIBERON), Instituto Salud Carlos III, 28029 Madrid, Spain.
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Abstract
OBJECTIVES This narrative review article provides an overview of current psychotherapeutic approaches specific for adjustment disorders (ADs) and outlines future directions for theoretically-based treatments for this common mental disorder within a framework of stepped care. METHODS Studies on psychological interventions for ADs were retrieved by using an electronic database search within PubMed and PsycINFO, as well as by scanning the reference lists of relevant articles and previous reviews. RESULTS The evidence base for psychotherapies specifically targeting the symptoms of AD is currently rather weak, but is evolving given several ongoing trials. Psychological interventions range from self-help approaches, relaxation techniques, e-mental-health interventions, behavioural activation to talking therapies such as psychodynamic and cognitive behavioural therapy. CONCLUSIONS The innovations in DSM-5 and upcoming ICD-11, conceptualising AD as a stress-response syndrome, will hopefully stimulate more research in regard to specific psychotherapeutic interventions for AD. Low intensive psychological interventions such as e-mental-health interventions for ADs may be a promising approach to address the high mental health care needs associated with AD and the limited mental health care resources in most countries around the world.
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Affiliation(s)
- Matthias Domhardt
- a Department of Clinical Psychology and Psychotherapy , University of Ulm , Ulm , Germany.,b Department of Child and Adolescent Psychiatry/Psychotherapy , University of Ulm , Ulm , Germany
| | - Harald Baumeister
- a Department of Clinical Psychology and Psychotherapy , University of Ulm , Ulm , Germany
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Sánchez-González R, Rodríguez-Urrutia A, Monteagudo-Gimeno E, Vieta E, Pérez-Solá V, Herranz-Villanueva S, Pintor-Pérez L. Clinical features of a sample of inpatients with adjustment disorder referred to a consultation-liaison psychiatry service over 10 years. Gen Hosp Psychiatry 2018; 55:98-99. [PMID: 30107936 DOI: 10.1016/j.genhosppsych.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/03/2018] [Accepted: 08/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Roberto Sánchez-González
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - Amanda Rodríguez-Urrutia
- Consultation-Liaison Psychiatry Unit, Department of Psychiatry, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Eila Monteagudo-Gimeno
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Eduard Vieta
- Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, CERCA Programme/Generalitat de Catalunya, Barcelona, Spain; Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Víctor Pérez-Solá
- Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Centro de Investigación Biomédica En Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Sandra Herranz-Villanueva
- Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, CERCA Programme/Generalitat de Catalunya, Barcelona, Spain
| | - Luis Pintor-Pérez
- Department of Psychiatry, Institut de Neurociències, Hospital Clínic i Provincial de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, CERCA Programme/Generalitat de Catalunya, Barcelona, Spain
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Ahern TP, Veres K, Jiang T, Farkas DK, Lash TL, Sørensen HT, Gradus JL. Adjustment disorder and type-specific cancer incidence: a Danish cohort study. Acta Oncol 2018; 57:1367-1372. [PMID: 29688114 DOI: 10.1080/0284186x.2018.1465586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Although adjustment disorder is common, there is a dearth of research on its physical health consequences. Earlier studies, biological mechanisms and stress-related behaviors suggest that cancer may be a potential sequelae of adjustment disorder. This study examined the association between adjustment disorder and type-specific cancer incidence in a nationwide cohort. METHODS Data were obtained from the comprehensive nationwide medical and administrative registries of Denmark. We calculated the incidence of type-specific cancers from 1995 to 2013 in patients with a prior adjustment disorder diagnosis (n = 58,712), and compared it with the incidence in the general population by calculating standardized incidence ratios (SIRs) with accompanying 95% confidence intervals (CIs). SIRs were adjusted using semi-Bayes shrinkage. RESULTS The SIR for any type of cancer was 1.0 (95% CI: 0.99, 1.1). Adjustment disorder was associated with a 10% lower rate of immune-related cancers (SIR = 0.9, 95% CI: 0.84, 0.97) and with a 20% higher rate of smoking- and alcohol-related cancers (SIR = 1.2, 95% CI: 1.1, 1.3). We found null associations for hematological (SIR = 1.1, 95% CI: 0.89, 1.3) and hormone-related (SIR = 0.98, 95% CI: 0.91, 1.1) malignancies. After semi-Bayes adjustment, type-specific cancer SIRs indicated no association between adjustment disorder and cancer incidence. CONCLUSIONS This study provides persuasive evidence for a null association between adjustment disorder and type-specific cancer incidence in a nationwide study cohort.
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Affiliation(s)
- Thomas P. Ahern
- Department of Surgery, Larner College of Medicine, University of Vermont, Burlington, VT, USA
- Department of Biochemistry, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Katalin Veres
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Tammy Jiang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | | | - Timothy L. Lash
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Jaimie L. Gradus
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Psychiatry, Boston University School of Public Health, Boston, MA, USA
- National Center for PTSD, VA Boston Healthcare System, Boston, MA, USA
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Salomonsson S, Hedman-Lagerlöf E, Öst LG. Sickness absence: a systematic review and meta-analysis of psychological treatments for individuals on sick leave due to common mental disorders. Psychol Med 2018; 48:1954-1965. [PMID: 29380722 DOI: 10.1017/s0033291718000065] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sick leave due to common mental disorders (CMDs) increase rapidly and present a major societal challenge. The overall effect of psychological interventions to reduce sick leave and symptoms has not been sufficiently investigated and there is a need for a systematic review and meta-analysis of the field. The aim of the present meta-analysis was to calculate the effect size of psychological interventions for CMDs on sick leave and psychiatric symptoms based on all published randomized controlled trials. Methodological quality, the risk of bias and publication bias were also assessed. The literature searches gave 2240 hits and 45 studies were included. The psychological interventions were more effective than care as usual on both reduced sick leave (g = 0.15) and symptoms (g = 0.21). There was no significant difference in effect between work focused interventions, problem-solving therapy, cognitive behavioural therapy or collaborative care. We conclude that psychological interventions are more effective than care as usual to reduce sick leave and symptoms but the effect sizes are small. More research is needed on psychological interventions that evaluate effects on sick leave. Consensual measures of sick leave should be established and quality of psychotherapy for patients on sick leave should be improved.
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Affiliation(s)
- Sigrid Salomonsson
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| | - Lars-Göran Öst
- Department of Psychology,Stockholm University,Stockholm,Sweden
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López MJM. Atención de las personas que sufren trastornos adaptativos. Herramientas asistenciales para atención primaria y especializada de salud mental. CLÍNICA CONTEMPORÁNEA 2018. [DOI: 10.5093/cc2018a10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Salomonsson S, Santoft F, Lindsäter E, Ejeby K, Ljótsson B, Öst LG, Ingvar M, Lekander M, Hedman-Lagerlöf E. Stepped care in primary care - guided self-help and face-to-face cognitive behavioural therapy for common mental disorders: a randomized controlled trial. Psychol Med 2018; 48:1644-1654. [PMID: 29095133 DOI: 10.1017/s0033291717003129] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Common mental disorders (CMD) cause large suffering and high societal costs. Cognitive behavioural therapy (CBT) can effectively treat CMD, but access to treatment is insufficient. Guided self-help (GSH) CBT, has shown effects comparable with face-to-face CBT. However, not all patients respond to GSH, and stepping up non-responders to face-to-face CBT, could yield larger response rates. The aim was to test a stepped care model for CMD in primary care by first evaluating the effects of GSH-CBT and secondly, for non-responders, evaluating the additional effect of face-to-face CBT. METHODS Consecutive patients (N = 396) with a principal disorder of depression, anxiety, insomnia, adjustment or exhaustion disorder were included. In Step I, all patients received GSH-CBT. In Step II, non-responders were randomized to face-to-face CBT or continued GSH. The primary outcome was remission status, defined as a score below a pre-established cutoff on a validated disorder-specific scale. RESULTS After GSH-CBT in Step I, 40% of patients were in remission. After Step II, 39% of patients following face-to-face CBT were in remission compared with 19% of patients after continued GSH (p = 0.004). Using this stepped care model required less than six therapy sessions per patient and led to an overall remission rate of 63%. CONCLUSIONS Stepped care can be effective and resource-efficient to treat CMD in primary care, leading to high remission rates with limited therapist resources. Face-to-face CBT speeded up recovery compared with continued GSH. At follow-ups after 6 and 12 months, remission rates were similar in the two groups.
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Affiliation(s)
- Sigrid Salomonsson
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| | - Fredrik Santoft
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| | - Elin Lindsäter
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| | - Kersti Ejeby
- Department of Neurobiology,Care Sciences and Society (NVS),H1, Division of Family Medicine,Karolinska Institutet,Stockholm,Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| | - Lars-Göran Öst
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
| | - Martin Ingvar
- Department of Clinical Neuroscience,Osher Center for Integrative Medicine, Karolinska Institutet,Stockholm,Sweden
| | - Mats Lekander
- Department of Clinical Neuroscience,Osher Center for Integrative Medicine, Karolinska Institutet,Stockholm,Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience,Division of Psychology,Karolinska Institutet,Stockholm,Sweden
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A computerized version of the Patient Health Questionnaire-4 as an ultra-brief screening tool to detect emotional disorders in primary care. J Affect Disord 2018; 234:247-255. [PMID: 29549826 DOI: 10.1016/j.jad.2018.01.030] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/19/2017] [Accepted: 01/28/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND The Patient Health Questionnaire-4 (PHQ-4) is an ultra-brief self-report consisting of a 2-item depression scale (PHQ-2) and a 2-item anxiety scale (GAD-2). The aim of the present study is to determine the psychometric properties of a computerized version of the PHQ-4 used to detect emotional disorders (anxiety and depression) in the primary care setting. METHOD A total of 1052 patients with suspected anxiety, depression, or somatic symptoms were recruited from 28 primary care centres participating in the PsicAP trial and completed the full version of the computerized PHQ. In addition, 178 of these patients also underwent in clinical interviews as a gold standard. RESULTS Confirmatory factor analyses showed very good fit indices for a two-factor solution. This model was structurally invariant among the various age and gender groups and internal consistency was acceptable (PHQ-4; α = .83, PHQ-2; α = .86, and GAD-2; α = .76). The best cut-off points to obtain high sensitivity values was 3, on both the PHQ-2 (major depressive disorder) and the GAD-2 (generalized anxiety disorder). The criterion validity (sensitivity and specificity) for the PHQ-2 were .90 and .61 and for the GAD-2, .88 and 0.61. LIMITATIONS The study was not designed as a prevalence study. Therefore, does not contain information on patients whose general practitioners do not consider them to suffer emotional disorders. CONCLUSION This is the first study to provide evidence for the reliability and validity of a computerized version of the PHQ-4. This computerized tool can be used to detect depression and anxiety in a primary care setting.
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O'Donnell ML, Metcalf O, Watson L, Phelps A, Varker T. A Systematic Review of Psychological and Pharmacological Treatments for Adjustment Disorder in Adults. J Trauma Stress 2018; 31:321-331. [PMID: 29958336 DOI: 10.1002/jts.22295] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 02/28/2018] [Accepted: 03/05/2018] [Indexed: 11/10/2022]
Abstract
Adjustment disorder is a common psychiatric disorder, yet knowledge of the efficacious treatments for adjustment disorder is limited. In this systematic review, we aimed to examine psychological and pharmacological interventions that target adjustment disorder in adults to determine which interventions have the best evidence for improving adjustment disorder symptoms. We performed database searches for literature published between January 1980 and September 2016 and identified studies that included both a sample majority of individuals diagnosed with adjustment disorder and findings on adjustment disorder symptom outcomes. There were 29 studies that met the inclusion criteria for qualitative synthesis; the majority of studies (59%) investigated psychological therapies rather than pharmacological treatments (35%). The range of psychological therapies tested was diverse, with the majority containing cognitive behavioral therapy (CBT) components (53%), followed by three studies that were psychodynamic-related, three studies that were behavioral therapy-based, and two studies that involved relaxation techniques. We rated individual studies using a modified National Health and Medical Research Council quality and bias checklist and then used the Grading of Recommendations Assessment, Development and Evaluation (GRADE; Grade Working Group, 2004) system to rate the overall quality of the evidence. Despite several randomized controlled trials, the quality of the evidence for positive effects of all psychological and pharmacological treatments on symptoms of adjustment disorder was ranked as low to very low. Future high-quality research in the treatment of adjustment disorder has the potential to make a significant difference to individuals who struggle to recover after stressful events.
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Affiliation(s)
- Meaghan L O'Donnell
- Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Olivia Metcalf
- Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Loretta Watson
- Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Andrea Phelps
- Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Tracey Varker
- Phoenix Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Australia
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Oh DJ, Lee DH, Kim EY, Kim WJ, Baik MJ. Altered autonomic reactivity in Korean military soldiers with adjustment disorder. Psychiatry Res 2018; 261:428-435. [PMID: 29353770 DOI: 10.1016/j.psychres.2017.12.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 12/21/2017] [Accepted: 12/30/2017] [Indexed: 10/18/2022]
Abstract
Only few studies addressing the biological background of adjustment disorder (AD) exist. We examined the psychophysiological correlates indicative of autonomic regulation in AD. Heart rate variability (HRV), skin conductance, skin temperature, electromyography, and respiration were measured during serial stress tasks in 33 soldiers with AD and 60 healthy controls (HC). Patients with AD displayed lower relative power of high frequency (rHF) HRV and higher relative power of very low frequency (rVLF) HRV compared with HC at baseline. Inversely, the rHF of patients with AD remained higher and their rVLF remained lower compared with HC parameters after the single stress task, which suggests a reversed sympathovagal balance in AD. Mean heart rate and skin conductance increased during stress tasks in patients, although to a lesser extent than in HC. Skin temperature remained unchanged in all tasks in patients with AD. The tension of the frontalis muscle was higher in patients compared with HC from the second stress task onward. Thoracic breathing was more prevalent in patients with AD. Our study suggests altered autonomic reactivity in AD, which leads to a lack of sympathetic response to stress. We conclude that the distinctive biological mechanisms underlying AD are different from normal stress reactions.
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Affiliation(s)
- Dae Jong Oh
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Psychiatry, Naval Pohang Hospital, Pohang, Republic of Korea
| | - Do Hyeong Lee
- Department of Psychiatry, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Eun Young Kim
- Department of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo Jung Kim
- Department of Psychiatry, Myongji Hospital, Goyang, Republic of Korea
| | - Myung Jae Baik
- Department of Psychiatry, Armed Forces Capital Hospital, Seongnam, Republic of Korea.
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Bachem R, Casey P. Adjustment disorder: A diagnosis whose time has come. J Affect Disord 2018; 227:243-253. [PMID: 29107817 DOI: 10.1016/j.jad.2017.10.034] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/06/2017] [Accepted: 10/19/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adjustment disorder is among the most frequently diagnosed mental disorders in clinical practice although it has received little academic attention and been the subject of substantial criticism over the past decades. While those suffering with adjustment disorders are often treated by mental health professionals, research interest in the origin of the disorder or the effectiveness of psychotherapeutic and medical interventions has only recently begun to emerge. This article summarizes the empirical literature published on adjustment disorder and points out current diagnostic developments in DSM-5 and ICD-11. METHODS Literature for this review was identified through established online search tools, including publications in English, German, and Spanish. RESULTS This paper reviews literature on the evolution of adjustment disorder, and highlights the current state of research with regard to genesis and treatment. Importantly, for the first time ICD-11 intends to define adjustment disorder by explicit symptom groups, unlike DSM-5. LIMITATIONS Publications without an English abstract were not included. CONCLUSIONS Key directions for future research include investigating the concordance of the ICD-11 and DSM-5 concepts and the effect that the diverging conceptualizations may have. Risk and protective factors specific to AD should be identified and the biological underpinnings of the disorder should be explored. Finally, given the high prevalence of AD in certain clinical settings effective disorder-specific interventions should be developed and evaluated.
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Affiliation(s)
- Rahel Bachem
- Bob Shapell School of Social Work, Tel Aviv University, Chaim Levanon 30, Tel Aviv 699780, Israel.
| | - Patricia Casey
- University College Dublin, School of Medicine, Mater Misericordiae Hospital, 62/63 Eccles Street, Dublin 7, Ireland
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Servant D, Leterme AC, Barasino O, Rougegrez L, Duhamel A, Vaiva G. Efficacy of Seren@ctif, a Computer-Based Stress Management Program for Patients With Adjustment Disorder With Anxiety: Protocol for a Controlled Trial. JMIR Res Protoc 2017; 6:e190. [PMID: 28970192 PMCID: PMC5643843 DOI: 10.2196/resprot.7976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adjustment disorder with anxiety (ADA) is the most frequent and best characterized stress-related psychiatric disorder. The rationale for prescription of benzodiazepine monotherapy is a public health issue. Cognitive behavioral stress management programs have been studied in many countries. Several reports have shown beyond reasonable doubt their efficiency at reducing perceived stress and anxiety symptoms and improving patient quality of life. Considering the number of people who could benefit from such programs but are unable to access them, self-help programs have been offered. First presented as books, these programs became enriched with computer-based and digital supports. Regrettably, programs for stress management based on cognitive behavioral therapy (CBT), both face-to-face and digital support, have been only minimally evaluated in France. To our knowledge, the Seren@ctif program is the first French language self-help program for stress management using digital supports. OBJECTIVE The aim of this study is to assess the effectiveness of a 5-week standardized stress management program for reducing anxiety conducted via eLearning (iCBT) or through face-to-face interviews (CBT) with patients suffering from ADA compared with a wait list control group (WLC). These patients seek treatment in a psychiatric unit for anxiety disorders at a university hospital. The primary outcome is change in the State Trait Anxiety Inventory scale trait subscale (STAI-T) between baseline and 2-month visit. METHODS This is a multicenter, prospective, open label, randomized controlled study in 3 parallel groups with balanced randomization (1:1:1): computer-based stress management with minimal contact (not fully automated) (group 1), stress management with face-to-face interviews (group 2), and a WLC group that receives usual health care from a general practitioner (group 3). Programs are based on standard CBT principles and include 5 modules in 5 weekly sessions that include the following topics: stress and stress reaction and assessment; deep respiration and relaxation techniques; cognitive restructuring, mindfulness, and acceptance; behavioral skills as problem solving; and time management, healthy behaviors, and emotion regulation. In the Internet-based group, patients have minimal contact with a medical professional before and after every session. In the first session, a flash memory drive is supplied containing videos, audio files, a self-help book portfolio in the form of an eGuide, and log books providing the exercises to be completed between 2 sessions. The patient is encouraged to practice a 20-minute daily exercise 5 or 6 times per week. In the face-to-face group, patients receive the same program from a therapist with 5 weekly sessions without digital support. Interviews and self-assessments were collected face-to-face with the investigator. RESULTS The feasibility of this program is being tested, and results show good accessibility in terms of acceptance, understanding, and treatment credibility. Results are expected in 2018. CONCLUSIONS To our knowledge, this is the first French study to examine the effectiveness of a computer-based stress management program for patients with ADA. The Seren@ctif program may be useful within the framework of a psychoeducative approach. It could also be advised for people suffering from other diseases related to stress and for people with a clinical level of perceived stress. TRIAL REGISTRATION Clinicaltrials.gov NCT02621775; https://clinicaltrials.gov/ct2/show/NCT02621775 (Archived by WebCite at http://www.webcitation.org/6tQrkPs1u).
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Affiliation(s)
- Dominique Servant
- Stress and Anxiety Unit, Department of Psychiatry, University Hospital, Lille, France.,Unité Mixte de Recherche 9193 Sciences Cognitives et Sciences Affectives, Centre National de la Recherche Scientifique, Department of Psychiatry, University Hospital Lille, Lille, France
| | - Anne-Claire Leterme
- Stress and Anxiety Unit, Department of Psychiatry, University Hospital, Lille, France.,Unité Mixte de Recherche 9193 Sciences Cognitives et Sciences Affectives, Centre National de la Recherche Scientifique, Department of Psychiatry, University Hospital Lille, Lille, France
| | - Olivia Barasino
- Stress and Anxiety Unit, Department of Psychiatry, University Hospital, Lille, France
| | - Laure Rougegrez
- Stress and Anxiety Unit, Department of Psychiatry, University Hospital, Lille, France
| | - Alain Duhamel
- Centre d'Etudes et de Recherche en Informatique Médicale, Department of Biostatistics, University of Lille, Lille, France
| | - Guillaume Vaiva
- Stress and Anxiety Unit, Department of Psychiatry, University Hospital, Lille, France.,Unité Mixte de Recherche 9193 Sciences Cognitives et Sciences Affectives, Centre National de la Recherche Scientifique, Department of Psychiatry, University Hospital Lille, Lille, France
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Impacto económico y carga de los trastornos mentales comunes en España: una revisión sistemática y crítica. ANSIEDAD Y ESTRES-ANXIETY AND STRESS 2017. [DOI: 10.1016/j.anyes.2017.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Muñoz-Navarro R, Cano-Vindel A, Ruiz-Rodríguez P, Adrián Medrano L, González-Blanch C, Moriana JA, Capafons Bonet A, Dongil-Collado E. Modelo jerárquico de diagnóstico y derivación de los trastornos mentales comunes en centros de atención primaria. Una propuesta a partir del ensayo clínico PsicAP. ANSIEDAD Y ESTRES-ANXIETY AND STRESS 2017. [DOI: 10.1016/j.anyes.2017.10.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Anastasia A, Colletti C, Cuoco V, Quartini A, Urso S, Rinaldi R, Bersani G. Demographic variables, clinical aspects, and medicolegal implications in a population of patients with adjustment disorder. Neuropsychiatr Dis Treat 2016; 12:737-43. [PMID: 27099504 PMCID: PMC4824367 DOI: 10.2147/ndt.s92637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Although adjustment disorder (AD) is considered as residual diagnosis and receives little attention in research, it plays an important role in clinical practice and also assumes an increasingly important role in the field of legal medicine, where the majority of diagnostic frameworks (eg, mobbing) often refer to AD. Our study aimed to look for specific stressor differences among demographic and clinical variables in a naturalistic setting of patients with AD. METHODS A restrospective statistical analysis of the data of patients diagnosed with AD from November 2009 to September 2012, identified via manual search from the archive of the outpatient setting at the University Unit of Psychiatry "A. Fiorini" Hospital, Terracina (Latina, Italy), was performed. RESULTS The sample consisted of 93 patients (46 males and 47 females), aged between 26 and 85, with medium-high educational level who were mainly employed. In most cases (54.80%), a diagnosis of AD with mixed anxiety and depressed mood was made. In all, 72% of the sample reported a negative family history for psychiatric disorders. In 22.60%, a previous history of psychopathology, especially mood disorders (76.19%), was reported. The main stressors linked to the development of AD were represented by working problems (32.30%), family problems (23.70%), and/or somatic disease (22.60%) with significant differences with respect to age and sex. Half of the patients were subjected to a single first examination; 24.47% requested a copy of medical records. CONCLUSION Confirming previous data from previous reports, our results suggest that AD may have a distinct profile in demographic and clinical terms. Increased scientific attention is hoped, particularly focused on addressing a better definition of diagnostic criteria, whose correctness and accuracy are critical, especially in situations with medicolegal implications.
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Affiliation(s)
- Annalisa Anastasia
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
| | - Chiara Colletti
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
| | - Valentina Cuoco
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
| | - Adele Quartini
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
| | - Stefania Urso
- Department of Anatomical, Istological, Forensic and Locomotor System Sciences, Sapienza University of Rome, Rome, Italy
| | - Raffaella Rinaldi
- Department of Anatomical, Istological, Forensic and Locomotor System Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Bersani
- Department of Medical-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Sapienza University of Rome, Rome, Italy
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Alvarado-Esquivel C, Sifuentes-Alvarez A, Salas-Martinez C. Adjustment Disorder in Pregnant Women: Prevalence and Correlates in a Northern Mexican City. J Clin Med Res 2015; 7:775-80. [PMID: 26346070 PMCID: PMC4554217 DOI: 10.14740/jocmr2275w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2015] [Indexed: 12/02/2022] Open
Abstract
Background The epidemiology of adjustment disorder in pregnant women is largely unknown. We sought to determine the prevalence and correlates of adjustment disorder in pregnant women in Durango City, Mexico. Methods Pregnant women (n = 300) attending in a public hospital in Durango City, Mexico were studied. All enrolled pregnant women had a psychiatric interview to evaluate the presence of adjustment disorder using the DSM-IV criteria. A questionnaire was submitted to obtain general epidemiological data of the pregnant women studied. Bivariate and multivariate analyses were used to assess the association of adjustment disorder with the epidemiological data of the women studied. Results Fifteen (5.0%) of the 300 women studied had adjustment disorder according to the DSM-IV criteria. Adjustment disorder was not associated with age, occupation, marital status, or education of pregnant women. In contrast, multivariate analysis of socio-demographic, clinical and psychosocial variables showed that adjustment disorder was associated with the variables lack of support from her couple (odds ratio (OR) = 3.83; 95% confidence interval (CI): 1.00 - 14.63; P = 0.04) and couple living abroad (OR = 10.12; 95% CI: 1.56 - 65.50; P = 0.01). Conclusions This is the first report about the epidemiology of adjustment disorder in pregnant women in Mexico. Results provide evidence of the presence of adjustment disorder and contributing psychosocial factors associated with this disorder in pregnant women in Mexico. Results point towards further clinical and research attention should be given to this neglected disorder in pregnant women.
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Affiliation(s)
- Cosme Alvarado-Esquivel
- Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juarez University of Durango State, Durango, Mexico
| | - Antonio Sifuentes-Alvarez
- Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juarez University of Durango State, Durango, Mexico ; Mothers and Children's Hospital, Secretary of Health, Durango, Mexico
| | - Carlos Salas-Martinez
- Biomedical Research Laboratory, Faculty of Medicine and Nutrition, Juarez University of Durango State, Durango, Mexico ; Mothers and Children's Hospital, Secretary of Health, Durango, Mexico
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Maercker A, Bachem RC, Lorenz L, Moser CT, Berger T. Adjustment Disorders Are Uniquely Suited for eHealth Interventions: Concept and Case Study. JMIR Ment Health 2015; 2:e15. [PMID: 26543920 PMCID: PMC4607384 DOI: 10.2196/mental.4157] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/05/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Adjustment disorders (also known as mental distress in response to a stressor) are among the most frequently diagnosed mental disorders in psychiatry and clinical psychology worldwide. They are also commonly diagnosed in clients engaging in deliberate self-harm and in those consulting general practitioners. However, their reputation in research-oriented mental health remains weak since they are largely underresearched. This may change when the International Statistical Classification of Diseases-11 (ICD-11) by the World Health Organization is introduced, including a new conceptualization of adjustment disorders as a stress-response disorder with positively defined core symptoms. OBJECTIVE This paper provides an overview of evidence-based interventions for adjustment disorders. METHODS We reviewed the new ICD-11 concept of adjustment disorder and discuss the the rationale and case study of an unguided self-help protocol for burglary victims with adjustment disorder, and its possible implementation as an eHealth intervention. RESULTS Overall, the treatment with the self-help manual reduced symptoms of adjustment disorder, namely preoccupation and failure to adapt, as well as symptoms of depression, anxiety, and stress. CONCLUSIONS E-mental health options are considered uniquely suited for offering early intervention after the experiences of stressful life events that potentially trigger adjustment disorders.
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Affiliation(s)
- Andreas Maercker
- Division of Psychopathology and Clinical Intervention Department of Psychology University of Zurich Zurich Switzerland
| | - Rahel C Bachem
- Division of Psychopathology and Clinical Intervention Department of Psychology University of Zurich Zurich Switzerland
| | - Louisa Lorenz
- Division of Psychopathology and Clinical Intervention Department of Psychology University of Zurich Zurich Switzerland
| | - Christian T Moser
- Division of Psychopathology and Clinical Intervention Department of Psychology University of Zurich Zurich Switzerland
| | - Thomas Berger
- Institute of Psychology Department of Clinical Psychology and Psychotherapy University of Berne Berne Switzerland
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Abstract
Adjustment disorders (ADs) have been included in the psychiatric classifications since 1952 although their name has changed over time. In DSM 5 they have been classified under the trauma and stress related disorders for the first time. Despite this positive step, there are still problems with the classification of ADs. There is no guidance on the distinction from normal stress reactions, it remains a subthreshold category, and the subtypes are not strongly underpinned by research. There are no specific diagnostic criteria in terms of symptom numbers or combinations of these, unlike most other conditions classified in DSM. Apart from epidemiological studies in those with medical illnesses, recent prevalence studies in other populations are scarce. Research is lacking in many aspects of AD, especially their biological underpinnings and treatments. One factor contributing to this is the absence of adequate diagnostic interview schedules. Interest in ADs may increase now that they are classified with the trauma-related group of disorders.
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Kocalevent RD, Mierke A, Danzer G, Klapp BF. Adjustment disorders as a stress-related disorder: a longitudinal study of the associations among stress, resources, and mental health. PLoS One 2014; 9:e97303. [PMID: 24825165 PMCID: PMC4019534 DOI: 10.1371/journal.pone.0097303] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 04/17/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Adjustment disorders are re-conceptualized in the DSM-5 as a stress-related disorder; however, besides the impact of an identifiable stressor, the specification of a stress concept, remains unclear. This study is the first to examine an existing stress-model from the general population, in patients diagnosed with adjustment disorders, using a longitudinal design. METHODS The study sample consisted of 108 patients consecutively admitted for adjustment disorders. Associations of stress perception, emotional distress, resources, and mental health were measured at three time points: the outpatients' presentation, admission for inpatient treatment, and discharge from the hospital. To evaluate a longitudinal stress model of ADs, we examined whether stress at admission predicted mental health at each of the three time points using multiple linear regressions and structural equation modeling. A series of repeated-measures one-way analyses of variance (rANOVAs) was performed to assess change over time. RESULTS Significant within-participant changes from baseline were observed between hospital admission and discharge with regard to mental health, stress perception, and emotional distress (p<0.001). Stress perception explained nearly half of the total variance (44%) of mental health at baseline; the adjusted R2 increased (0.48), taking emotional distress (i.e., depressive symptoms) into account. The best predictor of mental health at discharge was the level of emotional distress (i.e., anxiety level) at baseline (β= -0.23, R2corr=0.56, p<0.001). With a CFI of 0.86 and an NFI of 0.86, the fit indices did not allow for acceptance of the stress-model (Cmin/df=15.26; RMSEA=0.21). CONCLUSIONS Stress perception is an important predictor in adjustment disorders, and mental health-related treatment goals are dependent on and significantly impacted by stress perception and emotional distress.
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Affiliation(s)
- Rüya-Daniela Kocalevent
- Institute and Policlinic for Medical Psychology, University Medical Center, Hamburg-Eppendorf, Germany
| | - Annett Mierke
- Department of Psychosomatic Medicine, Charité University Medicine, Berlin, Germany
| | - Gerhard Danzer
- Department of Psychosomatic Medicine, Charité University Medicine, Berlin, Germany
| | - Burghard F. Klapp
- Department of Psychosomatic Medicine, Charité University Medicine, Berlin, Germany
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Hsiao FH, Lai YM, Chen YT, Yang TT, Liao SC, Ho RTH, Ng SM, Chan CLW, Jow GM. Efficacy of psychotherapy on diurnal cortisol patterns and suicidal ideation in adjustment disorder with depressed mood. Gen Hosp Psychiatry 2014; 36:214-9. [PMID: 24342115 DOI: 10.1016/j.genhosppsych.2013.10.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 10/23/2013] [Accepted: 10/23/2013] [Indexed: 10/26/2022]
Abstract
AIMS The aims were to examine the effects of psychotherapy on depressive and anxiety symptoms, the occurrence of suicidal ideations and diurnal cortisol patterns in patients with adjustment disorder (AD) with depressed mood. METHODS Participants recruited from an outpatient department of psychiatry at a general hospital were randomly assigned to one of two groups: 34 in psychotherapy group and 37 in control group. The control group consisted of one-session psychoeducation. Psychotherapy included the eight-weekly body-mind-spirit (BMS) group psychotherapy. Measures included Beck Depression Inventory-II and State Trait Anxiety Inventory. Salivary cortisol samples were collected from the patients at their homes on awakening; 30 and 45 min after awakening; and at 1200, 1700 and 2100 h. Measurements were taken at baseline and at months 2 (end of intervention), 5, 8 and 14. RESULTS There was no differential change over time between the BMS and control groups in self-reported depression or anxiety symptoms. However, suicidal ideation appeared to be reduced in the psychotherapy group. Changes in diurnal cortisol patterns were also significantly different in group × time interactions, in favor of BMS group. CONCLUSIONS Psychotherapy likely provides improvements in psychobiological stress responses and decreases the occurrence of suicidal ideation in patients with AD.
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Affiliation(s)
- Fei-Hsiu Hsiao
- Department of Nursing, College of Medicine National Taiwan University, Taipei, Taiwan.
| | - Yu-Ming Lai
- School of Nursing, Chang-Gung University, Taiwan
| | - Yu-Ting Chen
- School of Nursing, Chang-Gung University, Taiwan
| | - Tsung-Tsair Yang
- Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Cheng Liao
- Department of Psychiatry, National Taiwan University Hospital and Medical College, National Taiwan University
| | - Rainbow T H Ho
- Department of Social Work and Social Administration, Centre on Behavioral Health, The University of Hong Kong, Hong Kong
| | - Siu-Man Ng
- Department of Social Work and Social Administration, Centre on Behavioral Health, The University of Hong Kong, Hong Kong
| | - Cecilia L W Chan
- Department of Social Work and Social Administration, Centre on Behavioral Health, The University of Hong Kong, Hong Kong
| | - Guey-Mei Jow
- School of Medicine, Fu-Jen Catholic University, No 510 Chung-Cheng Road, Hsin-Chuang Dist, New Taipei City 24205, Taiwan.
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Psychiatric review should be mandatory for patients requesting assisted suicide. Gen Hosp Psychiatry 2014; 36:7-9. [PMID: 24091258 DOI: 10.1016/j.genhosppsych.2013.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 08/26/2013] [Indexed: 10/26/2022]
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Casey P, Pillay D, Wilson L, Maercker A, Rice A, Kelly B. Pharmacological interventions for adjustment disorders in adults. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010530] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Patricia Casey
- University College Dublin, Ireland and Mater Misericordiae University Hospital; Department of Psychiatry; Eccles Street Dublin Ireland 7
| | - Divina Pillay
- University College Dublin, Ireland and Mater Misericordiae University Hospital; Department of Psychiatry; Eccles Street Dublin Ireland 7
| | - Lorna Wilson
- University College Dublin, Ireland and Mater Misericordiae University Hospital; Department of Psychiatry; Eccles Street Dublin Ireland 7
| | - Andreas Maercker
- University of Zurich; Department of Psychology; Binzmuhlestr. 14/17 Zurich Switzerland 8050
| | - Angela Rice
- Mater Misericordiae University Hospital; Library and Information Service; Dublin Ireland
| | - Brendan Kelly
- University College Dublin, Ireland and Mater Misericordiae University Hospital; Department of Psychiatry; Eccles Street Dublin Ireland 7
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Bobes J, Iglesias García C, García-Portilla González MP, Bascarán MT, Jiménez Treviño L, Pelayo-Terán JM, Rodríguez Revuelta J, Sánchez Lasheras F, Sáiz Martínez P. Evolución de la prevalencia administrativa de los trastornos mentales durante 13 años en Asturias (norte de España). REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2013; 6:60-6. [DOI: 10.1016/j.rpsm.2012.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 10/24/2012] [Accepted: 10/25/2012] [Indexed: 10/27/2022]
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Abstract
Adjustment disorder is a common diagnosis in psychiatric settings and carries a significant rate of morbidity. However, diagnostic criteria are vague and not much helpful in clinical practice. Also there has been relatively little research done on this disorder. In this article, we review the information that is available on the epidemiology, clinical features, validity, and current diagnostic status of adjustment disorder. In this article, the controversy surrounding the diagnosis is also highlighted. It also discusses the differential and comorbid diagnosis. The various recommendations for DSM-V and ICD-11 conclude the article.
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Affiliation(s)
- Bichitra Nanda Patra
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, Haryana and Punjab, India
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Abstract
Adjustment disorder has been a recognised disorder for decades but has been the subject of little epidemiological research. Now researchers have identified the prevalence of adjustment disorder in primary care, and found general practitioner recognition very low but with high rates of antidepressant prescribing. Possible reasons for the seemingly low prevalence, recognition rate and inappropriate management include its recognition as a residual category in diagnostic instruments and poor delineation from other disorders or from normal stress responses. These problems could be rectified in ICD-11 and DSM-5 if changes according it full syndromal status, among others, were made. This would have an impact on future research.
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