创伤后适应障碍的纵向研究。

A Longitudinal Study of Adjustment Disorder After Trauma Exposure.

机构信息

From the Phoenix Australia Centre for Posttraumatic Mental Health, Carlton, Victoria, Australia; the Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia; the School of Psychology, University of New South Wales, Sydney, New South Wales, Australia; the School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; the Centre for Traumatic Stress, University of Adelaide, Adelaide South Australia, Australia; the Mental Health Centre, Psychiatry Research and Teaching Unit, Liverpool, New South Wales, Australia; the School of Psychology, University of Tasmania, Tasmania, Australia; and St. John of God Health Care, Richmond Hospital, North Richmond, Australia.

出版信息

Am J Psychiatry. 2016 Dec 1;173(12):1231-1238. doi: 10.1176/appi.ajp.2016.16010071. Epub 2016 Oct 24.

DOI:10.1176/appi.ajp.2016.16010071

PMID:27771970

Abstract

OBJECTIVE

Adjustment disorder has been recategorized as a trauma- and stressor-related disorder in DSM-5. The aim of this study was to determine the prevalence of adjustment disorder in the first 12 months after severe injury; to determine whether adjustment disorder was a less severe disorder compared with other disorders in terms of disability and quality of life; to investigate the trajectory of adjustment disorder; and to examine whether the subtypes described in DSM-5 are distinguishable.

METHOD

In a multisite, cohort study, injury patients were assessed during hospitalization and at 3 and 12 months postinjury (N=826). Structured clinical interviews were used to assess affective, anxiety, and substance use disorders, and self-report measures of disability, anxiety, depression, and quality of life were administered.

RESULTS

The prevalence of adjustment disorder was 19% at 3 months and 16% at 12 months. Participants with adjustment disorder reported worse outcomes relative to those with no psychiatric diagnosis but better outcomes compared with those diagnosed with other psychiatric disorders. Participants with adjustment disorder at 3 months postinjury were significantly more likely to meet criteria for a psychiatric disorder at 12 months (odds ratio=2.67, 95% CI=1.59-4.49). Latent-profile analysis identified a three-class model that was based on symptom severity, not the subtypes identified by DSM-5.

CONCLUSIONS

Recategorization of adjustment disorder into the trauma- and stressor-related disorders is supported by this study. However, further description of the phenomenology of the disorder is required.

摘要

目的

在 DSM-5 中，适应性障碍已被重新归类为与创伤和应激相关的障碍。本研究旨在确定严重损伤后 12 个月内适应性障碍的患病率；确定与其他障碍相比，在残疾和生活质量方面，适应性障碍是否为一种较不严重的障碍；调查适应性障碍的轨迹；并检验 DSM-5 中描述的亚型是否可区分。

方法

在一项多地点、队列研究中，在住院期间以及损伤后 3 个月和 12 个月对损伤患者进行评估（N=826）。使用结构化临床访谈评估情感、焦虑和物质使用障碍，并使用残疾、焦虑、抑郁和生活质量的自我报告措施进行评估。

结果

适应性障碍的患病率为 3 个月时为 19%，12 个月时为 16%。与无精神科诊断的患者相比，患有适应性障碍的患者报告的结局较差，但与被诊断为其他精神科障碍的患者相比，结局较好。在损伤后 3 个月患有适应性障碍的患者在 12 个月时更有可能符合精神科障碍的诊断标准（优势比=2.67，95%CI=1.59-4.49）。潜在剖面分析确定了一种基于症状严重程度而非 DSM-5 中确定的亚型的三分类模型。