Department of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland.
Soc Psychiatry Psychiatr Epidemiol. 2010 Jan;45(1):39-46. doi: 10.1007/s00127-009-0039-z. Epub 2009 Mar 31.
The present study explores whether severe life-events are associated with adjustment disorders (AD) by reanalyzing the data of a multisite epidemiological survey (de Jong et al. in Lancet 361:2128-2130, 2003). AD were diagnosed according to the new stress-response-model of AD (Maercker et al. in Psychopathology 40(3):135-146, 2007).
Data from 3048 persons from four different refugee settings in Ethiopia, Algeria, Gaza, and Cambodia were reanalyzed. Life events were assessed by an adapted version of the Life Events and Social History Interview (Mollica et al. in Am J Psychiatry 144:1567-1572, 1987). The current study focuses on non-directly life threatening events related to AD (e.g. loss of property) in contrast to life-threatening events related to Posttraumatic Stress Disorders (PTSD). AD Symptom measures were obtained from available psychopathology assessments: composite international diagnostic interview (WHO in CIDI, Geneva, 1997) and structured interview for disorders of extreme stress (Pelcovitz et al. J Trauma Stress 10:3-16, 1997).
The majority of the subjects had experienced one or more AD-related life event. Most common AD-related life events varied across the four sites with bad shelter conditions most prevalent in Ethiopia (100%) and Gaza (32%), forced social isolation in Algeria (61%), and lack of food in Cambodia (41%). Prevalences of AD diagnoses ranged from 6% (Ethiopia) to 40% (Algeria). The highest rates of comorbidity were between AD and PTSD, followed by anxiety disorders.
The present study shows that the new concept of AD can be of use for psychiatric epidemiology, e.g., in migration contexts. The high-comorbidity rates could indicate that AD and PTSD are parts of a stress response spectrum.
本研究通过重新分析一项多地点流行病学调查（de Jong 等人，《柳叶刀》361:2128-2130, 2003）的数据，探讨严重生活事件是否与适应障碍（AD）有关。AD 根据 AD 的新应激反应模型（Maercker 等人，《精神病理学》40(3):135-146, 2007）进行诊断。
重新分析了来自埃塞俄比亚、阿尔及利亚、加沙和柬埔寨四个不同难民环境的 3048 人的数据。生活事件通过改编版的生活事件和社会史访谈（Mollica 等人，《美国精神病学杂志》144:1567-1572, 1987）进行评估。本研究重点关注与 AD 相关的非直接危及生命的事件（例如财产损失），而不是与创伤后应激障碍（PTSD）相关的危及生命的事件。AD 症状测量来自现有精神病理学评估：复合国际诊断访谈（WHO 在 CIDI，日内瓦，1997 年）和极端应激障碍的结构化访谈（Pelcovitz 等人，《创伤应激》10:3-16, 1997 年）。
大多数受试者经历过一个或多个与 AD 相关的生活事件。最常见的 AD 相关生活事件因地点而异，埃塞俄比亚（100%）和加沙（32%）的不良住所条件最为普遍，阿尔及利亚（61%）的强制社会隔离，以及柬埔寨（41%）的食物匮乏。AD 诊断的患病率从 6%（埃塞俄比亚）到 40%（阿尔及利亚）不等。AD 与 PTSD 之间的共病率最高，其次是焦虑障碍。
本研究表明，AD 的新概念可用于精神病学流行病学，例如在移民环境中。高共病率可能表明 AD 和 PTSD 是应激反应谱的一部分。
