title: Adjustment disorders in primary care: prevalence, recognition and use of services.
abstract: BACKGROUND
  Within the ICD and DSM review processes there is growing debate on the future classification and status of adjustment disorders, even though evidence on this clinical entity is scant, particularly outside specialised care.
  
  
  OBJECTIVE
  To estimate the prevalence of adjustment disorders in primary care; to explore whether there are differences between primary care patients with adjustment disorders and those with other mental disorders; and to describe the recognition and treatment of adjustment disorders by general practitioners (GPs).
  
  
  METHODS
  Participants were drawn from a cross-sectional survey of a representative sample of 3815 patients from 77 primary healthcare centres in Catalonia. The prevalence of current adjustment disorders and subtypes were assessed face to face using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). Multilevel logistic regressions were conducted to assess differences between adjustment disorders and other mental disorders. Recognition and treatment of adjustment disorders by GPs were assessed through a review of patients' computerised clinical histories.
  
  
  RESULTS
  The prevalence of adjustment disorders was 2.94%. Patients with adjustment disorders had higher mental quality-of-life scores than patients with major depressive disorder but lower than patients without mental disorder. Self-perceived stress was also higher in adjustment disorders compared with those with anxiety disorders and those without mental disorder. Recognition of adjustment disorders by GPs was low: only 2 of the 110 cases identified using the SCID-I were detected by the GP. Among those with adjustment disorders, 37% had at least one psychotropic prescription.
  
  
  CONCLUSIONS
  Adjustment disorder shows a distinct profile as an intermediate category between no mental disorder and affective disorders (depression and anxiety disorders).
authors.affiliation: Parc Sanitari Sant Joan de Déu, Research and Development Unit, Fundació Sant Joan de Déu, Dr Antoni Pujadas 42, Sant Boi de Llobregat, Barcelona, Spain. afernandez@pssjd.org
authors.forename: Anna
authors.initials: A
authors.lastname: Fernández
authors.forename: Juan M
authors.initials: JM
authors.lastname: Mendive
authors.forename: Luis
authors.initials: L
authors.lastname: Salvador-Carulla
authors.forename: María
authors.initials: M
authors.lastname: Rubio-Valera
authors.forename: Juan Vicente
authors.initials: JV
authors.lastname: Luciano
authors.forename: Alejandra
authors.initials: A
authors.lastname: Pinto-Meza
authors.forename: Josep Maria
authors.initials: JM
authors.lastname: Haro
authors.forename: Diego J
authors.initials: DJ
authors.lastname: Palao
authors.forename: Juan A
authors.initials: JA
authors.lastname: Bellón
authors.forename: Antoni
authors.initials: A
authors.lastname: Serrano-Blanco
mesh_terms: D000275:Adjustment Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013030:Spain / Q000453:epidemiology; D055815:Young Adult