Kelber Marija Spanovic, Morgan Maria A, Beech Erin H, Smolenski Derek J, Bellanti Dawn, Galloway Lindsay, Ojha Suman, Otto Jean Lin, Wilson Abigail L Garvey, Bush Nigel, Belsher Bradley E
Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA.
Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA.
J Affect Disord. 2022 May 1;304:43-58. doi: 10.1016/j.jad.2022.02.038. Epub 2022 Feb 15.
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.
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.
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.
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.
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.
适应障碍在临床实践中很常见，但对其病因和流行病学的研究却很缺乏。本系统评价的目的是评估成年人适应障碍的预测因素。
我们在MEDLINE、EMBASE和PsycINFO中进行了系统检索。我们纳入了70项研究，这些研究考察了13个理论推导和预先定义的适应障碍预测因素，共有3,449,374名参与者。
我们发现女性、年轻、失业状态、压力、身体疾病和损伤、社会支持低以及精神健康障碍史可预测适应障碍。这些预测因素大多能区分患有适应障碍的个体和没有精神健康障碍的个体。与创伤后应激障碍患者相比，适应障碍患者经历事故的可能性更大，但遭受攻击和虐待、忽视及虐待的可能性较小。需要更多研究来确定区分适应障碍与其他精神健康障碍的因素。
由于很少有研究对混杂因素（如人口统计学变量、精神健康史和各种应激源）进行调整，因此无法确定预测因素与适应障碍之间的独立关联。
与未进行精神健康诊断相比，我们确定了一些可预测适应障碍的因素。大多数研究的偏倚风险被评为中度或高度，这表明需要更严格的研究来证实我们发现的关系。
