{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:06:49Z","timestamp":1784308009271,"version":"3.55.0"},"reference-count":36,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2019,8,18]],"date-time":"2019-08-18T00:00:00Z","timestamp":1566086400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Adjustment disorder (AD) is a condition commonly encountered by clinicians in emergency departments and liaison psychiatry settings and has been frequently reported among patients presenting with suicidal behaviours. A number of previous studies have noted the strong association between suicidal ideation and behaviours, and AD. In this paper, we aimed to explore this relationship, by establishing the incidence of AD in patients who present with self-harm and suicidal ideation, and the rates of self-harm among patients with a diagnosis of AD. Methods: We conducted a review of the literature of well-established databases using specific key words then synthesised the results into a descriptive narrative as well as representing it in table form. Results: Sample sizes and study methods varied significantly across the review. A majority of studies were retrospective chart-based reviews, and only three used structured diagnostic instruments. A high prevalence of AD (ranging from 9.8 to 100%) was found, with self-poisoning representing the most common form of suicide attempt in the majority of studies. Interpersonal difficulties were the main precipitant in studies which examined this. Conclusions: This study suggests there is a strong association between AD and suicidal behaviours. Given the paucity of research in the area, there is a need to build the evidence base for effective treatment strategies.<\/jats:p>","DOI":"10.3390\/ijerph16162967","type":"journal-article","created":{"date-parts":[[2019,8,19]],"date-time":"2019-08-19T06:10:14Z","timestamp":1566195014000},"page":"2967","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Adjustment Disorder and Suicidal Behaviours Presenting in the General Medical Setting: A Systematic Review"],"prefix":"10.3390","volume":"16","author":[{"given":"Joanne","family":"Fegan","sequence":"first","affiliation":[{"name":"Department of Psychiatry, University Hospital Galway, H91 YR71 Galway, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6995-5361","authenticated-orcid":false,"given":"Anne M.","family":"Doherty","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, University Hospital Galway, H91 YR71 Galway, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,8,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1097\/00005053-199601000-00008","article-title":"Prevalence of psychiatric disorders in medical inpatients","volume":"184","author":"Silverstone","year":"1996","journal-title":"J. Nerv. Ment. Dis."},{"key":"ref_2","unstructured":"World Health Organisation (1992). International Classification of Diseases, World Health Organisation. [10th ed.]."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_4","first-page":"257","article-title":"Is the distinction between adjustment disorder with depressed mood and adjustment disorder with mixed anxious and depressed mood valid?","volume":"25","author":"Zimmerman","year":"2013","journal-title":"Ann. Clin. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1159\/000207455","article-title":"Adjustment disorder with depressed mood: A critique of its DSM-IV and ICD-10 conceptualisations and recommendations for the future","volume":"42","author":"Baumeister","year":"2009","journal-title":"Psychopathology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1586\/14737175.8.8.1203","article-title":"Diagnosing adjustment disorder with depressive features","volume":"8","author":"Casey","year":"2008","journal-title":"Expert Rev. Neurother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S0165-0327(97)00137-7","article-title":"Characteristics of suicidal attempts in major depression versus adjustment reactions","volume":"47","author":"Polyakova","year":"1998","journal-title":"J. Affect. Disord."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1002\/wps.20057","article-title":"Diagnosis and classification of disorders specifically associated with stress: Proposals for ICD-11","volume":"12","author":"Maercker","year":"2013","journal-title":"World Psychiatry"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/S0163-8343(01)00139-6","article-title":"Consultation-Liaison psychiatric service delivery: Results from a European study","volume":"23","author":"Huyse","year":"2001","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_10","unstructured":"National Institutes of Health (NIH) (2019, August 12). Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies, Available online: https:\/\/www.nhlbi.nih.gov\/health-topics\/study-quality-assessment-tools."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1192\/bjp.2019.11","article-title":"Self-harm in older adults: Systematic review","volume":"214","author":"Troya","year":"2019","journal-title":"Br. J. Psychiatry"},{"key":"ref_12","first-page":"34","article-title":"Self-poisoning suicide attempts among students in Tehran, Iran","volume":"22","author":"Farzaneh","year":"2010","journal-title":"Psychiatr. Danub."},{"key":"ref_13","first-page":"69","article-title":"Suicidal behaviour trends in a pediatric population in Hawai\u2019i","volume":"673","author":"Magat","year":"2008","journal-title":"Hawaii Med. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1097\/01.pec.0000134925.08868.42","article-title":"Risk factors for nonfatal suicide behaviors among inner-city adolescents","volume":"20","author":"Suss","year":"2004","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"533","DOI":"10.4103\/0253-7176.194909","article-title":"Profile of Young Suicide Attempt Survivors in a Tertiary Care Hospital in Puducherry","volume":"38","author":"Lingeswaran","year":"2016","journal-title":"Indian J. Psychol. Med."},{"key":"ref_16","first-page":"11","article-title":"A study of deliberate self-poisoning in patients with adjustment disorders","volume":"38","author":"Mitrev","year":"1996","journal-title":"Folia Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"697","DOI":"10.31729\/jnma.2215","article-title":"Psychiatric Comorbidities in Patients with Deliberate Self-Harm in a Tertiary Care Center","volume":"52","author":"Ghimire","year":"2014","journal-title":"J. Nepal. Med. Assoc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1017\/S0790966700006583","article-title":"Assessment following deliberate self-harm: Who are we seeing and are we following the guidelines?","volume":"18","author":"McCauley","year":"2001","journal-title":"Ir. J. Psychol. Med."},{"key":"ref_19","first-page":"254","article-title":"Psychiatric diagnosis of self poisoning cases: A general hospital study","volume":"40","author":"Galgali","year":"1998","journal-title":"Indian J. Psychiatry"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/S0305-4179(01)00092-4","article-title":"Deliberate self-burning in Mazandaran, Iran","volume":"28","author":"Zarghami","year":"2002","journal-title":"Burn. J. Int. Soc. Burn Inj."},{"key":"ref_21","first-page":"22","article-title":"Deliberate self harm in a Saudi university hospital: A case series over 6 years","volume":"12","author":"AbuMadini","year":"2001","journal-title":"Arab J. Psychiatry"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/S0163-8343(98)00065-6","article-title":"Suicidal behavior among young people in Singapore","volume":"21","author":"Wai","year":"1999","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1016\/j.jad.2014.12.003","article-title":"Suicidal behaviours in adjustment disorder and depressive episode","volume":"174","author":"Casey","year":"2015","journal-title":"J. Affect. Disord."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1080\/j.1440-1665.2006.02262.x","article-title":"Patients with deliberate self-harm seen by a consultation-liaison service","volume":"14","author":"Brakoulias","year":"2006","journal-title":"Australas Psychiatry"},{"key":"ref_25","first-page":"160","article-title":"Deliberate Self-Harm in Older Adults: A General Hospital Emergency Department Survey","volume":"19","author":"Briskman","year":"2017","journal-title":"Isr. Med. Assoc. J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.genhosppsych.2012.03.015","article-title":"Comorbid psychiatric diagnoses in suicide attempt by charcoal burning: A 10-year study in a general hospital in Taiwan","volume":"34","author":"Lin","year":"2012","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"323","DOI":"10.2147\/PRBM.S167621","article-title":"Distinct psychopathology of patients who attempted suicide with rodenticide in Taiwan: A comparative study with patients of suicide with paraquat","volume":"29","author":"Lin","year":"2018","journal-title":"Psychol. Res. Behav. Manag."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.genhosppsych.2006.05.002","article-title":"Accuracy of diagnosis at routine psychiatric assessment in patients presenting to an accident and emergency department","volume":"28","author":"Taggart","year":"2006","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1007\/s00787-014-0624-x","article-title":"Suicidality and hospitalization as cause and outcome of pediatric psychiatric emergency room visits","volume":"24","author":"Grudnikoff","year":"2015","journal-title":"Eur. Child. Adolesc. Psychiatry"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1007\/s00127-005-0977-x","article-title":"Suicide among adolescents: A psychological autopsy study of psychiatric, psychosocial and personality-related risk factors","volume":"40","author":"Portzky","year":"2005","journal-title":"Soc. Psychiatry Psychiatr. Epidemiol. Int. J. Res. Soc. Genet. Epidemiol. Ment. Health Serv."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1007\/BF01977672","article-title":"Adolescent suicides with adjustment disorders or no psychiatric diagnosis","volume":"3","author":"Marttunen","year":"1994","journal-title":"Eur. Child. Adolesc. Psychiatry"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Lin, Y.W., Huang, H.C., Lin, M.F., Shyu, M.L., Tsai, P.L., and Chang, H.J. (2016). Influential Factors for and Outcomes of Hospitalized Patients with Suicide-Related Behaviors: A National Record Study in Taiwan from 1997\u20132010. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0149559"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/S1726-4901(09)70286-2","article-title":"Characteristics of adolescent suicide attempters admitted to an acute psychiatric ward in Taiwan","volume":"69","author":"Chiou","year":"2006","journal-title":"J. Chin. Med Assoc. JCMA"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2239","DOI":"10.1017\/S0033291716000696","article-title":"The communication of suicidal intentions: A meta-analysis","volume":"46","author":"Pompili","year":"2016","journal-title":"Psychol. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.comppsych.2007.10.002","article-title":"The adjustment disorders: The conundrums of the diagnoses","volume":"49","author":"Strain","year":"2008","journal-title":"Compr. Psychiatry"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/j.jad.2014.06.034","article-title":"Distinguishing between adjustment disorder and depressive episode in clinical practice: The role of personality disorder","volume":"168","author":"Doherty","year":"2014","journal-title":"J. Affect. Disord."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/16\/2967\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:11:58Z","timestamp":1760188318000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/16\/16\/2967"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,18]]},"references-count":36,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2019,8]]}},"alternative-id":["ijerph16162967"],"URL":"https:\/\/doi.org\/10.3390\/ijerph16162967","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,8,18]]}}}