Institute of Mental Health, 10 Buangkok View, Singapore, 539747, Singapore.
Yong Loo Lin School of Medicine, The National University of Singapore, Singapore, 117597, Singapore.
BMC Psychiatry. 2024 Jun 18;24(1):457. doi: 10.1186/s12888-024-05904-y.
Adjustment and stress-related disorders are prevalent among psychiatric service users. Despite their prevalence, little is known about their prognosis. To reduce that gap, the present article documents the service use and diagnostic outcomes of people with adjustment or stress-related disorders presenting at Singapore's largest psychiatric emergency department.
Administrative data from 2014 to 2021 was retrieved to follow a group of 683 service users whose first-ever psychiatric presentation in 2014 warranted a diagnosis of adjustment or stress-related disorder. People were grouped a priori depending on whether different diagnoses were recorded within 7 days, 9 months, after 9 months or not at all. Survival curves characterized conversion to other diagnoses and engagement with healthcare services. Service use outcomes include the number of hospitalizations, outpatient appointments, emergency department visits, and prescriptions.
Sixty-one percent (n = 417) never received another diagnosis over the 8-year period. This group used emergency services most and received the most pharmacotherapy shortly after their first visit. Of those who received another diagnosis, depression, personality disorders, and psychotic disorders were the most common. Those who received another diagnosis within 7 days (n = 70, 10%) received it on their first day of hospitalization (IQR 1-1), making the most use of inpatient services. The group who received another diagnosis within 9 months (n = 105, 15%) did so after 42 days (IQR 26-84) and had the highest relative number of deaths. Those who received another diagnosis after 9 months (n = 91, 13%) did so after 1,134 days (IQR 613-1,823) and had the longest period of engagement but made the least use of any psychiatric service, potentially suggesting a group whose early index diagnosis heralded vulnerability to future disorders.
A large group of service users with acute stress or adjustment disorders will likely never be given another psychiatric diagnosis and appear to disengage following an initial period of high-intensity service use. The group that received a different diagnosis after the 9-month mark had prolonged contact with services but low intensity of service use and may represent a target for preventative intervention to help them improve their stress-managing skills and avoid developing other disorders.
调整和与压力相关的障碍在精神科服务使用者中很常见。尽管它们很常见，但人们对它们的预后知之甚少。为了缩小这一差距，本文记录了新加坡最大的精神科急诊部门就诊的调整或与压力相关障碍患者的服务使用和诊断结果。
从 2014 年至 2021 年检索行政数据，以跟踪一组 683 名服务使用者，他们在 2014 年的首次精神科就诊被诊断为调整或与压力相关障碍。根据在 7 天内、9 个月内、9 个月后或根本没有记录到不同诊断，预先对人们进行分组。生存曲线描述了向其他诊断的转变和与医疗保健服务的接触。服务使用结果包括住院、门诊预约、急诊就诊和处方的数量。
61%（n=417）在 8 年内从未获得过其他诊断。这组人在急诊服务中使用最多，在首次就诊后不久接受了最多的药物治疗。在获得其他诊断的人群中，最常见的是抑郁症、人格障碍和精神病性障碍。那些在 7 天内获得另一个诊断的人（n=70，10%）在住院的第一天就获得了诊断（IQR 1-1），因此使用了最多的住院服务。那些在 9 个月内获得另一个诊断的人（n=105，15%）在 42 天后（IQR 26-84）获得了诊断，并且相对死亡人数最高。那些在 9 个月后获得另一个诊断的人（n=91，13%）在 1134 天后（IQR 613-1823）获得了诊断，并且有最长的服务参与期，但使用任何精神科服务的人数最少，这可能表明这群人最初的指数诊断预示着他们未来易患其他疾病。
一大群患有急性应激或适应障碍的服务使用者可能永远不会被给予另一个精神科诊断，并且在最初的高强度服务使用后似乎会脱离。在 9 个月后获得不同诊断的人群与服务的接触时间延长，但服务使用强度较低，他们可能是预防干预的目标，以帮助他们提高应对压力的技能，避免发展其他疾病。
