Psychometric evaluation of the Adjustment Disorder New Module-20 (ADNM-20): A multi-study analysis

Symptoms of adjustment disorder during social unrest: The role of varied stances in Israel's sociopolitical climate

BACKGROUND

Civil unrest related to political change can have detrimental effects on the mental health of the population. This study investigated probable Adjustment Disorder (AjD) among individuals with different attitudes in the context of a highly controversial judicial reform in Israel. The relationships between AjD symptoms across three groups were explored: those who support the proposed changes, others who oppose them, and those who adopt a neutral stance.

METHODS

This study was conducted with a nationally representative sample of Israeli adults (n = 1999). A Symptoms Network analysis of AjD was performed using the International Adjustment Disorder Questionnaire, examining groups with different levels of social unrest engagement.

RESULTS

Participants actively opposing the judicial reform reported higher levels of probable AjD compared to neutral participants and those in favor of the reform. Similarly, neutral participants reported higher levels of probable AjD than those in favor of the reform. The network structure of AjD was similar across the three groups. Item five ("difficult to relax/feel calm since the social unrest") was the node with the highest strength centrality in all networks.

LIMITATIONS

This study utilized cross-sectional methodology and self-report measures.

CONCLUSIONS

Mental health needs should be actively addressed by policymakers and mental health professionals during social unrest, regardless of political stance. The high rates of probable AjD and the similarity in the structure of AjD across the groups suggest common underlying mechanisms and a significant adjustment crisis in a large portion of the population following social unrest.

Adjustment Disorders and Quality of Life in Patients With Tracheostomy and Tracheal Cannula: A Scoping Review

INTRODUCTION

Tracheostomy (TCT) surgery and subsequent tracheal cannula (TC) insertion involve several physical, communicative, and psychological changes for the patient. Decreased mood and dysfunctional states such as morbid anxiety, depression, and stress are often experienced in these clinical situations, and affect the quality of life (QoL) and the rehabilitation process. This review aims to examine the studies in the literature on adjustment disorders (AjD) in patients with TCT or TC and how this affects their QoL during the rehabilitation process.

METHODS

Studies were identified from an online search of PubMed, Cochrane Library, and Embase databases. Studies published between 2013-2023 were selected. This review has been registered on OSF (n): DOI 10.17605/OSF.IO/RHX3J.

RESULTS

TCT patients were found to experience AjD in terms of anxiety, depression, and stress, which may have a significant impact on QoL and the recovery/extubation time during long-term rehabilitation.

CONCLUSIONS

The AjD must be considered seriously and carefully during the rehabilitation process in tracheostomized patients, as it can have significant repercussions on the QoL and caregivers. The rehabilitation path must consider the problems linked to this condition: physical, communicative, and psychological.

Comparing psychiatric symptom networks between individuals in resilience and non-resilience trajectories of adaptation amid the global pandemic

OBJECTIVE

The current study compared symptom networks between individuals exhibiting resilience and non-resilience trajectories of adaptation two years after the COVID-19 outbreak.

METHOD

A population-representative sample (N = 906) reported symptoms of anxiety and depression in February-July 2020 (T1), March-August 2021 (T2), and September 2021-February 2022 (T3), as well as symptoms of post-traumatic stress disorder (PTSD) and adjustment disorder (AD) at T3. After differentiating between individuals with resilience and non-resilience trajectories using growth mixture modeling, network analyses were conducted to investigate group differences in T3 network symptoms (undirected and directed).

RESULTS

Despite non-significant group differences (M = 0.184, p = .380; S = 0.096, p = .681), distinctive qualitative characteristics were observed between networks. Difficulty relaxing was identified as the single root cause in the more diffused resilience network, with anxiety and depressive symptoms as additional starting points in the non-resilience network, which was more interconnected into clusters with clear-cut diagnostic boundaries. Sad mood demonstrated a transdiagnostic communicative role across common mental disorders.

CONCLUSION

Our results contribute to the understanding of anxiety-depression-PTSD-AD symptom networks in resilient and non-resilient individuals by highlighting the consequences of heterogeneity in adaptation capacity in the development of pandemic-related psychopathology.

Nature of stressors, clinical manifestations and diagnostic concurrence with the new ICD-11 criteria in adjustment disorder: a retrospective data review

PURPOSE

Adjustment disorder (AD) is a maladaptive reaction to psychosocial stressors, with prevalence reaching up to 50% in certain consultation settings. Research on stressors, clinical profiles, and concurrence with ICD-11 criteria in AD is limited. We aim to assess stressor profiles, clinical manifestations, course, and diagnostic concurrence between ICD-10 and ICD-11 criteria in AD.

MATERIALS AND METHODS

Retrospective review of medical records of adults diagnosed with AD between 2016 and 2020. Stressors were categorized using the Adjustment Disorder New Module 8 (ADNM-8), a validated scale assessing AD symptom severity as per ICD-11 criteria. Data were analysed using PSPP.

RESULTS

Women comprised 57.8% of 445 patients, with a mean age of 32.24 (±9.97) years. The most common stressor was interpersonal relationship (IPR) issues or familial stressors (50.1%). The illness or death of loved ones was a more common stressor among women, while men noted work-related stress more often (p = 0.001). Those under 40 years predominantly faced interpersonal/familial stress (55%), while those over 40 years more frequently experienced illness or death of loved ones (32%; p = 0.001). Depressive symptoms were the most common presentation. Among ICD-11 criteria, preoccupation with and failure to adapt to the stressor were noted in 97.1% and 93.9% patients, respectively. Amongst patients who followed up, 77% showed significant improvement with 36.5% of them having follow up of 2-6 months.

CONCLUSION

IPR issues were the most common stressors, with gender and age influencing stressor types. AD commonly presented with depressive symptoms, showing high concurrence with ICD-11 criteria and favourable outcomes.

Validation of the Spanish version of the Adjustment Disorder New Module-20 (ADNM-20) in a non-clinical sample

BACKGROUND

There is a lack of self-report measures specifically designed for Adjustment disorder. One of the most widely used instruments is the Adjustment Disorder New Module (ADNM), which has already been validated in different countries. The aim of this study was to validate the Spanish version of the ADNM-20 with a non-clinical sample, including a comparison with a high-risk sample.

METHOD

203 participants of the general population (mean age = 33.84) completed an online survey which included the Spanish version of the ADNM, the anxiety and depression measures GAD-7 and PHQ-9, and an assesment of coping strategies using the Brief-COPE.

RESULTS

The analysis of the scale's internal structure revealed that a hierarchical model could best fit the data, as well as a bifactorial structure. The scale showed high internal consistency and an adequate differential validity, as differences were observed when comparing the high-risk and non-clinical groups. Positive correlations were also identified between ADNM and depression and anxiety, as well as different correlations with coping strategies.

CONCLUSION

This study presents the first validation of the ADNM-20 in Spanish showing good reliability and validity results. In addition, a comparison with a high-risk sample and norms are offered to help future evaluators.

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.

The prevalence of adjustment disorder and predisposing factors in infertile women

BACKGROUND

Infertility is a stressful life event that increases the risk of developing mental disorders, particularly adjustment disorder (AD). Given the paucity of data on the prevalence of AD symptoms in infertility, the purpose of this study was to ascertain the prevalence, clinical presentation, and risk factors for AD symptoms in infertile women.

METHOD

In a cross-sectional study, 386 infertile women completed questionnaires including the Adjustment Disorder New Module-20 (ADNM), the Fertility Problem Inventory (FPI), the Coronavirus Anxiety Scale (CAS), and the Primary Care Posttraumatic Stress Disorder (PC-PTSD-5) at an infertility center between September 2020 and January 2022.

RESULT

The results indicated that 60.1% of infertile women exhibited AD symptoms (based on ADNM > 47.5). In terms of clinical presentation, impulsive behavior was more common. No significant relationship was observed between prevalence and women's age or duration of infertility. Infertility stress (β = 0.27, p < 0.001), coronavirus anxiety (β = 0.59, p = 0.13), and a history of unsuccessful assisted reproductive therapies (β = 2.72, p = 0.008) were several predisposing factors for AD symptoms in infertile women.

CONCLUSIONS

The findings suggest that all infertile women be screened from the start of infertility treatment. Additionally, the study suggests that infertility specialists should focus on combining medical and psychological treatments for individuals predisposed to AD, particularly infertile women who exhibit impulsive behaviors.

Prevalence, nature, and severity of the psychiatric comorbidities and their impact on quality of life in adolescents with Juvenile myoclonic epilepsy

INTRODUCTION

Adults with Juvenile myoclonic epilepsy (JME) are at increased risk for psychiatric comorbidities, personality traits, and abnormality in executive function. But studies on adolescents and their impact on quality of life are scarce in the literature.

MATERIALS AND METHODS

This cross-sectional study was performed between August 2019 and October 2022 to compare the prevalence of psychiatric comorbidities in adolescents with JME and age and gender-matched healthy controls. After completing DSM-5 Structured Clinical Interview (SCID-5) initially in all patients, we measured the severity of individual psychiatric problems like anxiety, depression, and somatic symptoms by using an appropriate psychometric scale. We also measured both groups' intelligence quotient (IQ), executive function, and quality of life.

RESULTS

One hundred patients with JME (14.3 ± 2.5 years, 48 boys) and 100 controls were enrolled. Psychiatric disorders were observed in 46% of JME and 6% of controls (p < 0.01). Psychiatric comorbidities noted in the patients with JME were: somatic symptom and related disorders(n = 14), anxiety (n = 13), adjustment disorders (n = 12), depression (n = 11), oppositional defiant disorder (n = 6), conduct disorder (n = 5), anorexia nervosa (n = 3), narcissistic (n = 3), histrionic (n = 1), substance-related disorder (n = 1), borderline (n = 2) and antisocial personality disorder (n = 2). The prevalence of depressive disorders, anxiety disorders, adjustment disorders, somatic symptoms, related disorders, and any personality disorder was significantly more in the JME group (p < 0.01 for all). Female gender, higher Epilepsy Stigma Scale score, and lower Epilepsy Outcome Expectancy Scale were significantly associated with depressive disorders (p = 0.04, 0.03, 0.03 respectively). Similarly, for anxiety, only female gender and lower Epilepsy Outcome Expectancy Scale were significant associated factors (p = 0.03, 0.02 respectively).

CONCLUSIONS

Psychiatric disorders like anxiety, depression, and personality disorders are more frequent in adolescents with JME than in controls.

Everyday life experiences for evaluating post-traumatic stress disorder symptoms

Background: Previous research has highlighted the importance of regularizing daily routines for maintaining mental health. Little is known about whether and how regularity of daily routines is associated with reduced post-traumatic stress disorder (PTSD) symptoms.Objective: We aimed to examine the associations between regularity of daily routines and PTSD symptoms in two studies (N = 796).Method: In Study 1, prospective data were analysed with the latent change score model to investigate the association between sustainment of regular daily routines and change in PTSD symptoms over time amid massive civil unrest in Hong Kong in 2019. Study 2 used vignette as a quasi-experimental method to assess the ability of maintaining regular daily routines in face of a major stressor, and tested its associations with PTSD symptoms.Results: In Study 1, increased regularity of diverse daily routines was inversely associated with increased PTSD symptoms amid the civil unrest in Hong Kong (β = -.427 to -.224, 95% confidence intervals [-.543 to -.359, -.310 to -.090], p values < .01). In Study 2, a greater ability to maintain regular daily routines during stress was associated with lower levels of PTSD symptoms (β = -.285 to -.096, 95% confidence intervals [-.379 to -.189, -.190 to -.003], p values < .05).Conclusions: Our findings suggest the benefit of considering diverse everyday activities in evaluating PTSD symptoms in both clinical and subclinical populations. Interventions with the direct focus on the role of daily living could promote psychological resilience during and after potentially traumatic events.

Cross-Cultural Comparison of ICD-11 Adjustment Disorder Prevalence and Its Risk Factors in Japanese and Lithuanian Adolescents

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.

Coping resources mediate the prospective associations between disrupted daily routines and persistent psychiatric symptoms: A population-based cohort study

This study examined the mediating effects of coping resources in the prospective associations between daily routine disruptions in the acute phase of COVID-19 and persistent probable anxiety and depression. A prospective, population-representative cohort of 1318 Hong Kong Chinese respondents completed a baseline survey between February and July 2020 (T1) and a 1-year follow-up survey between March and August 2021 (T2). Respondents reported demographics and disruptions to primary and secondary daily routines at T1, coping resources (i.e., self-efficacy and meaning making) at T2, and anxiety and depressive symptoms at T1 and T2. We found that 8.1% and 10.0% of respondents reached cutoff scores for probable anxiety and depression respectively at both T1 and T2. Logistic regression showed that T1 daily routine disruptions were positively associated with heightened risk of persistent probable anxiety and depression amid COVID-19. Path analysis showed that 15.3% and 13.1% of the associations of daily routine disruptions with persistent probable anxiety and depression were explained by coping resources, respectively, while the direct routine-outcome associations remained significant. Daily routine disruptions predict higher odds of persistent probable anxiety and depression directly and partially through reducing coping resources. Sustainment of regular daily routines should be advocated and fostered to enhance coping resources and reduce the risk of poorer adjustment among the affected populations amid public health crises.

Validation of the International Adjustment Disorder Questionnaire in Israel and Switzerland

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.

Adjustment Disorder in the Face of COVID-19 Outbreak: The Impact of Death Anxiety, Media Exposure, Fear of Contagion and Hypochondriasis Symptoms

Based on the theoretical view of Terror Management Theory, the current research examines whether higher levels of death anxiety symptoms, in the face of the COVID-19 outbreak, increase the extent to which participants are exposed to information regarding the spread of the pandemic, as well as the fear of contagion and symptoms of hypochondriasis, which all in turn increase symptoms of adjustment disorder. A total number of 302 participants filled out self-report questionnaires regarding death anxiety, adjustment disorder, the extent of exposure to information regarding COVID-19, fear of contagion, hypochondriasis, and demographic information. Structural Equation Modeling analysis indicated a very good fit of the theoretical model with the data, confirming the mediation effect of exposure to information, fear of contagion, and symptoms of hypochondriasis on the association between death anxiety and adjustment disorder symptoms. Implications for practice are discussed.