Validation of the International Adjustment Disorder Questionnaire in Israel and Switzerland

Adolescents during wartime: Vulnerability-based profiles

Adolescents in war zones face the dual burden of normative developmental challenges and stressors from their proximity to active conflict, raising critical questions about their vulnerability during wartime. The aim of the current study was to identify distinct vulnerability profiles among Israeli adolescents (ages 11-18) during Israel's ongoing Swords of Iron War. Drawing on Hobfoll's conservation of resources theory, we assessed protective factors (positive affect, resilience, and perceived social support) and one risk factor (war-related adjustment disorder symptoms). Differences in profiles were also examined in relation to demographic variables and war impact variables (house damage, displacement, and injury). In this quantitative, cross-sectional study, we utilized self-report questionnaires from 305 Jewish Israeli adolescents (ages 11-18). LatentGold was employed to conduct a three-step latent profile analysis. Wald tests were used to explore differences between the various adolescent profiles in terms of protective and risk factors, as well as to assess associations with distal variables. Three distinct vulnerability profiles were identified: low, moderate, and high. Adolescents in the low-vulnerability group were younger, lived farther from conflict borders, experienced fewer war-related adjustment disorder symptoms, and reported higher levels of positive affect, resilience, and perceived social support. Among these factors, perceived social support emerged as the most sensitive variable differentiating profiles. These findings highlight the importance of internal and external resources in mitigating vulnerability and fostering resilience among adolescents in conflict-affected regions. The categorization into vulnerability levels enables faster identification of at-risk adolescents and more efficient resource allocation. Given the critical role of social support, clinicians should prioritize interventions that enhance such support to promote adolescents' well-being during wartime.

Nurses during war: Profiles-based risk and protective factors

INTRODUCTION

Nurses in southern Israel's public hospitals were exposed to unusual traumatic events following the October 7, 2023, Hamas attack on Israel, and the ensuing Swords of Iron War. This study aimed to clarify the complexity of wartime nursing by identifying profiles based on risk factors (i.e., psychological distress and adjustment disorders) and protective factors (i.e., positive affect (PA), resilience, and perceived social support [PSS]).

DESIGN

This study utilizes a cross-sectional design.

METHOD

Two hundred nurses at a major public hospital in southern Israel completed self-report questionnaires. A latent profile analysis (LPA) was conducted to identify distinct profiles based on nurses' risk and protective factors. Differences in profiles were examined alongside sociodemographic and occupational variables and traumatic event exposure. The LPA was conducted using MPlus 8.8 Structural Equation Modeling (SEM) software.

FINDINGS

Two distinct profiles were identified: "reactive" and "resilient." The "reactive" group included nurses who had higher risk factor scores (psychological distress and adjustment disorder), whereas the "resilient" group included nurses who had higher protective factor scores (PA, resilience, and PSS). Furthermore, nurses in the "reactive" group were younger, with greater seniority, worse self-rated health, and a higher frequency of kidnapped family members compared to nurses from the "resilient" group.

CONCLUSION

Nurses in wartime are at risk if identified as "reactive." Identifying these profiles can assist in developing effective support practices to help nurses cope with wartime challenges and maintain their mental well-being.

CLINICAL RELEVANCE

Healthcare organizations should tailor interventions to prepare and support nurses of various ages and experience levels, during and after conflicts. This approach aims to reduce risk factors and promote protective factors among nurses during wartime.

Translation and Validation of the Arabic International Adjustment Disorder Questionnaire Among Patients with Physical Illness and Their Families in Iraq

Background

The populations of middle- and low-income countries are exposed to many stressors, and these are associated with worse mental health. The ICD-11 includes a section "Disorders specifically associated with stress" and there are many validated measures for the assessment of stress-related disorders. However, there is no self-reported measure of ICD-11 adjustment disorder available for use in Arabic-speaking populations. This study aimed to translate and validate the Arabic version of the self-reported International Adjustment Disorder Questionnaire.

Methods

Data was collected from Iraqi patients with physical illness and their families from October 6 to October 14, 2024, through a cross-sectional study conducted at Baghdad's Teaching Hospital and the Oncology Teaching Hospital. The R Environment for Statistical Programming was utilized for analysis.

Results

Findings from confirmatory factor analysis were consistent with previous studies by identifying two strongly correlated factors (r = 0.72), representing the 'preoccupation' and 'failure to adapt' symptom clusters. These factors showed reliable scores (α = 0.695 and 0.814) and significant relations to depression and anxiety. To avoid multicollinearity, a total symptom scale can be used, based on similarly positive relations to psychological states and high reliability (α = 0.798).

Conclusion

The Arabic translation demonstrates good psychometric properties and can be utilized in clinical and research settings.

ICD-11 adjustment disorder: Translation and validation of the Danish international adjustment disorder questionnaire among a working population of social educators

Adjustment disorder is frequently used as a diagnostic category for work-related stress disorders in Denmark. However, the diagnostic category is poorly delineated in ICD-10 which has hampered clinical practice as well as research studying the development of work-related adjustment disorders. In ICD-11, the diagnostic category of adjustment disorder has been refined and a new self-report measure is available to operationalize symptoms. The aim of the current study is to translate the International Adjustment Disorder Questionnaire (IADQ) to Danish and test the psychometric properties of the scale in a sample of social educators. A total of 609 social educators in current employment participated in an online survey including the IADQ and data was analyzed using confirmatory factor analysis. Findings suggested that a two-factor model reflecting the distinction between preoccupation and failure to adapt as part of the diagnostic criterion fitted the data best, although strong factor correlations and one cross-factor loading suggests that differentiating between the dimensions of preoccupation and failure to adapt is difficult. Relationships to burnout, posttraumatic stress and general distress support the validity of the Danish translation of the IADQ. Further research should explore the structure of adjustment disorder among other working populations.

Savoring mediates the mental health benefits of positive coping processes: A prospective population-based analysis

Positive coping (e.g., self-efficacy and positive reappraisal) and savoring could bear mental health implications under large-scale disasters such as COVID-19. The integrative affect-regulation framework of psychological resilience proposes that evaluative efforts regulate affect, which then predicts positive short-term consequences and better mental health. This two-wave study was done during the prolonged, intensive COVID-19 control rules in Hong Kong and examined (1) the prospective associations of positive coping processes (i.e., self-efficacy and positive reappraisal) (T1, March-August 2021) with subsequent psychiatric symptoms (T2, September 2021-February 2022) and (2) the mediating effect of T2 savoring in the associations. Path analyses revealed that T1 self-efficacy and positive reappraisal were inversely related to T2 psychiatric symptoms. T2 savoring partially mediated the effect of T1 self-efficacy but fully mediated the effect of T1 positive reappraisal. Self-efficacy could have more sustainable direct positive associations with mental health, whereas the benefit of positive reappraisal might need to be catalyzed by savoring over time. Our study offered concrete illustrations of the conceptual tenets of the affect-regulation framework.

Trajectories of Adjustment Disorder and Well-Being in Austria and Croatia during 20 Months of the COVID-19 Pandemic

The present study aimed to investigate the trajectories of adjustment disorder (AD) symptoms and well-being over 20 months of the COVID-19 pandemic in Austria and Croatia. Further objectives of this study were to examine whether sociodemographic characteristics and the symptoms of anxiety and depression could predict these trajectories. As part of the pan-European ESTSS ADJUST study, N = 1144 individuals were recruited using convenience sampling and assessed four times between June 2020 and January 2022 through an online survey. Latent growth curve modelling was applied to estimate the trajectories of AD symptoms and well-being. Over time, the prevalence of probable AD varied between 9.8% and 15.1%. The symptoms of AD tended to increase, whereas well-being tended to decrease. According to the majority of the models tested, women, participants from Austria and those with lower income had higher initial AD symptoms, whereas older participants and those from Croatia had higher initial well-being. In all models and at all timepoints, anxiety and depression significantly predicted AD and well-being scores. Overall, our study points to several predictors of AD and well-being and indicates high variability in people's reactions to the pandemic. Psychosocial support for the general population is needed during pandemics and similar crises, with a special focus on vulnerable groups.

Relationship between adjustment disorder symptoms and probable diagnosis before and after second lockdown in Israel: longitudinal symptom network analysis

BACKGROUND

There is cumulative evidence of the importance of exploring the change of dynamics between symptoms over time as reflective of consolidation of psychopathology.

AIMS

To explore the interactions between symptoms of ICD-11 adjustment disorder before and after the second lockdown of the COVID-19 pandemic in Israel and identify the most central symptoms and their concurrent and prospective associations with probable adjustment disorder.

METHOD

This is a population-based study drawn from a probability-based internet panel. A representative sample of the adult Israeli population was assessed at two time points (T1, pre-second lockdown, n = 1029, response rate 76.17%; T2, post-second lockdown, n = 764, response rate 74.24%). Symptoms of adjustment disorder were assessed by the International Adjustment Disorder Questionnaire (IADQ).

RESULTS

Although the overall strength of associations at the two measurement points was similar and two same communities were found, there was a significant change in their structure, with a more consolidated network at T2. The most central item was 'difficult to relax' in both networks. Cross-sectionally, all symptoms of failure to adapt significantly predicted adjustment disorder. 'Worry a lot more' (preoccupation) and 'difficult to adapt to life' (failure to adapt) at T1 significantly predicted this diagnosis at T2.

CONCLUSIONS

Adjustment disorder symptoms consolidated during the second lockdown of the pandemic. In line with the ICD-11 conceptualisation of adjustment disorder, both preoccupation and failure-to-adapt symptoms have prognostic validity. This highlights the importance of identifying and targeting adjustment disorder symptoms during a period of stress such as the COVID-19 pandemic.