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Miori S, Sanna A, Lassola S, Cicolini E, Zanella R, Magnoni S, De Rosa S, Bellani G, Umbrello M. Incidence, Risk Factors, and Consequences of Post-Traumatic Stress Disorder Symptoms in Survivors of COVID-19-Related ARDS. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085504. [PMID: 37107786 PMCID: PMC10138688 DOI: 10.3390/ijerph20085504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/28/2023] [Accepted: 04/06/2023] [Indexed: 05/11/2023]
Abstract
Purpose: To assess the prevalence of symptoms of Post-Traumatic Stress Disorder (PTSD) in survivors of COVID-19 Acute Respiratory Distress Syndrome that needed ICU care; to investigate risk factors and their impact on the Health-Related Quality of life (HR-QoL). Materials and Methods: This multicenter, prospective, observational study included all patients who were discharged from the ICU. Patients were administered the European Quality of Life 5 Dimensions 5 Level Version (EQ-5D-5L) questionnaire, the Short-Form Health Survey 36Version 2 (SF-36v2), a socioeconomic question set and the Impact of Event Scale-Revised (IES-R) to assess PTSD. Results: The multivariate logistic regression model found that an International Standard Classification of Education Score (ISCED) higher than 2 (OR 3.42 (95% CI 1.28-9.85)), monthly income less than EUR 1500 (OR 0.36 (95% CI 0.13-0.97)), and more than two comorbidities (OR 4.62 (95% CI 1.33-16.88)) are risk factors for developing PTSD symptoms. Patients with PTSD symptoms are more likely to present a worsening in their quality of life as assessed by EQ-5D-5L and SF-36 scales. Conclusion: The main factors associated with the development of PTSD-related symptoms were a higher education level, a lower monthly income, and more than two comorbidities. Patients who developed symptoms of PTSD reported a significantly lower Health-Related Quality of life as compared to patients without PTSD. Future research areas should be oriented toward recognizing potential psychosocial and psychopathological variables capable of influencing the quality of life of patients discharged from the intensive care unit to better recognize the prognosis and longtime effects of diseases.
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Affiliation(s)
- Sara Miori
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
| | - Andrea Sanna
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
- Correspondence: ; Tel.: +0039-903687; Fax: +0039-902692
| | - Sergio Lassola
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
| | - Erica Cicolini
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
| | - Roberto Zanella
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
| | - Sandra Magnoni
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
| | - Silvia De Rosa
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
- Centre for Medical Sciences—CISMed, University of Trento, 38122 Trento, Italy
| | - Giacomo Bellani
- Department of Anesthesia and Intensive Care, Santa Chiara Hospital, 38122 Trento, Italy
- Centre for Medical Sciences—CISMed, University of Trento, 38122 Trento, Italy
| | - Michele Umbrello
- Department of Intensive Care Unit, San Carlo Borromeo University Hospital, 20142 Milan, Italy
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Lonergan M, Saumier D, Pigeon S, Etienne PE, Brunet A. Treatment of adjustment disorder stemming from romantic betrayal using memory reactivation under propranolol: A open-label interrupted time series trial. J Affect Disord 2022; 317:98-106. [PMID: 36031005 DOI: 10.1016/j.jad.2022.08.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/25/2022] [Accepted: 08/22/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVES In a sustained relationship, romantic betrayal is a catastrophic event that can precipitate an adjustment disorder (AD). Surprisingly, there exists no empirically validated treatment for AD, despite its high prevalence in clinical practice. Considering the promise of memory reactivation under propranolol (i.e., reconsolidation interference) for treating posttraumatic stress disorder, we sought to extend this finding to AD, given that in both disorders, symptoms stem from an identified stressor. METHOD A single-blind interrupted time series design was used to examine the efficacy of memory reactivation under propranolol to alleviate symptoms of AD. After being placed on a 4-week waitlist, sixty-one participants received 5 weekly 25-min treatments during which they recalled the betrayal event, 1 h after having orally ingested the beta-blocker propranolol. RESULTS Segmented regression analyses on the intent-to-treat sample revealed that AD symptoms significantly decreased during the treatment phase (pre/post Cohen's d = 1.44), compared to the waitlist phase (d = 0.01). Significant pre/post reductions in anxio-depressive symptomatology were also found. Improvement was maintained at the 4-month follow-up on all outcomes. CONCLUSION Memory reactivation under propranolol shows promise in reducing symptoms of AD. This study provides the theoretical framework and necessary effect sizes to inform larger, double-blind, placebo-controlled clinical trials.
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Affiliation(s)
- Michelle Lonergan
- University of Ottawa, School of Psychology, Ottawa, Ontario, Canada; Research Center of the Douglas Mental Health University Institute, Montreal, Québec, Canada
| | - Daniel Saumier
- Research Center of the Douglas Mental Health University Institute, Montreal, Québec, Canada; University of Sherbrooke, Department of Psychology, Longueuil, Québec, Canada
| | - Sereena Pigeon
- Research Center of the Douglas Mental Health University Institute, Montreal, Québec, Canada; McGill University, Department of Educational and Counselling Psychology, Montreal, Québec, Canada
| | - Pierre E Etienne
- Research Center of the Douglas Mental Health University Institute, Montreal, Québec, Canada
| | - Alain Brunet
- Research Center of the Douglas Mental Health University Institute, Montreal, Québec, Canada; McGill University, Department of Psychiatry, Montreal, Québec, Canada.
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Cross-Cultural Comparison of ICD-11 Adjustment Disorder Prevalence and Its Risk Factors in Japanese and Lithuanian Adolescents. Brain Sci 2022; 12:brainsci12091172. [PMID: 36138907 PMCID: PMC9496776 DOI: 10.3390/brainsci12091172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Although there is increasing knowledge about adjustment disorder (AjD) based on the new diagnostic criteria of the International Classification of Diseases (ICD-11), less is known on AjD in adolescents. This study aimed to examine the prevalence of AjD and its risk factors in Japanese and Lithuanian adolescents. Methods: The cross-sectional study sample comprised 1745 adolescents from Japan (n = 913) and Lithuania (n = 832). AjD was assessed using the Adjustment Disorder New Module-8 (ADNM-8). We compared the prevalence of AjD in Japanese and Lithuanian adolescents. Using multinominal logistic regression analysis, we examined the effects of age, gender, socioeconomic status, and cumulative stressors as societal and cultural factors, resilience as an intrapersonal factor, and loneliness and perceived support as interpersonal factors on adolescent AjD. Results: The prevalence of probable AjD was 11.7% in Lithuanian adolescents and 6.9% in Japanese adolescents. Gender, socioeconomic status, cumulative stressors, resilience, loneliness, and perceived positive social support were each significantly associated with AjD risk. Conclusions: This cross-cultural comparative study revealed characteristics of the stressors and prevalence of AjD among Japanese and Lithuanian adolescents. In terms of the socio-interpersonal framework model for the stress–response syndrome, sociocultural, intrapersonal, and interpersonal factors were found to be risk factors associated with AjD in adolescents.
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The potential impact of Covid-19 on CNS and psychiatric sequels. Asian J Psychiatr 2022; 72:103097. [PMID: 35405524 PMCID: PMC8982477 DOI: 10.1016/j.ajp.2022.103097] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/19/2022] [Accepted: 04/02/2022] [Indexed: 01/08/2023]
Abstract
Due to its high prevalence and fatality, the current Severe Acute Respiratory Syndrome-coronavirus-2 (SARS-CoV-2) virus, which first emerged in China in 2019, quickly spread around the world and immediately became a serious global health concern. Although respiratory issues were initially the most prominent symptom of coronavirus disease 2019 (COVID-19), it became obvious rapidly that COVID-19, like many other coronavirus family members, could affect the central nervous system (CNS). During the pandemic, CNS involvement expressed itself in a variety of forms, including insomnia, anosmia, headaches, encephalopathies, encephalitis, cerebrovascular accidents, cognitive and memory impairment, and increased psychiatric disorders. Almost everyone who has been infected has at least one of these neurological symptoms, demonstrating that the virus has a high ability to impact the CNS. As the coronavirus pandemic passes its second year, the manifestations it can cause in the long run, such as its psychological sequels, have not yet been thoroughly studied. Given the high importance of this issue in today's society and due to the lack of reliable knowledge about the COVID-19 landscape on psychiatric disorders, we intend to investigate coronavirus's possible effect on mental illnesses based on available literature. Because the majority of the psychological effects of the coronavirus can continue for a long period after the pandemic ends, our research can give insight into potential psychiatric sequels associated with COVID-19.
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Kelber MS, Morgan MA, Beech EH, Smolenski DJ, Bellanti D, Galloway L, Ojha S, Otto JL, Wilson ALG, Bush N, Belsher BE. Systematic review and meta-analysis of predictors of adjustment disorders in adults. J Affect Disord 2022; 304:43-58. [PMID: 35176345 DOI: 10.1016/j.jad.2022.02.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/22/2021] [Accepted: 02/13/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. LIMITATIONS 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. CONCLUSIONS 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.
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Affiliation(s)
- Marija Spanovic Kelber
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA.
| | - Maria A Morgan
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Erin H Beech
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Derek J Smolenski
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Dawn Bellanti
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Lindsay Galloway
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Suman Ojha
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Jean Lin Otto
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Abigail L Garvey Wilson
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA; Department of Epidemiology, George Washington University, Washington, DC, USA
| | - Nigel Bush
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA
| | - Bradley E Belsher
- Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA; Carl T Hayden Veterans Medical Center, Phoenix, AZ, USA
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6
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Brunet A, Rivest-Beauregard M, Lonergan M, Cipolletta S, Rasmussen A, Meng X, Jaafari N, Romero S, Superka J, Brown AD, Sapkota RP. PTSD is not the emblematic disorder of the COVID-19 pandemic; adjustment disorder is. BMC Psychiatry 2022; 22:300. [PMID: 35484539 PMCID: PMC9047380 DOI: 10.1186/s12888-022-03903-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/29/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) has been hailed by some as the emblematic mental disorder of the COVID-19 pandemic, assuming that PTSD's life-threat criterion was met de facto. More plausible outcomes like adjustment disorder (AD) have been overlooked. METHODS An online cross-sectional survey was launched in the initial stage of the pandemic using a convenience sample of 5 913 adults to compare the prevalence of COVID-related probable PTSD versus probable AD. The abridged Impact of Event Scale - Revised (IES-6) assessed the severity of trauma- and stressor-related symptoms over the previous week. Demographic and pandemic-related data (e.g., receiving a formal diagnosis of COVID-19, job loss, loss of loved one, confinement, material hardship) were collected. A Classification and Regression Tree analysis was conducted to uncover the pandemic experiences leading to clinical 'caseness'. Caseness was defined by a score > 9 on the IES-6 symptom measure and further characterized as PTSD or AD depending on whether the Peritraumatic Distress Inventory's life-threat item was endorsed or not. RESULTS The participants were predominantly Caucasian (72.8%), women (79.2%), with a university degree (85%), and a mean age of 42.22 (SD = 15.24) years; 3 647 participants (61.7%; 95%CI [60.4, 63.0]) met the threshold for caseness. However, when perceived life-threat was accounted for, only 6.7% (95%CI [6.1, 7.4]) were classified as PTSD cases, and 55% (95%CI [53.7, 56.2]) as AD cases. Among the AD cases, three distinct profiles emerged marked by the following: (i) a worst personal pandemic experience eliciting intense fear, helplessness or horror (in the absence, however, of any life-threat), (ii) a pandemic experience eliciting sadness/grief, and (iii) worrying intensely about the safety of significant others. CONCLUSIONS Studies considering the life-threat criterion as met de facto during the pandemic are confusing PTSD for AD on most counts. This misconception is obscuring the various AD-related idioms of distress that have emerged during the pandemic and the actual treatment needs.
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Affiliation(s)
- Alain Brunet
- Research Center of the Douglas Mental Health University Institute (CIUSSS-ODIM), 6875 boulevard LaSalle, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Marjolaine Rivest-Beauregard
- grid.412078.80000 0001 2353 5268Research Center of the Douglas Mental Health University Institute (CIUSSS-ODIM), 6875 boulevard LaSalle, Montreal, QC H4H 1R3 Canada ,grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, Montreal, QC Canada
| | - Michelle Lonergan
- grid.412078.80000 0001 2353 5268Research Center of the Douglas Mental Health University Institute (CIUSSS-ODIM), 6875 boulevard LaSalle, Montreal, QC H4H 1R3 Canada ,grid.28046.380000 0001 2182 2255School of Psychology, Ottawa University, Ottawa, ON Canada
| | - Sabrina Cipolletta
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, Padua, Italy
| | - Andrew Rasmussen
- grid.256023.0000000008755302XDepartment of Psychology, Fordham University, New York, NY USA
| | - Xiangfei Meng
- grid.412078.80000 0001 2353 5268Research Center of the Douglas Mental Health University Institute (CIUSSS-ODIM), 6875 boulevard LaSalle, Montreal, QC H4H 1R3 Canada ,grid.14709.3b0000 0004 1936 8649Department of Psychiatry, McGill University, Montreal, QC Canada
| | - Nematollah Jaafari
- grid.11166.310000 0001 2160 6368Department of Psychiatry, Université de Poitiers, Poitiers, France
| | - Sara Romero
- grid.38142.3c000000041936754XDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Julia Superka
- grid.264933.90000 0004 0523 9547Department of Psychology, The New School for Social Research, New York, NY USA
| | - Adam D. Brown
- grid.264933.90000 0004 0523 9547Department of Psychology, The New School for Social Research, New York, NY USA
| | - Ram P. Sapkota
- grid.412078.80000 0001 2353 5268Research Center of the Douglas Mental Health University Institute (CIUSSS-ODIM), 6875 boulevard LaSalle, Montreal, QC H4H 1R3 Canada ,grid.57926.3f0000 0004 1936 9131Online Therapy Unit, Department of Psychology, University of Regina, Regina, SK Canada
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Trajectories of adjustment disorder symptoms in post-treatment breast cancer survivors. Support Care Cancer 2022; 30:3521-3530. [PMID: 35020075 PMCID: PMC8857158 DOI: 10.1007/s00520-022-06806-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 12/31/2021] [Indexed: 11/06/2022]
Abstract
Objective Breast cancer survivors (BCS) may experience problems to adjust to their situation after cancer treatment completion. In case of severe distress, an adjustment disorder (AD) might develop. This study investigates the course of AD symptoms during 1 year and its predictors in BCS up to 5 years post-treatment. Methods BCS completed the Hospital Anxiety and Depression Scale (HADS) at baseline, 3, 6, and 12 months. HADS total scores were defined as no mental disorder (MD) symptoms (≤ 10), AD symptoms (11–14), and any other MD symptoms (≥ 15). Over the course of four assessments, symptom trajectories were a priori defined as no MD symptoms, AD symptoms, fluctuating AD symptoms below and above cut-offs, or any other MD symptoms. Complementary, latent class growth analysis (LCGA) was used to identify data-driven trajectories. Results Among 293 BCS with complete data, the majority was classified as no MD symptoms (54.4%), followed by 37.5% in the fluctuating AD symptoms trajectory. Only 1.4% had AD symptoms, and 6.8% had any other MD symptoms. With LCGA (N = 459), three trajectories were found: stable no MD symptoms (58.6%), stable AD symptoms (32.9%), and high increasing any other MD symptoms (8.5%). Compared to BCS with no MD symptoms, BCS with fluctuating AD symptoms or any other MD symptoms were younger, less able to handle daily activities, and showed more social support discrepancy, neuroticism, and less optimism. Conclusions Results of our study showed that AD symptoms in BCS up to 5 years post-treatment fluctuate over 1 year. It is thus important to appropriately assess AD over the course of 5 years post-treatment as AD symptoms can fluctuate.
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Levin Y, Bachem R, Hyland P, Karatzias T, Shevlin M, Ben-Ezra M, Maercker A. Validation of the International Adjustment Disorder Questionnaire in Israel and Switzerland. Clin Psychol Psychother 2022; 29:1321-1330. [PMID: 35018693 DOI: 10.1002/cpp.2710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/26/2021] [Accepted: 12/28/2021] [Indexed: 11/05/2022]
Abstract
The ICD-11 has introduced a new conceptualization of adjustment disorder (AjD) as a stress response syndrome with core symptoms of preoccupations and failure to adapt to the stressor. The current study aimed to assess the reliability and validity of the International Adjustment Disorder Questionnaire (IADQ) in two culturally distinct samples from Israel and Switzerland. Two samples were recruited in Israel (N = 1142) and Switzerland (N = 699) during the initial stages of the COVID-19 pandemic. Confirmatory factor analysis indicated that a correlated two-factor model provided an excellent fit to the Israeli and Swiss sample data. The IADQ scores correlated strongly with another measure of AjD symptoms, and with symptoms of depression, anxiety, acute stress, and negative emotions whereas correlations with posttraumatic stress disorder, complex posttraumatic stress disorder, and positive emotions were weaker. In the Swiss sample, 18.8% met diagnostic criteria for probable AjD and 10.2% in the Israeli sample. The current study provides the first evidence of the validity of the German and Hebrew versions of the IADQ and can be used for the screening of this debilitating condition.
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Affiliation(s)
- Yafit Levin
- Education Department, University of Ariel, Ariel, Israel.,School of Social Work, University of Ariel, Ariel, Israel
| | - Rahel Bachem
- University of Zurich, Institute of Psychology, Psychopathology and Clinical Intervention, Zurich, Switzerland
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Co, Kildare, Ireland
| | - Thanos Karatzias
- Edinburgh Napier University, Edinburgh, Scotland, UK.,NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, Scotland, UK
| | - Mark Shevlin
- Psychology Research Institute, School of Psychology, Derry, Northern Ireland
| | | | - Andreas Maercker
- University of Zurich, Institute of Psychology, Psychopathology and Clinical Intervention, Zurich, Switzerland
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9
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Levin Y, Karatzias T, Shevlin M, Ben-Ezra M, Maercker A, Bachem R. The network structure of ICD-11 adjustment disorder: A comparison of clinical and nonclinical samples. Eur Psychiatry 2022; 65:e43. [PMID: 35903852 PMCID: PMC9393912 DOI: 10.1192/j.eurpsy.2022.2303] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background International Classification of Diseases, 11th revision (ICD-11) adjustment disorder (AjD) is characterized by two main symptom clusters: preoccupation with the stressor and failure to adapt to the stressor. The network analytic approach provides important information on the structural validity of a disorder and reveals which symptoms are most prominent. To date, no study compared the network structure of AjD symptoms in clinical and nonclinical samples, which could potentially inform our understanding of psychopathological mechanisms that underlie AjD and identify core targets for therapy. Methods A network analysis was conducted on AjD symptoms as assessed by the Adjustment Disorder—New Module (ADNM-8) using data from 330 clinical participants from the UK and a nonclinical sample of 699 participants from Switzerland. Results Comparisons of network structure invariance revealed differences between the network structure of the clinical and the nonclinical samples. Results highlight that in terms of both edges strength and centrality, failure to adapt symptoms was more prominent in the clinical sample, while the preoccupation symptoms were more prominent in the nonclinical sample. Importantly, global strength was similar across networks. Conclusions Results provide evidence of the coherence of AjD in the ICD-11 as assessed by the ADNM questionnaire. They tentatively suggest that subclinical AjD may be characterized by emerging preoccupation symptoms that may result in failure to adapt and functional impairment in clinical manifestation of AjD. However, there is a need for replication and longitudinal research to further validate this hypothesis.
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Vancappel A, Jansen E, Bachem R, Bray A, Egreteau L, Réveillère C, Maercker A, El-Hage W. Validation of the French ADNM-20 in the assessment of emotional difficulties resulting from COVID-19 quarantine and outbreak. BMC Psychol 2021; 9:180. [PMID: 34774108 PMCID: PMC8590117 DOI: 10.1186/s40359-021-00683-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 11/01/2021] [Indexed: 12/04/2022] Open
Abstract
Background Multiple psychological consequences of the COVID-19 outbreak and quarantine have been described. However, there is a lack of global conceptualization. We argue that the stressful aspects of the situation, the multiple environmental consequences of the outbreak, and the diversity of symptoms observed in such a situation, suggest that Adjustment disorder (AD) is a promising way to conceptualize the psychological consequences of the outbreak and quarantine. The first aim of the study was to validate the French version of the ADNM. The second aim was to set out adjustment difficulties resulting from COVID-19 outbreak and quarantine. Method We recruited 1010 (840 women, 170 men) who consented online to participate. They filled out the French ADNM, visual analogic scales, HADS, IES, and the COPE, to evaluate coping strategies. Results We confirmed the factor structure of the ADNM and we found good psychometric properties. We found that 61.3% of participants presented an adjustment disorder related to COVID-19 outbreak. We found multiple risk factors and protective factors to AD due to quarantine and outbreak. We also identified the coping strategies negatively and positively associated with AD. Conclusion Adjustment disorder is a relevant concept to understand psychological manifestations caused by quarantine and outbreak. The French ANDM has good psychometric properties to evaluate such manifestations. The association between coping strategies and AD symptoms suggest that CBT may be the best intervention to help people suffering from AD. Supplementary Information The online version contains supplementary material available at 10.1186/s40359-021-00683-7.
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Affiliation(s)
- A Vancappel
- Pôle de Psychiatrie-Addictologie, Clinique Psychiatrique Universitaire, CHRU de Tours, Tours, France. .,Département de Psychologie, EE 1901 Qualipsy, Qualité de vie et Santé Psychologique, Université de Tours, Tours, France. .,UMR 1253, iBrain, Inserm, Université de Tours, Tours, France.
| | - E Jansen
- Pôle de Psychiatrie-Addictologie, Clinique Psychiatrique Universitaire, CHRU de Tours, Tours, France
| | - R Bachem
- Universität Zürich, Zurich, Switzerland
| | - A Bray
- Pôle de Psychiatrie-Addictologie, Clinique Psychiatrique Universitaire, CHRU de Tours, Tours, France
| | - L Egreteau
- Pôle de Psychiatrie-Addictologie, Clinique Psychiatrique Universitaire, CHRU de Tours, Tours, France
| | - C Réveillère
- Département de Psychologie, EE 1901 Qualipsy, Qualité de vie et Santé Psychologique, Université de Tours, Tours, France
| | | | - W El-Hage
- Pôle de Psychiatrie-Addictologie, Clinique Psychiatrique Universitaire, CHRU de Tours, Tours, France.,UMR 1253, iBrain, Inserm, Université de Tours, Tours, France
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11
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Levin Y, Bachem R, Karatzias T, Shevlin M, Maercker A, Ben-Ezra M. Network structure of ICD-11 adjustment disorder: a cross-cultural comparison of three African countries. Br J Psychiatry 2021; 219:557-564. [PMID: 35048882 DOI: 10.1192/bjp.2021.46] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Adjustment disorder is one of the most widespread mental disorders worldwide. In ICD-11, adjustment disorder is characterised by two main symptom clusters: preoccupation with the stressor and failure to adapt. A network analytic approach has been applied to most ICD-11 stress-related disorders. However, no study to date has explored the relationship between symptoms of adjustment disorder using network analysis. AIMS We aimed to explore the network structure of adjustment disorder symptoms and whether its structure replicates across questionnaire versions and samples. METHOD A network analysis was conducted on adjustment disorder symptoms as assessed by the Adjustment Disorder-New Module (ADNM-8) and an ultra-brief version (ADNM-4) using data from 2524 participants in Nigeria (n = 1006), Kenya (n = 1018) and Ghana (n = 500). RESULTS There were extensive connections between items across all samples in both ADNM versions. Results highlight that preoccupation symptoms seem to be more prominent in terms of edges strengths (i.e. connections) and had the highest centrality in all networks across samples and ADNM versions. Comparisons of network structure invariance revealed one difference between Nigeria and Ghana in both ADNM versions. Importantly, the ADNM-8 global strength was similar in all networks whereas in the ADNM-4 Kenya had a higher global strength score compared with Nigeria. CONCLUSIONS Results provide evidence of the coherence of adjustment disorder in ICD-11 as assessed by the ADNM questionnaire. The prominence of preoccupation symptoms in adjustment disorder highlights a possible therapeutic target to alleviate distress. There is a need to further replicate the network structure of adjustment disorder in non-African samples.
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Affiliation(s)
- Yafit Levin
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Switzerland
| | - Rahel Bachem
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Switzerland
| | - Thanos Karatzias
- Edinburgh Napier University, Scotland, UK; and NHS Lothian, Rivers Centre for Traumatic Stress, Scotland, UK
| | - Mark Shevlin
- Psychology Research Institute, School of Psychology, Ulster University, Northern Ireland, UK
| | - Andreas Maercker
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Switzerland
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12
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Eberle DJ, Maercker A. Preoccupation as psychopathological process and symptom in adjustment disorder: A scoping review. Clin Psychol Psychother 2021; 29:455-468. [PMID: 34355464 PMCID: PMC9291616 DOI: 10.1002/cpp.2657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 01/28/2023]
Abstract
In the ICD‐11 diagnostic guidelines, preoccupation has been introduced as the new core symptom of adjustment disorder. Despite this essential innovation, preoccupation has so far largely been defined as rumination and worry and does not feature a distinct character as an independent symptom. In order to investigate the nature of preoccupation, various cognitive approaches are evaluated and linked to preoccupation. Furthermore, the aim of this review is to define preoccupation more precisely and to distinguish it from other symptoms in psychopathology. The evaluation of key features of cognitive dissonance theory, attention bias theory, memory theories, and other cognitive paradigms indicates that preoccupation is constituted by a complex interaction of cognitive–emotional mechanisms. In addition, this review implies that preoccupation in AjD can be defined as stressor‐related factual thinking, which is time‐consuming and often associated with negative emotions. It is assumed that rumination and dysfunctional worry serve as reactive processes to cope with preoccupation. For further distinction, this review presents similarities and differences of preoccupation and other symptoms, including negative automatic thoughts, flashbacks, and yearning. Finally, implications and suggestions for future research on preoccupation are offered. Overall, it is plausible that preoccupation is not only associated with adjustment disorder but also possesses a transdiagnostic character.
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Affiliation(s)
- David J Eberle
- Division of Psychopathology and Clinical Intervention, Institute of Psychology, University of Zurich, Zürich, Switzerland
| | - Andreas Maercker
- Division of Psychopathology and Clinical Intervention, Institute of Psychology, University of Zurich, Zürich, Switzerland
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13
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Qin Z, Mei S, Gao T, Liang L, Li C, Hu Y, Guo X, Meng C, Lv J, Yuan T, Fei J, Tong Q, Yang Y. Self-Esteem as a Mediator between Life Satisfaction and Depression among Cardiovascular Disease Patients. Clin Nurs Res 2021; 31:115-121. [PMID: 34259087 DOI: 10.1177/10547738211030002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explores the association between life satisfaction and depression among patients with cardiovascular diseases and whether this association is mediated by self-esteem. A cross-sectional study was conducted in a third-grade hospital. We examined 300 patients with cardiovascular diseases with a mean age of 62.00 years (females, 133). Life satisfaction was associated with depression. Adding self-esteem to the model weakened the strength of the association between the two. Moreover, 34.2% of the effect of life satisfaction on depression could be explained by self-esteem. We found that self-esteem could totally explain the effect of life satisfaction on depression among patients with cardiovascular diseases.
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14
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[Symptoms of Adjustment Disorder after an accidental injury: risk and protective factors]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2021; 67:403-415. [PMID: 34180356 DOI: 10.13109/zptm.2021.67.oa9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Symptoms of Adjustment Disorder after an accidental injury: risk and protective factors Objectives: The identification of protective and risk factors for symptoms of adjustment disorder (AD) after an accident injury. Methods: In this prospective long-term study, data from 73 patients with ankle and lower leg fractures were analyzed. Symptoms of AD were assessed at enrollment (T0), 1 month (T1) and 12 months (T2) after injury. In addition, questionnaires regarding adverse childhood experiences, coping strategies and the number of stressors during the last year were obtained. The Structured Clinical Interview for DSM-IV (SCID) was conducted at T1 and T2. Results: 4.1 % of patients met the criteria for AD at T1 and 2.7 % at T2. Acceptance coping predicted a lower level of AD symptoms 1 year after the injury (β = -.42, p <.001). Conclusions: It could be confirmed that the selection of coping strategies predicts the level of AD symptoms 12 months after the injury. The results show that acceptance is a protective factor for AD and contribute to a better understanding of a little-researched diagnosis.
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15
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Liang L, Ben-Ezra M, Chan EWW, Liu H, Lavenda O, Hou WK. Psychometric evaluation of the Adjustment Disorder New Module-20 (ADNM-20): A multi-study analysis. J Anxiety Disord 2021; 81:102406. [PMID: 33932632 DOI: 10.1016/j.janxdis.2021.102406] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 03/31/2021] [Accepted: 04/15/2021] [Indexed: 12/15/2022]
Abstract
The Adjustment Disorder New Module (ADNM) is a self-report instrument for assessing Adjustment disorder (AjD), but uncertainties remain in evaluating factor structure and psychometric properties of ADNM in previous studies. Three studies were conducted to examine the factor structure, psychometrics properties, and clinical utility of the 20-item version of ADNM (ADNM-20) and 4-item version (ADNM-4) among samples of Hong Kong Chinese (N = 1,415). Confirmatory factor analysis demonstrated good model fitness with a bifactor model. Statistical indices indicated unidimensionality of AjD. The model-based reliability showed that the total score of ADNM-20 should be used in scoring and interpretation for capturing the construct of AjD. ADNM-4 model demonstrated full invariance between women and men and partial invariance between age groups. Receiver operating characteristic analysis revealed a cutoff score of 10 for probable AjD. The prevalence of probable AjD was 20.5 % excluding cases with probable depression among a population-representative sample of Hong Kong Chinese amid civil unrest in Hong Kong in July 2019. Cutoff scores of ADNM-20 (49) and ADNM-4 (9) were established for clinically significant common psychiatric conditions, namely PTSD, depression, and anxiety. Both ADNM-20 and ADNM-4 were reliable and valid to assess probable AjD. Implications for clinical research and practice are discussed.
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Affiliation(s)
- Li Liang
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong Special Administrative Region, China
| | | | - Edward W W Chan
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Huinan Liu
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Psychology, The Education University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Osnat Lavenda
- School of Social Work, Ariel University, Ariel, 40700, Israel
| | - Wai Kai Hou
- Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong Special Administrative Region, China; Department of Psychology, The Education University of Hong Kong, Hong Kong Special Administrative Region, China.
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16
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Perkonigg A, Strehle J, Beesdo-Baum K, Lorenz L, Hoyer J, Venz J, Maercker A. Reliability and Validity of a German Standardized Diagnostic Interview Module for ICD-11 Adjustment Disorder. J Trauma Stress 2021; 34:275-286. [PMID: 33151596 DOI: 10.1002/jts.22597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 07/30/2020] [Accepted: 08/04/2020] [Indexed: 02/04/2023]
Abstract
The ICD-11 includes a new definition of adjustment disorder (AjD). The present study aimed to examine interrater reliability, internal consistency, and construct validity of a new diagnostic interview module to assess ICD-11 AjD. Data from two studies that used a standardized diagnostic interview assessment (i.e., DIA-X/M-CIDI and updated DIA-X-5) were used. For interrater reliability, agreement indicators (i.e., κ) were calculated using data from the DIA-X-5 test-retest study (N = 60). To examine internal consistency and construct validity, Cronbach's alpha values and the Kuder-Richardson correlation coefficient were computed along with confirmatory factor and latent class analyses (LCA), using data from the Zurich Adjustment Disorder Study (N = 330). Interrater reliability analyses found an adjusted kappa of 0.807 for the ICD-11 AjD diagnosis. Few items from the impairment criterion of the diagnostic algorithm performed poorly. The internal consistency was acceptable, Cronbach's αs = .43-.80; the lower-bound estimate resulted from the two-item preoccupation symptom pattern. However, both items were significantly associated, OR = 3.14, 95% CI [1.97, 4.99]. Regarding LCA results, a two-class model was favored. We found that 94.3% of all ICD-11 AjD cases belonged to Class 2, OR = 23.69, 95% CI [7.15, 79.54], which was associated with subjectively rated distress, OR = 2.18, 95% CI [1.57, 3.02], and the external measure of the Brief Symptom Inventory global severity index, OR = 2.18, 95% CI [1.57, 3.02]. Overall, the new AjD interview module provided a reliable, valid assessment of the ICD-11 diagnosis; confirmation by other studies is needed.
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Affiliation(s)
- Axel Perkonigg
- University of Zurich, Department of Psychology, Psychopathology and Clinical Intervention, Zurich, Switzerland
| | - Jens Strehle
- Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany
| | - Katja Beesdo-Baum
- Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany.,Technische Universität Dresden, Behavioral Epidemiology & Center for Clinical Epidemiology and Longitudinal Studies, Dresden, Germany
| | - Louisa Lorenz
- University of Zurich, Department of Psychology, Psychopathology and Clinical Intervention, Zurich, Switzerland
| | - Jana Hoyer
- Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany.,Technische Universität Dresden, Behavioral Epidemiology & Center for Clinical Epidemiology and Longitudinal Studies, Dresden, Germany
| | - John Venz
- Technische Universität Dresden, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany.,Technische Universität Dresden, Behavioral Epidemiology & Center for Clinical Epidemiology and Longitudinal Studies, Dresden, Germany
| | - Andreas Maercker
- University of Zurich, Department of Psychology, Psychopathology and Clinical Intervention, Zurich, Switzerland
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17
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Brog NA, Hegy JK, Berger T, Znoj H. An internet-based self-help intervention for people with psychological distress due to COVID-19: study protocol for a randomized controlled trial. Trials 2021; 22:171. [PMID: 33648555 PMCID: PMC7917378 DOI: 10.1186/s13063-021-05089-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The coronavirus-19 (COVID-19) has reached pandemic status and is affecting countries all over the world. The COVID-19 pandemic is accompanied by various stressors that require adjustment in everyday life and possibly changes in personal future prospects. While some individuals cope well with these challenges, some develop psychological distress including depressive symptoms, anxiety, or stress. Internet-based self-help interventions have proven to be effective in the treatment of various mental disorders such as depression and anxiety. Based on that, we developed an internet-based self-help program for individuals with psychological distress due to the situation surrounding the COVID-19 pandemic. The 3-week self-help program consists of 6 modules comprising texts, videos, figures, and exercises. Participants can request guidance within the self-help program (guidance on demand). The primary aim of this study is to evaluate the efficacy and feasibility of the self-help program compared to a waiting control condition. METHODS The design is a parallel group randomized controlled trial. Participants are allocated to a 3-week self-help intervention plus care as usual or a 3-week waiting period with only care as usual. There are follow-ups after 6 weeks and 18 weeks. At least 80 participants with COVID-19 pandemic related psychological distress will be recruited. Primary outcome are depressive symptoms. Secondary outcomes include anxiety and chronic stress, suicidal experiences and behavior, health-related quality of life, generalized optimism and pessimism, embitterment, optimistic self-beliefs, emotion regulation skills, loneliness, resilience, and the satisfaction with and usability of the self-help program. DISCUSSION To the best of our knowledge, this is one of the first studies investigating the efficacy of an internet-based self-help program for psychological distress due to the situation surrounding the COVID-19 pandemic. Thus, the results of this study may give further insight into the use of internet-based self-help programs in pandemic-related psychological distress. TRIAL REGISTRATION ClinicalTrials.gov NCT04380909 . Retrospectively registered on 8 May 2020.
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Affiliation(s)
- Noemi Anja Brog
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Julia Katharina Hegy
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Thomas Berger
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
| | - Hansjörg Znoj
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland
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18
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Simons C, Martin LA, Balcombe L, Dunn PK, Clark RA. Mental health impact on at-risk high-level athletes during COVID-19 lockdown: A pre-, during and post-lockdown longitudinal cohort study of adjustment disorder. J Sci Med Sport 2021; 24:329-331. [PMID: 33402273 PMCID: PMC8837901 DOI: 10.1016/j.jsams.2020.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Chantal Simons
- University of the Sunshine Coast, School of Health and Behavioural Sciences, Australia.
| | - Lisa A Martin
- University of the Sunshine Coast, School of Health and Behavioural Sciences, Australia
| | - Luke Balcombe
- University of the Sunshine Coast, School of Health and Behavioural Sciences, Australia
| | - Peter K Dunn
- University of the Sunshine Coast, School of Health and Behavioural Sciences, Australia
| | - Ross A Clark
- University of the Sunshine Coast, School of Health and Behavioural Sciences, Australia
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19
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Tang H, Xiong H, Deng L, Maercker A, Zhang J, Meng H. Psychometric properties of the Chinese version of adjustment disorder new module-20 in breast cancer patients. BMC Psychol 2020; 8:128. [PMID: 33298167 PMCID: PMC7724707 DOI: 10.1186/s40359-020-00494-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/24/2020] [Indexed: 01/30/2023] Open
Abstract
Background After the new definition of adjustment disorder (AjD) by the International Classification of Diseases-11(ICD-11), AjD has attracted more and more attention. Adjustment disorder new module-20 (ADNM-20), which is used to diagnose AjD, has been verified in some countries, but it has not been verified in China. As a result, the purpose of this study was to investigate the validity and reliability of the Chinese version of the Adjustment disorder new module-20 (ADNM-20) in female breast cancer patients.
Methods The ADNM-20 translated into Chinese employed the translation and back translation technique. Three hundred fifty four newly diagnosed (< 1 year) female breast cancer patients were recruited from Tongji Hospital and Hubei Cancer Hospital in Hubei, China. The patients completed the self-report questionnaire including demographic characteristics and the scale ADNM-20. Data on psychometric properties were evaluated in terms of internal consistency, item-total correlations, test-retest reliability, and factorial validity. Results ADNM-20 core symptoms included 8 items and two factors, which were extracted by using exploratory factor analysis (EFA). It could explain 61.74% of the total variance. ADNM-20 accessory symptoms including 12 items and four factors, which were extracted by using EFA. It could explain 68.34% of the total variance. Cronbach’s α coefficient for ADNM-20 was 0.93, split-half reliability was 0.87, and the test-retest correlation coefficient was 0.74. The correlation coefficient between each subscale was ranged from 0.53 to 0.71 (P < 0.01), while the correlation coefficient between the subscales and total scale was ranged from 0.79 to 0.89 (P < 0.01). Conclusions The study verified the validity and reliability of the Chinese version of ADNM-20. It is applicable to measure the prevalence of adjustment disorder in the breast cancer population.
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Affiliation(s)
- Haiyan Tang
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Qiaoko District, Wuhan, Hubei, 430030, People's Republic of China
| | - Huihua Xiong
- Department of Comprehensive Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Wuhan, People's Republic of China
| | - Lingchao Deng
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Qiaoko District, Wuhan, Hubei, 430030, People's Republic of China
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Jun Zhang
- Wuhan Mental Health Center, Wuhan, People's Republic of China
| | - Heng Meng
- Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, 13 Hangkong Road, Qiaoko District, Wuhan, Hubei, 430030, People's Republic of China.
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20
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Van Overmeire R. Comment on Dutheil, Mondillon, and Navel (2020): the importance of adjustment disorders and resilience. Psychol Med 2020; 52:1-2. [PMID: 32895089 PMCID: PMC7487745 DOI: 10.1017/s003329172000344x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Roel Van Overmeire
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090Jette, Belgium
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21
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Smith ML, Farkas DK, Sumner JA, Jiang T, Lash TL, Galea S, Sørensen HT, Gradus JL. Associations between adjustment disorder and hospital-based infections in the Danish population. J Psychosom Res 2020; 132:109976. [PMID: 32142971 DOI: 10.1016/j.jpsychores.2020.109976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE There is some evidence that posttraumatic stress disorder (PTSD) is associated with increased risk of infections, and it is unknown whether adjustment disorder is as well. We assessed the association between adjustment disorder and subsequent infections, and assessed additive interaction with sex. METHODS The study population included a nationwide cohort of all Danish-born residents of Denmark diagnosed with adjustment disorder between 1995 and 2011, and an age- and sex-matched general population comparison cohort. We compared rates of infections requiring inpatient or outpatient hospitalization in the two cohorts. We fit Cox proportional hazards models to compute adjusted hazard ratios (aHR) for the associations between adjustment disorder and 32 types of infections, and calculated interaction contrasts to assess interaction between adjustment disorder and sex. RESULTS Adjustment disorder was associated with increased rates of infections overall (n = 19,838 infections, aHR = 1.8, 95% confidence interval = 1.8. 1.9), and increased rates of each individual infection type (aHRs for 30 infections ranged from 1.5 to 2.3), adjusting for baseline psychiatric and somatic comorbidities and marital status. For many infection types (e.g., skin infections, pneumonia), interaction contrasts indicated rate differences were greater among men than women, while for two (urinary tract infections and sexually transmitted infections), rate differences were greater for women. CONCLUSIONS These findings are consistent with studies examining the relationship between psychological stress and infections, and between PTSD and infections. They may be explained by a combination of the triggering of unhealthy behaviors as well as immune responses to stress.
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Affiliation(s)
- Meghan L Smith
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.
| | | | - Jennifer A Sumner
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Tammy Jiang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
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22
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Shevlin M, Hyland P, Ben-Ezra M, Karatzias T, Cloitre M, Vallières F, Bachem R, Maercker A. Measuring ICD-11 adjustment disorder: the development and initial validation of the International Adjustment Disorder Questionnaire. Acta Psychiatr Scand 2020; 141:265-274. [PMID: 31721147 DOI: 10.1111/acps.13126] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Adjustment disorder (AjD) is one of the most frequently used diagnoses in psychiatry but a diagnostic definition for AjD was only introduced in release of the ICD-11. This study sought to develop and validate a new measure operationalizing the ICD-11's narrative description of AjD, and to determine the current rate of people meeting the symptoms indicative of AjD in the general population of the Republic of Ireland. METHODS The International Adjustment Disorder Questionnaire (IADQ) was constructed to measure the core diagnostic criteria of ICD-11 AjD: stressor exposure, preoccupations with, and failure to adapt to, the stressor, timing of symptom onset, and functional impairment. A nationally representative sample (N = 1,020) of adults from Ireland completed the IADQ. RESULTS Confirmatory factor analysis supported construct validity and the reliability estimates were excellent. The IADQ correlated strongly with depression, anxiety, and posttraumatic stress. The criteria were met by 7.0% of the sample, adjusted for other exclusionary disorders. DISCUSSION The IADQ is a measure based on the ICD-11's description and produces reliable scores, however it should not be used for clinical assessment until validated with clinical interviews.
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Affiliation(s)
- M Shevlin
- School of Psychology, Ulster University, Coleraine, Northern Ireland
| | - P Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - M Ben-Ezra
- School of Social Work, Ariel University, Ariel, Israel
| | - T Karatzias
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK.,School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - M Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
| | - F Vallières
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - R Bachem
- School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - A Maercker
- Department of Psychology, Psychopathology and Clinical Intervention, University of Zürich, Zurich, Switzerland
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23
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Stein DJ, Szatmari P, Gaebel W, Berk M, Vieta E, Maj M, de Vries YA, Roest AM, de Jonge P, Maercker A, Brewin CR, Pike KM, Grilo CM, Fineberg NA, Briken P, Cohen-Kettenis PT, Reed GM. Mental, behavioral and neurodevelopmental disorders in the ICD-11: an international perspective on key changes and controversies. BMC Med 2020; 18:21. [PMID: 31983345 PMCID: PMC6983973 DOI: 10.1186/s12916-020-1495-2] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 01/09/2020] [Indexed: 12/16/2022] Open
Abstract
An update of the chapter on Mental, Behavioral and Neurodevelopmental Disorders in the International Classification of Diseases and Related Health Problems (ICD) is of great interest around the world. The recent approval of the 11th Revision of the ICD (ICD-11) by the World Health Organization (WHO) raises broad questions about the status of nosology of mental disorders as a whole as well as more focused questions regarding changes to the diagnostic guidelines for specific conditions and the implications of these changes for practice and research. This Forum brings together a broad range of experts to reflect on key changes and controversies in the ICD-11 classification of mental disorders. Taken together, there is consensus that the WHO's focus on global applicability and clinical utility in developing the diagnostic guidelines for this chapter will maximize the likelihood that it will be adopted by mental health professionals and administrators. This focus is also expected to enhance the application of the guidelines in non-specialist settings and their usefulness for scaling up evidence-based interventions. The new mental disorders classification in ICD-11 and its accompanying diagnostic guidelines therefore represent an important, albeit iterative, advance for the field.
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Affiliation(s)
- Dan J. Stein
- SA Medical Research Council Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Peter Szatmari
- Centre for Addiction and Mental Health, Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Berk
- Deakin University, IMPACT, the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia
- Orygen, The National Centre of Excellence in Youth Mental Health and the Centre for Youth Mental Health, Parkville, Australia
- Florey Institute for Neuroscience and Mental Health, Parkville, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Australia
| | - Eduard Vieta
- Bipolar Disorders Unit, Hospital Clinic, Institute of Neurosciences, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia Spain
| | - Mario Maj
- Department of Psychiatry, University of Campania ‘L. Vanvitelli’, Naples, Italy
| | - Ymkje Anna de Vries
- Department of Developmental Psychology, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Annelieke M. Roest
- Department of Developmental Psychology, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Peter de Jonge
- Department of Developmental Psychology, Interdisciplinary Center Psychopathology and Emotion Regulation, University of Groningen, Groningen, The Netherlands
| | - Andreas Maercker
- Department of Psychology – Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | - Chris R. Brewin
- Research Deparment of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Kathleen M. Pike
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
| | - Naomi A. Fineberg
- Hertfordshire Partnership University NHS Foundation Trust and University of Hertfordshire, Welwyn Garden City, UK
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine & Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | | | - Geoffrey M. Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY USA
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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24
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Zelviene P, Kazlauskas E, Maercker A. Risk factors of ICD-11 adjustment disorder in the Lithuanian general population exposed to life stressors. Eur J Psychotraumatol 2020; 11:1708617. [PMID: 32002141 PMCID: PMC6968697 DOI: 10.1080/20008198.2019.1708617] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/09/2019] [Accepted: 12/06/2019] [Indexed: 11/16/2022] Open
Abstract
Background: A new definition of adjustment disorder symptoms has been included in the 11th edition of the International Classification of Diseases (ICD-11). However, little is known about risk factors of ICD-11 adjustment disorder. Objective: The study aimed to analyse risk factors of adjustment disorder in a sample of the Lithuanian general population exposed to life-stressors. Method: In total, the study included 649 adult participants from the general population with various recent significant life-stressor experiences. ICD-11 adjustment disorder symptoms were measured using the Adjustment Disorder New Module-8 (ADNM-8) scale. Results: The prevalence of the ICD-11 adjustment disorder diagnosis in the sample was 16.5%. Job-related stressors and health-related stressors were significantly associated with adjustment disorder. Other risk factors for adjustment disorder in this study were female gender, greater age, and university education. Conclusions: We conclude that stressor type and demographic characteristics are associated with the risk of developing an adjustment disorder.
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Affiliation(s)
- Paulina Zelviene
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Andreas Maercker
- Division of Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland
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Strain JJ. The Adjustment Disorder Diagnosis, Its Importance to Liaison Psychiatry, and its Psychobiology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234645. [PMID: 31766628 PMCID: PMC6926656 DOI: 10.3390/ijerph16234645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/15/2019] [Accepted: 11/16/2019] [Indexed: 11/16/2022]
Abstract
Adjustment Disorder (AD) is one of the most common psychiatric diagnoses employed. In fact, it is the most frequent diagnosis utilized for psychiatric disorders in the military and in children, and is often utilized in the consultation-liaison medical setting. However, it is acknowledged that the diagnosis is not reliable, it cannot be validated, and it has an important degree of subjective consideration in its use. Commonly used screening tools like the Hamilton and Beck Depression Scales do not give an assessment of AD. Furthermore, its use is accompanied with descriptors of depression, anxiety, mixed affects, etc., so that it crosses over several areas of psychiatric dysfunction. It does allow the placement of a patient within a psychiatric diagnosis when they do not reach criteria for a major psychiatric nomenclature. To date, biological studies have not been reported. It is not known if AD with depression is closer to the biological characteristics of depression, or AD with anxiety would have similar characteristics to that seen with major anxiety. It is also not known if AD has a biological signature that would make them an entity with common features, or if they may be more closely allied biologically with the descriptor that accompanies them. Nevertheless, AD is an important category in any psychiatric lexicon and warrants further study and biological understanding.
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Affiliation(s)
- James J Strain
- Icahn School of Medicine at Mount Sinai, 1425 Madison Avenue, New York, NY 10029, USA
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26
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Lorenz L, Ho GWK, Chan ACY, Bressington DT, Chien WT, Shevlin M, Hyland P, Maercker A, Karatzias T. Translation and psychometric evaluation of the Chinese Adjustment Disorder – New Module 20. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2019. [DOI: 10.1080/00207411.2019.1684687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Louisa Lorenz
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Stationaere Therapie, Klinik im Hasel, Gontenschwil, Switzerland
| | - Grace W. K. Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Athena C. Y. Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | | | - Wai Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, United Kingdom
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27
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Horn AB, Boettcher VS, Holzer BM, Siebenhuener K, Maercker A, Battegay E, Zimmerli L. Couples Adjusting to Multimorbidity: A Dyadic Study on Disclosure and Adjustment Disorder Symptoms. Front Psychol 2019; 10:2499. [PMID: 31781000 PMCID: PMC6856782 DOI: 10.3389/fpsyg.2019.02499] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 10/22/2019] [Indexed: 01/03/2023] Open
Abstract
Background Multimorbidity is challenging not only for the patient but also for the romantic partner. Strategies for interpersonal emotion regulation like disclosing to the partner are supposed to play a major role in the psychosocial adjustment to multimorbidity. Research has often focused on disease-related disclosure, even though disclosing thoughts and feelings related to mundane, everyday life occurrences might also play a role in coadjustment. The current dyadic study aimed at investigating the association between these two types of interpersonal regulation strategies and adjustment disorder symptoms, following the new ICD 11 criteria in multimorbid patients and their partners. Methods Shortly after being hospitalized due to an acute health crisis, N = 28 multimorbid patients (average age 70 years) and their partners filled in questionnaires on disclosure in the couple, adjustment disorder criteria of the ICD 11 (“preoccupation,” “failure to adapt”), and sleep problems. Results Both patients and their partners did show similarly high levels of preoccupation and failure to adapt indicating adjustment problems to the complex health situation. The adjustment symptoms of both partners correlated between r = 0.22 and 0.45. Regression based on Actor-Partner Interdependence-Models revealed that own mundane disclosure was related to less adjustment symptoms in the patients. Beyond that, a partner effect was observed, revealing a negative association between partners’ illness-related disclosure and the patients’ level of preoccupation. For the partners, mundane disclosure of the partner was associated with less preoccupation, failure to adapt, and reported sleep problems above and beyond own disclosure reports. Furthermore, there was an actor effect of disease-related disclosure on less sleep problems for the partners. Conclusion These results support an interpersonal view on adjustment processes to physical disease. Disclosure as a way of regulating the relationship and emotional responses might play a relevant role here, which seems to be different for patients and their partners. Further research is needed to shed more light on the differential role of disease-related and mundane everyday disclosure for psychosocial adjustment in couples confronted with health challenges.
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Affiliation(s)
- Andrea B Horn
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland.,Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.,Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Victoria S Boettcher
- Department of Clinical Psychology and Psychotherapy, Bielefeld University, Bielefeld, Germany
| | - Barbara M Holzer
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.,Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Klarissa Siebenhuener
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.,Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Andreas Maercker
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland.,Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Edouard Battegay
- University Research Priority Program "Dynamics of Healthy Aging", University of Zurich, Zurich, Switzerland.,Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.,Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Lukas Zimmerli
- Center of Competence Multimorbidity, University of Zurich, Zurich, Switzerland.,Department of Internal Medicine, Cantonal Hospital Olten, Olten, Switzerland
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28
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Bachem R, Baumann J, Köllner V. ICD-11 Adjustment Disorder among Organ Transplant Patients and Their Relatives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173030. [PMID: 31438589 PMCID: PMC6747135 DOI: 10.3390/ijerph16173030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/14/2019] [Accepted: 08/17/2019] [Indexed: 01/06/2023]
Abstract
Adjustment disorder (AD) is one of the most frequent mental health conditions after stressful life experiences in the medical setting. The diagnosis has been conceptually redefined in International Classification of Diseases (ICD-11) and now includes specific symptoms of preoccupations and failure to adapt. The current study assesses the prevalence of self-reported ICD-11 AD among organ transplantation patients and their relatives, explores the association of patients’ demographic-, transplant-, and health-related characteristics and ICD-11 AD symptoms, and evaluates the role of social support in the post- transplant context. A total of N = 140 patient-relative dyads were examined cross-sectionally. Hierarchical linear regression analyses were conducted to explore potential predictive factors of AD. The results revealed an AD prevalence of 10.7% among patients and 16.4% among relatives at an average of 13.5 years after the transplantation. The time that had passed since the transplantation was unrelated to AD symptom severity. Women tended to be at a higher risk in both groups. Somatic issues were predictive for AD only among patients and social support was predictive mainly among relatives. The results suggest that ICD-11 AD is a relevant diagnosis after organ transplantations for patients and relatives and its specific symptom clusters may provide important information for developing intervention strategies.
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Affiliation(s)
- Rahel Bachem
- I-Core Research Center for Mass Trauma, Tel Aviv University, Chaim Levanon 30, Tel Aviv 6997801, Israel.
- Bob Shapell School of Social Work, Tel-Aviv University, Chaim Levanon 30, Tel Aviv 6997801, Israel.
| | - Jan Baumann
- Saarland University Medical Center, Faculty of Medicine, University of Saarland, 66421 Homburg/Saar, Germany
| | - Volker Köllner
- Department of Psychosomatic Medicine, Rehabilitation Center Seehof, Federal German Pension Agency, 14513 Teltow, Germany
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology Charité-Universitätsmedizin Berlin, 10098 Berlin, Germany
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29
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O'Donnell ML, Agathos JA, Metcalf O, Gibson K, Lau W. Adjustment Disorder: Current Developments and Future Directions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16142537. [PMID: 31315203 PMCID: PMC6678970 DOI: 10.3390/ijerph16142537] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/09/2019] [Accepted: 07/10/2019] [Indexed: 12/20/2022]
Abstract
Despite its high prevalence in clinical and consultant liaison psychiatry populations, adjustment disorder research has traditionally been hindered by its lack of clear diagnostic criteria. However, with the greater diagnostic clarity provided in the Diagnostic and Statistical Manual of Mental Disorders – fifth edition (DSM-5) and the International Statistical Classification of Diseases and Related Health Problems, 11th edition (ICD-11), adjustment disorder has been increasingly recognised as an area of research interest. This paper evaluates the commonalities and differences between the ICD-11 and DSM-5 concepts of adjustment disorder and reviews the current state of knowledge regarding its symptom profile, course, assessment, and treatment. In doing so, it identifies the gaps in our understanding of adjustment disorder and discusses future directions for research.
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Affiliation(s)
- Meaghan L O'Donnell
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia.
- Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia.
| | - James A Agathos
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
| | - Olivia Metcalf
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
| | - Kari Gibson
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
| | - Winnie Lau
- Phoenix Australia Centre for Posttraumatic Mental Health, 161 Barry Street, Carlton VIC, Melbourne 3053, Australia
- Department of Psychiatry, University of Melbourne, Melbourne 3053, Australia
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Esser P, Glaesmer H, Faller H, Koch U, Härter M, Schulz H, Wegscheider K, Weis J, Mehnert A. Posttraumatic stress disorder among cancer patients-Findings from a large and representative interview-based study in Germany. Psychooncology 2019; 28:1278-1285. [PMID: 30946502 DOI: 10.1002/pon.5079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/27/2019] [Accepted: 03/28/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVE In order to optimize psycho-oncologic care for patients with severe stressor-related symptomatology, we aimed to provide (a) valid and generalizable prevalence rates of posttraumatic stress disorder (PTSD) in oncological patients and (b) the percentage of PTSD cases elicited by cancer-related events. METHODS This multi-center study was based on a representative sample of patients across cancer types. A diagnostic interview (CIDI-O) was used to assess PTSD according to DSM-IV. We first describe type and frequency of potentially traumatic events (A1-events) and the degree to which they meet the trauma criteria (A2-events). Subsequently, we present adjusted prevalence rates of PTSD and explore the proportion of patients with cancer-related PTSD. RESULTS Four thousand twenty patients participated (response rate: 68 %), and 2141 completed the diagnostic interview; 1641 patients reported at least one A1-event, of whom 16% (n = 257) reported cancer-related events. Ninety-one percent (n = 232) of theses cancer-related events qualified as A2-events. Across cancer types, the adjusted 4-week prevalence of PTSD was 2.0% (95% CI, 1.5-2.7); 9% (n = 5) of the 4-week PTSD cases were cancer-related. CONCLUSIONS Across cancer types and treatment settings, few cancer patients fulfilled diagnostic criteria for PTSD. Of those, a mere fraction was attributable to cancer-related events. These robust findings should be taken into account in both research and practice to develop and provide adequate care for cancer patients with severe stressor-related symptomatology.
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Affiliation(s)
- Peter Esser
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Heide Glaesmer
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | - Uwe Koch
- Deanery of the Medical Faculty, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Schulz
- Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Weis
- Department of Peer Support Research, University Clinic Center, Comprehensive Cancer Center Freiburg, Freiburg, Germany
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
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Subjective traumatic outlook as a screening tool for psychological trauma: Cut-off values and diagnostic criteria. Psychiatry Res 2019; 273:121-126. [PMID: 30641341 DOI: 10.1016/j.psychres.2019.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/18/2018] [Accepted: 01/03/2019] [Indexed: 11/27/2022]
Abstract
The Subjective Traumatic Outlook (STO) deals with changes in individuals' perception, following a traumatic event and the difficulties of integrating pre-trauma past memories, inner traumatic memories, and current daily life. Although this short scale has excellent psychometric properties its cut-off scores for potential clinical use have yet to be established. In addition, due to the discrepancy between the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) in the meaurement of post-traumatic stress disorder (PTSD), the present study aimed at revalidating the STO and establishing cut-off scores for potential clinical use, based on both approaches to measure PTSD and complex post-traumatic stress disorder (CPTSD). Three hundred forty-three adults who were recruited through social media apps filled in self-report online questionnaires dealing with subjective perception of psychological trauma, PTSD and CPTSD. Results revalidate the STO as a screening tool for PTSD and CPTSD. We recommend a STO cut-off score of 13 and above when using the ICD-11 PTSD proposed algorithm along the PCL-5 cutoff score and a STO cut-off score of 15 when using the ICD-11 CPTSD proposed algorithm. In light of the present findings, the integration of DSM and ICD approaches is discussed.
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Abstract
OBJECTIVES This narrative review article provides an overview of current psychotherapeutic approaches specific for adjustment disorders (ADs) and outlines future directions for theoretically-based treatments for this common mental disorder within a framework of stepped care. METHODS Studies on psychological interventions for ADs were retrieved by using an electronic database search within PubMed and PsycINFO, as well as by scanning the reference lists of relevant articles and previous reviews. RESULTS The evidence base for psychotherapies specifically targeting the symptoms of AD is currently rather weak, but is evolving given several ongoing trials. Psychological interventions range from self-help approaches, relaxation techniques, e-mental-health interventions, behavioural activation to talking therapies such as psychodynamic and cognitive behavioural therapy. CONCLUSIONS The innovations in DSM-5 and upcoming ICD-11, conceptualising AD as a stress-response syndrome, will hopefully stimulate more research in regard to specific psychotherapeutic interventions for AD. Low intensive psychological interventions such as e-mental-health interventions for ADs may be a promising approach to address the high mental health care needs associated with AD and the limited mental health care resources in most countries around the world.
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Affiliation(s)
- Matthias Domhardt
- a Department of Clinical Psychology and Psychotherapy , University of Ulm , Ulm , Germany.,b Department of Child and Adolescent Psychiatry/Psychotherapy , University of Ulm , Ulm , Germany
| | - Harald Baumeister
- a Department of Clinical Psychology and Psychotherapy , University of Ulm , Ulm , Germany
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Abstract
OBJECTIVES Adjustment disorder (AD) is a frequent diagnosis in clinical practice worldwide. After long neglect in mental health research, the new DSM definition and in particular the ICD-11 model of AD is about to create a fresh impulse for research on AD and for refined clinical use of the diagnosis. METHODS This paper outlines the clinical features of AD according to the ICD-10, ICD-11 and DSM-5 definitions, and provides case vignettes of patients with AD with clinical presentations of dominating anxiety, depressed mood or mixed symptom presentations. The available clinical assessments and diagnostic tools are described in detail, together with findings on their psychometric properties. RESULTS The current AD definitions are consistent with a new nosological grouping of AD with posttraumatic stress disorder in the chapter on trauma- and stressor-related disorders, or stress response syndromes. CONCLUSIONS This nosological specification opens new avenues for neurobiological and psychological research on AD and for developing novel therapies.
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Affiliation(s)
- Andreas Maercker
- a Department of Psychology , University of Zurich , Zurich , Switzerland
| | - Louisa Lorenz
- a Department of Psychology , University of Zurich , Zurich , Switzerland
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Abstract
OBJECTIVES This paper focuses on the psychobiology of stress, depression, adjustment disorders (ADs), and resilience. Since the ADs fall under the rubric in DSM-5 of Trauma and Stressor-Related Disorders, essentials of the psychobiology of stress-response syndromes will be reviewed. METHODS A narrative review of the psychobiology of stress-response syndromes is undertaken, and the implications for our understanding of ADs are discussed. RESULTS Advances in our understanding of the psychobiology of stress-response syndromes provide an important foundation for understanding ADs, and for conceptualizing their diagnosis, as well as issues of resilience. CONCLUSIONS Future investigations of the psychobiology of trauma- and stressor-related disorders may shed additional light on ADs, and ultimately improve their treatment.
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Affiliation(s)
- James J Strain
- a Department of Psychiatry , Icahn School of Medicine at Mount Sinai , New York , NY , USA
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35
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Perkonigg A, Lorenz L, Maercker A. Prevalence and correlates of ICD-11 adjustment disorder: Findings from the Zurich Adjustment Disorder Study. Int J Clin Health Psychol 2018; 18:209-217. [PMID: 30487926 PMCID: PMC6224856 DOI: 10.1016/j.ijchp.2018.05.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/03/2018] [Indexed: 11/07/2022] Open
Abstract
Background/Objective: The 11th revision of the International Classification of Diseases (ICD-11) will provide a new definition of adjustment disorder (AjD). The aim of the present study is to report on prevalence and correlates of ICD-11 AjD in a high-risk sample. Method: Three hundred thirty persons who had lost their job involuntarily were sampled by local job centres. The Munich Composite International Diagnostic Interview was administered with a new AjD module. Associations between AjD and correlates were investigated with logistic regression analyses. Results: 27.3% of the participants reported the AjD core symptom pattern. 13.8% men and 17.2% women met diagnostic guidelines of ICD-11 AjD. Prevalence increased with age and exposure to multiple stressors. The AjD core symptom pattern was associated with various sociodemographic correlates (e. g., lower financial household budget), whereas the full ICD-11 diagnosis including the exclusion algorithm was not. Regarding work-related factors, AjD occurred with a lower probability if the last job position had higher responsibilities and more general confidence for the future. Conclusions: ICD-11 AjD has a high prevalence among persons who lost their jobs involuntarily. Healthcare professionals should be aware of this problem. Research to investigate the ICD-11 AjD concept in the general populations and other subpopulations is needed.
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Ben-Ezra M, Mahat-Shamir M, Lorenz L, Lavenda O, Maercker A. Screening of adjustment disorder: Scale based on the ICD-11 and the Adjustment Disorder New Module. J Psychiatr Res 2018; 103:91-96. [PMID: 29803077 DOI: 10.1016/j.jpsychires.2018.05.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 05/08/2018] [Accepted: 05/12/2018] [Indexed: 11/17/2022]
Abstract
In line with ICD-11 new conceptualization of Adjustment disorder (AjD), a self-report Adjustment Disorder-New Module (ADNM) was developed and validated. Nevertheless, the ADNM-20 is a long research tool and potentially problematic in the use in epidemiological and clinical studies. The present study introduces the brief ADNM-8 and the ultra-brief ADNM-4, examines their validity and establishes cut-off scores for their clinical use. The study used a representative national sample of 1003 Israelis who reported on the ICD-11 stress spectrum ranging from AjD, PTSD, complex PTSD and complicated grief. Construct validity was assessed via confirmatory factor analysis and cut-off scores were established through ROC analysis. The original and brief instruments were highly correlated (r > 0.918 or better). Cronbach's Alpha for the Brief ADNM-8 and the Ultra-Brief ADNM-4 were above 0.800. Correlations with stress related conditions indicated a good convergent and construct validity for both instruments as well. The ultra-brief ADNM-4 was found to have a very good fit with the data. These findings indicate that the brief ADNM-8 and the ultra-brief ADNM-4 can serve as a brief screening tools for assessing AjD symptoms according to the ICD-11 definition.
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Affiliation(s)
| | | | - Louisa Lorenz
- Department of Psychology, Psychopathology and Clinical Intervention, University of Zürich, Zurich, Switzerland
| | - Osnat Lavenda
- School of Social Work, Ariel University, Ariel 40700, Israel
| | - Andreas Maercker
- Department of Psychology, Psychopathology and Clinical Intervention, University of Zürich, Zurich, Switzerland
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An empirical assessment of adjustment disorder as proposed for ICD-11 in a general population sample of Israel. J Anxiety Disord 2018; 54:65-70. [PMID: 29426030 DOI: 10.1016/j.janxdis.2018.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND A new diagnostic concept of Adjustment Disorder (AjD) was proposed for inclusion in the International Classification of Diseases, 11th version (ICD-11). However, the symptom structure of AjD is poorly understood. The aim of the present study was to investigate the dimensionality of AjD as a stress-response syndrome. METHODS A general population sample of the Israeli population (N = 1003) completed the Adjustment Disorder - New Module 20 and the WHO-5 Wellbeing Scale. We compared seven alternative models of AjD using confirmatory factor analysis (CFA). A latent profile analysis (LPA) was performed to determine if subtypes of AjD were present. The performance of the unidimensional and multidimensional models of AjD were evaluated using regression analyses. RESULTS CFA results supported a unidimensional model of AjD. The LPA identified three quantitatively distinct classes (low, medium, and high) with no evidence of any subtypes of AjD. The criterion validity of AjD was superior when treated as unidimensional. AjD was associated with lower levels of psychological wellbeing (β = -.32, p < .001). CONCLUSIONS Our results suggest that AjD is better conceptualised as a unidimensional construct. Future work should focus on a reduction of required symptoms in order to improve clinical utility and validity of the diagnosis.
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Bachem R, Casey P. Adjustment disorder: A diagnosis whose time has come. J Affect Disord 2018; 227:243-253. [PMID: 29107817 DOI: 10.1016/j.jad.2017.10.034] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/06/2017] [Accepted: 10/19/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Adjustment disorder is among the most frequently diagnosed mental disorders in clinical practice although it has received little academic attention and been the subject of substantial criticism over the past decades. While those suffering with adjustment disorders are often treated by mental health professionals, research interest in the origin of the disorder or the effectiveness of psychotherapeutic and medical interventions has only recently begun to emerge. This article summarizes the empirical literature published on adjustment disorder and points out current diagnostic developments in DSM-5 and ICD-11. METHODS Literature for this review was identified through established online search tools, including publications in English, German, and Spanish. RESULTS This paper reviews literature on the evolution of adjustment disorder, and highlights the current state of research with regard to genesis and treatment. Importantly, for the first time ICD-11 intends to define adjustment disorder by explicit symptom groups, unlike DSM-5. LIMITATIONS Publications without an English abstract were not included. CONCLUSIONS Key directions for future research include investigating the concordance of the ICD-11 and DSM-5 concepts and the effect that the diverging conceptualizations may have. Risk and protective factors specific to AD should be identified and the biological underpinnings of the disorder should be explored. Finally, given the high prevalence of AD in certain clinical settings effective disorder-specific interventions should be developed and evaluated.
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Affiliation(s)
- Rahel Bachem
- Bob Shapell School of Social Work, Tel Aviv University, Chaim Levanon 30, Tel Aviv 699780, Israel.
| | - Patricia Casey
- University College Dublin, School of Medicine, Mater Misericordiae Hospital, 62/63 Eccles Street, Dublin 7, Ireland
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Abstract
Adjustment disorder (AjD) is among the most often diagnosed mental disorders in clinical practice. This paper reviews current status of AjD research and discusses scientific and clinical issues associated with AjD. AjD has been included in diagnostic classifications for over 50 years. Still, the diagnostic criteria for AjD remain vague and cause difficulties to mental health professionals. Controversies in definition resulted in the lack of reliable and valid measures of AjD. Epidemiological data on prevalence of AjD is scarce and not reliable because prevalence data are biased by the diagnostic algorithm, which is usually developed for each study, as no established diagnostic standards for AjD are available. Considerable changes in the field of AjD could follow after the release of the 11th edition of International Classification of Diseases (ICD-11). A new AjD symptom profile was introduced in ICD-11 with 2 main symptoms as follows: 1) preoccupation and 2) failure to adapt. However, differences between the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and ICD-11 AjD diagnostic criteria could result in diverse research findings in the future. The best treatment approach for AjD remains unclear, and further treatment studies are needed to provide AjD treatment guidelines to clinicians.
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Affiliation(s)
- Paulina Zelviene
- Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania
| | - Evaldas Kazlauskas
- Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania
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Bachem R, Perkonigg A, Stein DJ, Maercker A. Measuring the ICD-11 adjustment disorder concept: Validity and sensitivity to change of the Adjustment Disorder - New Module questionnaire in a clinical intervention study. Int J Methods Psychiatr Res 2017; 26:e1545. [PMID: 27862575 PMCID: PMC6877162 DOI: 10.1002/mpr.1545] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 07/19/2016] [Accepted: 09/23/2016] [Indexed: 11/07/2022] Open
Abstract
Adjustment disorder (AjD) is a frequent but under-researched diagnosis due in part to a lack of specific symptom criteria and adequate tools of measurement. The ICD-11 for the first time proposes a positive symptom catalogue to define AjD. This study presents a validation of the Adjustment Disorder - New Module (ADNM), the first symptom severity measure for AjD according to the ICD-11 concept. Validity and sensitivity to change were investigated in a sample of 190 individuals with a DSM-IV diagnosis of AjD. The ADNM scales demonstrated convergent and discriminant validity for anxiety symptoms (Hamilton Anxiety Scale; psychic anxiety r = 0.18-0.31), functional impairment (Sheehan Disability Scale; r = 0.18-0.47), and depression (Montgomery-Asberg Depression Scale; r = 0.13-0.30). At baseline 78% of the individuals with a DSM-IV diagnosis of AjD were also classified so by the ADNM. Repeated-measures ANOVA indicated significant ADNM-symptom decrease during treatment, replicating the patterns of the Hamilton Anxiety Scale, Sheehan Disability Scale, and Clinical Global Impression Scale. This article presents the first use of the ADNM as a measure for ICD-11 AjD in a randomized-controlled intervention study of AjD. It provides support for the construct validity and sensitivity to symptom change of this scale during pharmacological treatment.
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Affiliation(s)
- Rahel Bachem
- Department of Psychology, Psychopathology and Clinical Intervention Unit, University of Zurich, Zurich, Switzerland
| | - Axel Perkonigg
- Department of Psychology, Psychopathology and Clinical Intervention Unit, University of Zurich, Zurich, Switzerland
| | - Dan J Stein
- Department of Psychiatry, Groote Schuur Hospital J2, University of Cape Town and MRC Unit on Anxiety & Stress Disorders, Cape Town, South Africa
| | - Andreas Maercker
- Department of Psychology, Psychopathology and Clinical Intervention Unit, University of Zurich, Zurich, Switzerland
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Mahat-Shamir M, Ring L, Hamama-Raz Y, Ben-Ezra M, Pitcho-Prelorentzos S, David UY, Zaken A, Lavenda O. Do previous experience and geographic proximity matter? Possible predictors for diagnosing Adjustment disorder vs. PTSD. Psychiatry Res 2017; 258:438-443. [PMID: 28951140 DOI: 10.1016/j.psychres.2017.08.085] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 08/06/2017] [Accepted: 08/29/2017] [Indexed: 02/05/2023]
Abstract
The minority of people who have experienced a traumatic event and were diagnosed as either suffering from PTSD or from Adjustment disorder, may suggest that victims of a traumatic event vary in risk factors for the disorders. The current research aimed at examining the association between reports of Adjustment disorder and PTSD symptoms (In accordance with the proposed revisions of the ICD-11) and several vulnerability variables: previous traumatic event, previous stressful event and physical proximity to the terror attack. Using an online survey, 379 adult participants were recruited, and filled out Adjustment disorder, PTSD symptomatology scales, as well as a previous exposure, magnitude of exposure and death anxiety scales. Findings revealed that previous experience of traumatic events was a significant predictor associated with both PTSD and Adjustment disorder symptoms. Previous experience of stressful events was a significant predictor associated with Adjustment disorder alone. Physical proximity to the site of the attack was a significant predictor associated with PTSD symptoms but not Adjustment disorder symptoms. The importance of previous traumatic events, previous stressful events and physical proximity to the terror attack as factors which are associated with Adjustment disorder and PTSD symptomatology is discussed.
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Affiliation(s)
| | - Lia Ring
- School of Social Work, Ariel University, Israel
| | | | | | | | - Udi Y David
- School of Social Work, Ariel University, Israel
| | - Adi Zaken
- School of Social Work, Ariel University, Israel
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Escobar Echavarría J, Montoya González LE, Restrepo Bernal D, Mejía Rodríguez D. [Cyberbullying and Suicidal Behavior: What is the Connection? About a Case]. ACTA ACUST UNITED AC 2017; 46:247-251. [PMID: 29122233 DOI: 10.1016/j.rcp.2016.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/11/2016] [Accepted: 08/01/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Social networks have increased in recent decades, and with them the bullying, causing difficulties in young people's mental health expressed through depressive symptoms, suicidal ideation and suicide attempts. Up next, we present a case that exemplifies this situation. OBJECTIVE To describe a case report that exemplifies this new outlook in young people and how it affects their mental health. METHODOLOGY Case report and non-systematic literature review. RESULTS One case report, treated at a hospital in Medellin due to two suicide attempts related to social networks is presented. DISCUSSION Currently, there are multiple social media resources, the advent of internet and smartphones is not only a strategy for improving social interactions, but it also contributes to impair mental health of some vulnerable young people. CONCLUSION This case sensitize us, about the relationship between the growing social networking and cyberbullying as well as suicidal thoughts / attempts; thanks to this case and the available literature, we can't establish causality but we could deduce that the internet utter a increased risk for young people who are exposed and more vulnerable.
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Eimontas J, Gegieckaite G, Dovydaitiene M, Mazulyte E, Rimsaite Z, Skruibis P, Zelviene P, Kazlauskas E. The role of therapist support on effectiveness of an internet-based modular self-help intervention for adjustment disorder: a randomized controlled trial. ANXIETY STRESS AND COPING 2017; 31:146-158. [DOI: 10.1080/10615806.2017.1385065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jonas Eimontas
- Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania
| | - Goda Gegieckaite
- Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania
| | - Migle Dovydaitiene
- Department of General Psychology, Vilnius University, Vilnius, Lithuania
| | - Egle Mazulyte
- Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania
| | - Zivile Rimsaite
- Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania
| | - Paulius Skruibis
- Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania
| | - Paulina Zelviene
- Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania
| | - Evaldas Kazlauskas
- Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania
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Yazdanshenas Ghazwin M, Tavakoli SAH, Latifi S, Saberi H, Derakhshanrad N, Yekaninejad MS, Sadeghi M, Emami Razavi SH, Norouzi Javidan A, Ghodsi SM. Psychological defense mechanisms among individuals with SCI with adjustment disorder. J Spinal Cord Med 2017; 40:538-547. [PMID: 27077569 PMCID: PMC5815149 DOI: 10.1080/10790268.2016.1140389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES The used psychological defense styles among individuals with spinal cord injury (SCI) with adjustment disorders (AJD) have not yet been described. In the present investigation, the prevalence of AJD among people with SCI has been estimated and the pattern of used defense styles has been identified. DESIGN Cross-sectional investigation. SETTING A tertiary rehabilitation center in Iran. PARTICIPANTS Individuals referred to Brain and Spinal Cord Injury Research Center were invited to participate in a screening interview. AJD was diagnosed based on DSM-V criteria. Those with AJD diagnosis were scheduled for another interview to assess defense mechanisms. OUTCOME MEASURES Demographic and injury-related variables were recorded. Defense mechanisms were assessed by the 40-item version of the Defense-Style Questionnaire (DSQ-40). RESULTS Among 114 participants, 32 (28%) were diagnosed with AJD among whom 23 subjects attended the second interview. Mean age and time since injury were 29.57 ± 9.29 years and 11.70 ± 6.34 months, respectively. The majority of patients were using idealization defense mechanism (91.3%). In the second and third place, passive aggression (87.0%) and somatization (82.6%) defense mechanisms were observed, respectively. Neurotic style was dominantly used (11.52 ± 2.26). Sex, marital status, educational level, cause of the injury and injury level were not related to defense style (P: 0.38, 0.69, 0.88, 0.73, and P: 0.32, respectively). CONCLUSION Prevalence of AJD is estimated to be 28% among individuals with SCI. The most prevalent defense style was neurotic and the dominant used defense mechanism was "idealization." The role of demographic and injury-related variables in determining the used defense mechanisms was insignificant.
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Affiliation(s)
- Manijeh Yazdanshenas Ghazwin
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran,Correspondence to: Manijeh Yazdanshenas Ghazwin, Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Imam Khomeini Complex Hospital, Keshavarz Boulevard, Gharib Street, PO. Box: 6114185, Tehran, Iran.
| | | | - Sahar Latifi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hooshang Saberi
- Department of Neurosurgery, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazi Derakhshanrad
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mir Saeed Yekaninejad
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Majid Sadeghi
- Psychiatric and Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed-Hassan Emami Razavi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Norouzi Javidan
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed-Mohammad Ghodsi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Studerus-Germann AM, Engel DC, Stienen MN, von Ow D, Hildebrandt G, Gautschi OP. Three versus seven days to return-to-work after mild traumatic brain injury: a randomized parallel-group trial with neuropsychological assessment. Int J Neurosci 2017; 127:900-908. [PMID: 28042930 DOI: 10.1080/00207454.2017.1278589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Although most patients with a mild traumatic brain injury (mTBI) recover within days to weeks, some experience persistent physical, cognitive and emotional symptoms, often described as post-concussion syndrome (PCS). The optimal recovery time including return-to-work (RTW) after mTBI is unclear. In this single-centre parallel-group trial, patients assigned three days (3D-group) or seven days (7D-group) sick leave were compared with a comprehensive neuropsychological test battery including the Post-Concussion Symptom Scale (PCSS) within one week, after three and 12 months post-injury. The influence of the effective time until RTW on post-concussional symptoms and cognitive performance was analysed. The 3D-group rated significantly higher mean scores in some PCSS symptoms, tended to fulfil diagnosis criteria of PCS more often and showed better cognitive performance in several neuropsychological test scores than the 7D-group at all three time-points of follow-up. Overall, patients returned to work 11.35 d post-injury, thus distinctly above both recommended sick leaves. There was a trend for longer sick leave in patients randomized into the 3D-group. Further analyses revealed that the group with an absolute RTW within one week showed lower symptom severity in fatigue at 3 and 12 months, less PCS and faster performance in fine motor speed at 12 months than the group with an absolute RTW after one week. Our data underline the heterogeneity of mTBI and show that acute and sub-acute symptoms are not prognostic factors for neuropsychological outcome at one year. Later, ability to work seems to be prognostic for long-term occurrence of PCS.
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Affiliation(s)
- Aline M Studerus-Germann
- a Division of Neuropsychology , Department of Neurology , State Hospital St. Gallen , St. Gallen , Switzerland.,b Department of Psychopathology and Clinical Intervention , University of Zurich , Zurich , Switzerland
| | - Doortje C Engel
- c Department of Neurosurgery , Cantonal Hospital St. Gallen , St. Gallen , Switzerland.,d Department of Neurosurgery , University Hospital Tübingen , Tübingen , Germany
| | - Martin N Stienen
- c Department of Neurosurgery , Cantonal Hospital St. Gallen , St. Gallen , Switzerland.,e Department of Neurosurgery and Faculty of Medicine , University Hospital Geneva , Geneva , Switzerland
| | - Dieter von Ow
- f Emergency Department , Cantonal Hospital St. Galllen , St. Gallen , Switzerland
| | - Gerhard Hildebrandt
- c Department of Neurosurgery , Cantonal Hospital St. Gallen , St. Gallen , Switzerland
| | - Oliver P Gautschi
- c Department of Neurosurgery , Cantonal Hospital St. Gallen , St. Gallen , Switzerland.,f Emergency Department , Cantonal Hospital St. Galllen , St. Gallen , Switzerland
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Gerdau I, Kizilhan JI, Noll-Hussong M. Posttraumatic Stress Disorder and Related Disorders among Female Yazidi Refugees following Islamic State of Iraq and Syria Attacks-A Case Series and Mini-Review. Front Psychiatry 2017; 8:282. [PMID: 29326610 PMCID: PMC5733480 DOI: 10.3389/fpsyt.2017.00282] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 11/29/2017] [Indexed: 12/20/2022] Open
Abstract
Following the severe attacks by the so-called "Islamic State of Iraq and Syria" on the Yazidi population, which started in summer 2014, the state government of Baden-Württemberg, Germany, funded a Special-Quota Project to bring 1,000 very ill or left-behind women and children who were being held hostage to 22 cities and towns in Baden-Württemberg to receive integrated care. Here, we report for the first time on the cases of four Yazidi women living in Ulm, Germany, focusing on the clinically observed and psychometrically assessed mental phenomena or disorders. Our primary aim was to explore what International Classification of Diseases, 10th Revision diagnoses are present in this population. Although highly traumatized, these women were suffering primarily from adjustment disorder rather than posttraumatic stress disorder according to official classification systems. Despite their symptoms of depression and anxiety, the women's responses to self-assessment questionnaires provided no evidence of compulsion, somatization, or eating disorders. The results suggest that further investigation of the individual-level effects of rape and torture, as well the historic, systemic, and collective effects, e.g., on families and societies, is required.
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Affiliation(s)
- Inga Gerdau
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
| | - Jan Ilhan Kizilhan
- Duale Hochschule Baden-Württemberg Villingen-Schwenningen, Villingen-Schwenningen, Germany
| | - Michael Noll-Hussong
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm, Ulm, Germany
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Kazlauskas E, Zelviene P, Lorenz L, Quero S, Maercker A. A scoping review of ICD-11 adjustment disorder research. Eur J Psychotraumatol 2017; 8:1421819. [PMID: 29372011 PMCID: PMC5774403 DOI: 10.1080/20008198.2017.1421819] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 12/15/2017] [Indexed: 10/31/2022] Open
Abstract
Background: Adjustment disorder (AjD) is one of the most used mental disorder diagnoses among mental health professionals. Important revisions of the AjD definition in the 11th edition of the International Classification of Diseases (ICD-11) are proposed. AjD is included in a chapter of disorders specifically associated with stress in ICD-11. Objective: This paper aims to review recent developments in ICD-11 AjD research, and to discuss the available ICD-11 AjD diagnosis validation studies, AjD measures, treatment studies, and outline the future perspectives for AjD research and clinical practice. Methods: In total, 10 empirical studies of AjD ICD-11 were identified and included in this review. We searched for studies in Embase, PubMed, PsycINFO, Scopus, PILOTS, SocINDEX, and via additional search by contacting authors of published empirical studies and reference screening. Results: Review of the studies revealed a lack of validation studies of the ICD-11 AjD symptom structure. AjD validation study findings are ambiguous, and there is still little support for the proposed two symptom structure of AjD for the ICD-11. A self-report AjD measure 'Adjustment Disorder New Module' (ADNM) based on the ICD-11 definition has been developed and used in all 10 reviewed studies. Two self-help interventions have been developed for the ICD-11 AjD, and findings from these studies indicate that self-help low-intensity cognitive-behavioural interventions, delivered via bibliography or internet-based, might be effective treatment of AjD. Conclusions: The AjD definition in ICD-11 with a description of a new symptom profile facilitates AjD measurement and AjD-focused treatment developments. More studies and insights from clinical practice are needed to move the field of AjD research and practice forward.
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Affiliation(s)
- Evaldas Kazlauskas
- Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania
| | - Paulina Zelviene
- Department of Clinical and Organizational Psychology, Vilnius University, Vilnius, Lithuania
| | - Louisa Lorenz
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | - Soledad Quero
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellon de la Plana, Spain
| | - Andreas Maercker
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
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Adjustment Disorder: Empirical Study of a New Diagnostic Concept for Icd-11 in the General Population in Lithuania. Eur Psychiatry 2016; 40:20-25. [DOI: 10.1016/j.eurpsy.2016.06.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 06/20/2016] [Accepted: 06/22/2016] [Indexed: 11/18/2022] Open
Abstract
AbstractObjectiveAdjustment disorder (AD) is one of the most debated diagnoses in psychiatry since it has been recognised as vaguely defined and causing a lot of difficulties in clinical practice. We aimed to analyse the structure of adjustment disorder based on International Classification of Diseases (ICD)–11 proposals by the WHO ICD-11 Working Group on the Classification of Disorders Specifically Associated with Stress in the general population in Lithuania. Three structural models of adjustment disorder were tested using Confirmatory Factor Analysis (CFA).MethodData from the sample of 649 participants who experienced at least one significant stressor during the last two years was included in CFA analysis. Stressor exposure and AD symptoms were measured with the Lithuanian version of the Adjustment Disorder New Module (ADNM-20).ResultsThe CFA analysis revealed that the two core factor model of the AD with two core symptoms: preoccupation and failure to adapt fitted data the best in contrast to other two models.ConclusionThe study supports the ICD-11 proposal for the structure of adjustment disorder with two core symptoms: preoccupation and failure to adapt. Further studies are needed to analyse the structure of AD in other populations.
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Lorenz L, Bachem RC, Maercker A. The Adjustment Disorder--New Module 20 as a Screening Instrument: Cluster Analysis and Cut-off Values. THE INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE 2016; 7:215-20. [PMID: 27651082 PMCID: PMC6817961 DOI: 10.15171/ijoem.2016.775] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/23/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Adjustment disorder (AjD) is a transient mental health condition emerging after stressful life events. Its diagnostic criteria have recently been under revision which led to the development of the Adjustment Disorder--New Module 20 (ADNM-20) as a self-report assessment. OBJECTIVE To identify a threshold value for people at high risk for AjD. METHODS As part of a randomized controlled trial evaluating a self-help manual for burglary victims, the baseline data of all participants (n=80) were analyzed. Besides the ADNM-20, participants answered self-report questionnaires regarding the external variables post-traumatic stress disorder symptomatology, depression, anxiety, and stress levels. We used cluster analysis and ROC analysis to identify the most appropriate cut-off value. RESULTS The cluster analysis identified three different subgroups. They differed in their level of AjD symptomatology from low to high symptom severity. The same pattern of impairment was found for the external variables. The ROC analysis testing the ADNM-20 sum scoreagainst the theory-based diagnostic algorithm, revealed an optimal cut-off score at 47.5 to distinguish between people at high risk for AjD and people at low risk. CONCLUSION The ADNM-20 distinguishes between people with low, moderate, and high symptomatology. The recommendation for a cut-off score at 47.5 facilitates the use of the ADNM-20 in research and practice.
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Affiliation(s)
- L Lorenz
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland.
| | - R C Bachem
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | - A Maercker
- Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
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Skruibis P, Eimontas J, Dovydaitiene M, Mazulyte E, Zelviene P, Kazlauskas E. Internet-based modular program BADI for adjustment disorder: protocol of a randomized controlled trial. BMC Psychiatry 2016; 16:264. [PMID: 27456085 PMCID: PMC4960748 DOI: 10.1186/s12888-016-0980-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 07/15/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Adjustment disorder is one of the most common mental health diagnoses. Still it receives relatively little attention from researchers trying to establish best interventions to treat it. With high prevalence of stressful life events, which might be leading to adjustment disorder, and limited resources of mental health service providers, online interventions could be a very practical way of helping people who have these disorders or are in the risk to develop them. The proposed study protocol is aimed to describe a randomized controlled trial of an internet-based modular intervention for adjustment disorder as it is defined in a proposal for the ICD-11. METHODS/DESIGN This study is a two-armed Randomized Controlled Trial (RCT) to examine the effectiveness of a web-based intervention BADI (Brief Adjustment Disorder Intervention) for adjustment disorder symptoms. BADI has four modules: Relaxation, Time management, Mindfulness and Strengthening relationships. It is based on stress and coping research and integrates evidence-based treatment approaches such as Cognitive Behavioural therapy (CBT), mindfulness and body-mind practices, as well as exercises for enhancing social support. Primary outcome of the study are symptoms of adjustment disorder and well-being. Engagement into the program and motivation for change is a secondary outcome. All participants after completing the baseline assessment are randomly assigned to one of the two groups: either to the one in which participant will instantly gain access to the BADI intervention or a group in which participants will be given access to the BADI program after waiting one month. Participants of BADI can choose exercises of the program flexibly. There is no particular order in which the exercises should be completed. DISCUSSION Study will provide new insights of modular internet-based interventions efficacy for adjustment disorders. The study will also provide information about the role of motivation and expectancies on engagement in modular internet-based interventions. In case this RCT supports effectiveness of fully automated version of BADI, it could be used very broadly. It could become a cost-effective and accessible intervention for adjustment disorder. TRIAL REGISTRATION The study was retrospectively registered with the Australian and New Zealand Clinical Trials Registry with the registration number ACTRN12616000883415 . Registered 5 July, 2016.
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Affiliation(s)
- Paulius Skruibis
- Department of Clinical and Organizational Psychology, Vilnius University, Universiteto str. 9/1, Vilnius, 01513 Lithuania
| | - Jonas Eimontas
- Department of Clinical and Organizational Psychology, Vilnius University, Universiteto str. 9/1, Vilnius, 01513 Lithuania
| | - Migle Dovydaitiene
- Department of General Psychology, Vilnius University, Universiteto str. 9/1, Vilnius, 01513 Lithuania
| | - Egle Mazulyte
- Department of Clinical and Organizational Psychology, Vilnius University, Universiteto str. 9/1, Vilnius, 01513 Lithuania
| | - Paulina Zelviene
- Department of Clinical and Organizational Psychology, Vilnius University, Universiteto str. 9/1, Vilnius, 01513 Lithuania
| | - Evaldas Kazlauskas
- Department of Clinical and Organizational Psychology, Vilnius University, Universiteto str. 9/1, Vilnius, 01513, Lithuania.
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