A longitudinal study of risk and protective factors for symptoms of adjustment disorder during the COVID-19 pandemic.

Background: The COVID-19 pandemic caused multiple stressors that may lead to symptoms of adjustment disorder.Objective: We longitudinally examined relationships between risk and protective factors, pandemic-related stressors and symptoms of adjustment disorder during the COVID-19 pandemic, as well as whether these relationships differed by the time of assessment.Method: The European Society for Traumatic Stress Studies (ESTSS) ADJUST Study included N = 15,169 participants aged 18 years and above. Participants from 11 European countries were recruited and screened three times at 6-month intervals from June 2020 to January 2022. Associations between risk and protective factors (e.g. gender), stressors (e.g. fear of infection), and symptoms of adjustment disorder (AjD, ADNM-8) and their interaction with time of assessment were examined using mixed linear regression.Results: The following predictors were significantly associated with higher AjD symptom levels: female or diverse gender; older age; pandemic-related news consumption >30 min a day; a current or previous mental health disorder; trauma exposure before or during the pandemic; a good, satisfactory or poor health status (vs. very good); burden related to governmental crisis management and communication; fear of infection; restricted social contact; work-related problems; restricted activity; and difficult housing conditions. The following predictors were associated with lower AjD levels: self-employment or retirement; working in healthcare; and face-to-face contact ≥ once a week with loved ones or friends. The effects of the following predictors on AjD symptoms differed by the time of assessment in the course of the pandemic: a current or previous mental disorder; burden related to governmental crisis management; income reduction; and a current trauma exposure.Conclusions: We identified risk factors and stressors predicting AjD symptom levels at different stages of the pandemic. For some predictors, the effects on mental health may change at different stages of a pandemic.

We longitudinally examined predictors of symptoms of adjustment disorder in 15,563 adults during the COVID-19 pandemic.We found stressors, risk, and protective factors predicting adjustment disorder symptom levels at different stages of the pandemic.For some predictors, the effects appear to change in different phases of a pandemic.

Esquemas desadaptativos Iniciales como predictores de conductas disfuncionales: una revisión de la literatura / Esquemas iniciais desadaptativos como preditores de comportamentos disfuncionais: uma revisão de literatura / Early maladaptive schemes as predictors of dysfunctional behaviors: a literature review

Este artigo pretende verificar a quantidade de pesquisas publicadas no mundo nos últimos cinco anos e sua predição para com o comportamento humano. Foram encontrados 75 artigos nas bases de dados Scielo, Medline e Lilacs, a través de uma busca utilizando descritores em português e na língua inglesa no Portal Periódicos.capes. Os resultados apontaramque os estudos encontrados tiveram relação aos transtornos da personalidade, referindode forma direta a comportamentos relacionados aos esquemas desadaptativos como preditores dos transtornos da personalidade. Outros temas considerados foram o suicídio, o divórcio, a violência conjugal, patologias orgânicas e/ou dor crônica, a parentalidade,comportamentos erráticos, saúde e validação de escalas. Conclui-se que esta revisão tem sua importância na análise criteriosa dos estudos sobre os EIDs e sua relação com a personalidade, já que a teoria cognitiva traz a priori que os comportamentos disfuncionais estão relacionados com os Esquemas Iniciais Desadaptativos AU

Este artículo tiene como objetivo verificar la cantidad de investigaciones publicadas en el mundo en los últimos cinco años y su predicción para el comportamiento humano. Se encontraron un total de 75 artículos en las bases de datos Scielo, Medline y Lilacs, a través de una búsqueda con descriptores en portugués e inglés en el Portal Periódicos.capes. Los resultados mostraron que los estudios encontrados estaban relacionados con los trastornos de personalidad, refiriéndose directamente a conductas relacionadas con esquemas desadaptativos como predictores de trastornos de personalidad. Otros temas considerados fueron suicidio, divorcio, violencia conyugal, patologías orgánicas y/o dolor crónico, crianza, comportamiento errático, salud y validación de escalas. Se concluye que esta revisión es importante en el análisis cuidadoso de los estudios sobre las EID y su relación con la personalidad, ya que la teoría cognitiva muestra a priori que las conductas disfuncionales están relacionadas con los Esquemas Desadaptativos Iniciales AU

This article aims to verify the amount of research published in the world in the last five years and its prediction for human behavior. A total of 75 articles were found in the Scielo, Medline and Lilacs databases, through a search using descriptors in Portuguese and English on the Portal Periódicos.capes. The results showed that the studies found were related topersonality disorders, referring directly to behaviors related to maladaptive schemas as predictors of personality disorders. Other topics considered were suicide, divorce, marital violence, organic pathologies and/or chronic pain, parenting, erratic behavior, health and validation of scales. It is concluded that this review is important in the careful analysis of studies on EIDs and their relationship with personality, since the cognitive theory shows a priori that dysfunctional behaviors arerelated to Initial Maladaptive Schemas AU

Adjustment Disorder: Diagnosis and Treatment in Primary Care.

Adjustment disorder is a disorder characterized by an extreme emotional reaction to a stressor. It is defined diagnostically with either the Diagnostic and Statistical Manual V or ICD-11 definitions. There is currently a diagnostic tool that is still being validated to assist with diagnosing adjustment disorder. The prevalence of this disorder ranges from 0.2% to 40%, depending on the stressful circumstances that the patient experiences. There are several treatments available for adjustment disorder, ranging from psychological interventions, natural therapies to pharmacotherapies.

Psychometric and factorial validity of the International Adjustment Disorder Questionnaire (IADQ) in an Italian sample: A validation and prevalence estimate study.

INTRODUCTION: Adjustment disorder (AjD) is a is a maladaptive emotional or behavioural reaction to a stressful event or change in a person's life. Compared to other previously validated tools, the International Adjustment Disorder Questionnaire (IADQ) stands out as one of the most reliable and handy one for AjD. Since no homologous instrument exists now, in this study, we aimed to validate an Italian version of the IADQ. METHODS: Twenty-one thousand two hundred and six subjects (80.4% females) during the initial stages of the SARS-CoV-2 pandemic were recruited. We conducted a confirmatory factor analysis (CFA), testing two latent models, a monofactorial and a bifactorial one. Concurrent validity by correlating the total and the two factors' scores with measures of depression, anxiety and post-traumatic stress was then estimated. We finally estimated the rates of AjD among the population, and a binary logistic regression was conducted to analyse the predictors of such disorder. RESULTS: CFA showed a bifactorial validity, with both excellent incremental and comparative fit indices. The IADQ scores correlated strongly with symptoms of depression, anxiety and stress. In the Italian sample, the prevalence of probable AjD was 8.23%. Female gender, being engaged, widowed and having COVID-19-related stressors resulted as significant independent risk factors for AjD. CONCLUSIONS: IADQ is an easy-to-use, brief and psychometrically sound self-report measure for AjD. Thus, it may be considered a reliable tool for both research and clinical settings. To the best of our knowledge, our study reported for the first time the prevalence of AjD during COVID-19 pandemic.

A Longitudinal Course of ICD-11 Adjustment Disorder Symptom Profiles: A 12-Month Follow-Up Study.

INTRODUCTION: Adjustment disorder is frequently diagnosed in clinical practice; however, the course of adjustment disorder over time has not yet been studied extensively. METHODS: This longitudinal study was one of the first that aimed to analyze trajectories of adjustment disorder symptoms in a 12-month follow-up among a high-risk community sample (n = 205) exposed to various stressors. Adjustment disorder symptoms were measured at baseline and 12-month follow-up with the Brief Adjustment Disorder New Module based on the definition of adjustment disorder provided in the 11th Edition of International Classification of Diseases (ICD-11) released in 2018 by the World Health Organization (WHO). RESULTS: A latent transition analysis of adjustment symptoms identified four distinct trajectories: "high symptom," "recovery," "onset," and "low symptom." We found 46% of ICD-11 adjustment disorder at baseline, and 29% of the sample was classified as having a high-symptom adjustment symptom profile. The high-symptom profile was predicted by ongoing stressors, female gender, and higher education. CONCLUSION: Study findings indicate that adjustment disorder among high-risk samples, in particular, those exposed to ongoing stressors, could have a high-symptom course over 12 months.

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.

Psychosocial Effects of Vitiligo: A Systematic Literature Review.

BACKGROUND: Patients with vitiligo experience reduced quality of life. OBJECTIVE: To comprehensively describe the available evidence for psychosocial burden in vitiligo. METHODS: A systematic review of observational studies and clinical trials identified using PubMed, EMBASE, Scopus, and the Cochrane databases was performed through 1 March, 2021, to assess psychosocial comorbidities in vitiligo. Two independent reviewers performed an assessment of articles and extracted data for qualitative synthesis. RESULTS: Included studies (N = 168) were published between 1979 and 1 March, 2021; 72.6% were published since 2010. Disorders including or related to depression (41 studies, 0.1-62.3%) and anxiety (20 studies, 1.9-67.9%) were the most commonly reported. The most prevalent psychosocial comorbidities were feelings of stigmatization (eight studies, 17.3-100%), adjustment disorders (12 studies, 4-93.9%), sleep disturbance (seven studies, 4.6-89.0%), relationship difficulties including sexual dysfunction (ten studies, 2.0-81.8%), and avoidance or restriction behavior (12.5-76%). The prevalence of most psychosocial comorbidities was significantly higher vs healthy individuals. Factors associated with a significantly higher burden included female sex, visible or genital lesions, age < 30 years (particularly adolescents), and greater body surface area involvement, among others. The most commonly reported patient coping strategy was lesion concealment. LIMITATIONS: Available studies were heterogeneous and often had limited details; additionally, publication bias is possible. CONCLUSIONS: The results of this systematic review show that vitiligo greatly affects psychosocial well-being. The extent of psychosocial comorbidities supports the use of multidisciplinary treatment strategies and education to address the vitiligo-associated burden of disease. PROTOCOL REGISTRATION: PROSPERO (CRD42020162223).

Inflammatory proteins and miRNA-144-5p in patients with depression, anxiety, or stress- and adjustment disorders after psychological treatment.

Both inflammatory proteins and microRNAs (miRNA) have been reported to be associated with various psychiatric disorders. However, the association between inflammatory proteins and miRNAs remains largely unknown, especially for patients with depression, anxiety, or stress- and adjustment disorders. In this study, we analyzed plasma levels of 92 inflammatory proteins from 178 patients with depression, anxiety, or stress- and adjustment disorders at baseline and after 8-week psychological treatments which resulted in a significant decrease in the Montgomery Åsberg Depression Rating Scale (MADRS-S) score. We investigated the response of the proteins after treatment and the correlation with miR-144-5p. After Benjamini-Hochberg correction for multiple testing, a total of 36 inflammatory proteins changed significantly after 8-week psychological treatments. Among the 36 significantly changed proteins, 21 proteins showed a decrease, and 17/21 proteins were inversely associated with plasma miR-144-5p levels at baseline. In addition, decreases in these proteins were associated with increases in miR-144-5p after treatment. The findings were similar after stratification by use of medications. The associations between the proteins and depression at baseline, measured by MADRS-S, as well as the change in protein levels and treatment response were, however, less clear. These findings need to be examined in future studies.

Psychological complexities of visual restoration.

In this paper, we report the psychological and emotional experience of a patient who regained vision after over a decade of vision loss. The negative psychological implications of blindness are well recognised and there is a robust link between visual impairment and low mood and depressive symptoms. Although uncommon, low mood and depressive symptoms have been reported in patients whose sight has been restored, and lack of research gives rise to the possibility their prevalence may be grossly under-recognised in such patient groups. The effects can be so severe that patients may revert to living in darkness in mimicry of their previous lifestyle, effectively obviating the sight-restoring surgery. Healthcare professionals have a responsibility to address this traditionally neglected need by facilitating social, psychological and medical interventions that may ease the return to vision.

Adjustment disorder, traumatic stress, depression and anxiety in Poland during an early phase of the COVID-19 pandemic.

Background: The current COVID-19 pandemic is associated with a variety of stressors. Preliminary research has demonstrated that general public are experiencing a range of psychological problems, including stress-related disturbances. However, to date, there is not much research on the prevalence of adjustment disorder during the current pandemic. Objectives: This study aimed to assess the prevalence and severity of symptoms of adjustment disorder compared to posttraumatic symptoms, depression and generalized anxiety in a large sample of adult Poles, in the first phase of the current pandemic. Method: Self-report data from a web-based sample (N = 1,742) was collected between March 25 and April 27, just after the introduction of nationwide quarantine measures in Poland. Results: The current COVID-19 pandemic was a highly stressful event for 75% of participants and the strongest predictor of adjustment disorder. Increased symptoms of adjustment disorder were reported by 49%, and they were associated with female gender and not having a full-time job. However, after exclusion of co-occurring symptomatology, 14% of the sample were finally qualified as meeting diagnostic criteria of adjustment disorder. A substantial proportion of the sample screened also positive for generalized anxiety (44%) and depression (26%); the rate for presumptive PTSD diagnosis was 2.4%. Conclusions: High rates of negative mental health outcomes were found in the Polish population in the first weeks into the COVID-19 pandemic and lockdown measures. They indicate the intense current stress-related symptoms in the early phase of the pandemic and warrant further monitoring on population's mental health.

Antecedentes: La actual pandemia de COVID-19 está asociada con una variedad de estresores. Investigaciones preliminares han demostrado que la población general está experimentando una variedad de problemas psicológicos, incluyendo trastornos relacionados con el estrés. Sin embargo, hasta la fecha no hay mucha investigación acerca de la prevalencia de trastornos de adaptación durante la actual pandemia.Objetivos: Este estudio tuvo como objetivo evaluar la prevalencia y severidad de los síntomas del trastorno adaptativo comparado con los síntomas postraumáticos, depresión y ansiedad generalizada en una gran muestra de adultos polacos, en la primera fase de la actual pandemia.Método: Se recolectó información auto-reportada de una muestra basada en la web (N=1.742) entre el 25 de marzo y el 27 de Abril, justo después de la introducción de medidas de cuarentena a nivel nacional en Polonia.Resultados: La pandemia actual de COVID-19 fue un evento altamente estresante para el 75% de los participantes y el predictor más poderoso de trastorno de adaptación. 49% informó un aumento de síntomas de trastorno de adaptación, y se asociaron con género femenino y no tener trabajo de tiempo completo. Sin embargo, después de la exclusión de la sintomatología concurrente, 14% de la muestra cumplía los criterios para diagnóstico de trastorno de adaptación. Una proporción importante de la muestra tambien resultó positiva para ansiedad generalizada (44%) y depresión (26%): la tasa de diagnóstico presuntivo de TEPT fue de 2,4%.Conclusiones: Se encontraron altas tasas de consecuencias negativas de salud mental en la población Polaca en las primeras semanas de pandemia y medidas de confinamiento por COVID-19. Indican los intensos síntomas actuales relacionados con el estrés en la fase inicial de la pandemia y justifican un mayor seguimiento de la salud mental de la población.

Risk and protective factors, stressors, and symptoms of adjustment disorder during the COVID-19 pandemic - First results of the ESTSS COVID-19 pan-European ADJUST study.

Background: The COVID-19 pandemic exposes individuals to multiple stressors, such as quarantine, physical distancing, job loss, risk of infection, and loss of loved ones. Such a complex array of stressors potentially lead to symptoms of adjustment disorder. Objective: This cross-sectional exploratory study examined relationships between risk and protective factors, stressors, and symptoms of adjustment disorder during the first year of the COVID-19 pandemic. Methods: Data from the first wave of the European Society of Traumatic Stress Studies (ESTSS) longitudinal ADJUST Study were used. N = 15,563 participants aged 18 years and above were recruited in eleven countries (Austria, Croatia, Georgia, Germany, Greece, Italy, Lithuania, the Netherlands, Poland, Portugal, and Sweden) from June to November 2020. Associations between risk and protective factors (e.g. gender, diagnosis of a mental health disorder), stressors (e.g. fear of infection, restricted face-to-face contact), and symptoms of adjustment disorder (ADNM-8) were examined using multivariate linear regression. Results: The prevalence of self-reported probable adjustment disorder was 18.2%. Risk factors associated with higher levels of symptoms of adjustment disorder were female gender, older age, being at risk for severe COVID-19 illness, poorer general health status, current or previous trauma exposure, a current or previous mental health disorder, and longer exposure to COVID-19 news. Protective factors related to lower levels of symptoms of adjustment disorder were higher income, being retired, and having more face-to-face contact with loved ones or friends. Pandemic-related stressors associated with higher levels of symptoms of adjustment disorder included fear of infection, governmental crisis management, restricted social contact, work-related problems, restricted activity, and difficult housing conditions. Conclusions: We identified stressors, risk, and protective factors that may help identify individuals at higher risk for adjustment disorder.

Antecedentes: La pandemia de COVID-19 expone a las personas a múltiples factores estresantes, como la cuarentena, el distanciamiento físico, la pérdida del trabajo, el riesgo de infección, y la pérdida de seres queridos. Esta compleja serie de factores estresantes puede potencialmente conducir a síntomas del trastorno de adaptación.Objetivo: Este estudio exploratorio transversal examinó las relaciones entre los factores de riesgo y de protección, los factores estresantes, y los síntomas del trastorno de adaptación durante el primer año de la pandemia de COVID-19.Métodos: Se utilizaron datos de la primera ola del estudio longitudinal ADJUST de la Sociedad Europea de Estudios de Estrés Traumático (ESTSS en su sigla en inglés). N = 15.563 participantes de 18 años o más fueron reclutados en once países (Austria, Croacia, Georgia, Alemania, Grecia, Italia, Lituania, Países Bajos, Polonia, Portugal, y Suecia) de junio a noviembre de 2020. Se examinaron mediante regresión lineal multivariante las asociaciones entre los factores de riesgo y de protección (p. ej., género, diagnóstico de un trastorno de salud mental), factores estresantes (p. ej., miedo a la infección, contacto restringido cara a cara), y síntomas del trastorno de adaptación (ADNM-8 en su sigla en inglés).Resultados: La prevalencia del trastorno de adaptación probable autoinformado fue del 18,2%. Los factores de riesgo asociados con niveles más altos de síntomas del trastorno de adaptación fueron género femenino, edad avanzada, riesgo de enfermedad grave por COVID-19, peor estado de salud general, exposición a un trauma actual o anterior, un trastorno de salud mental actual o anterior, y una exposición más prolongada a las noticias de COVID-19. Los factores de protección relacionados con niveles más bajos de síntomas del trastorno de adaptación fueron mayores ingresos, estar jubilado, y tener más contacto cara a cara con sus seres queridos o amigos. Los factores estresantes relacionados con la pandemia que se asociaron con niveles más altos de síntomas del trastorno de adaptación incluyeron miedo a la infección, manejo gubernamental de crisis, contacto social restringido, problemas relacionados con el trabajo, actividad restringida, y condiciones de vivienda difíciles.Conclusiones: Identificamos factores estresantes, de riesgo, y protectores que pueden ayudar a identificar a las personas con mayor riesgo de trastorno de adaptación.

Meaning-making as a mediator of anxiety and depression reduction during cognitive behavioral therapy intervention in participants with adjustment disorders.

There is a consensus among researchers about the link between low meaning in life and anxiety and depressive symptoms. One unanswered question is whether meaning-making is a mediator of the change in anxiety and depression symptoms in participants with adjustment disorders during cognitive behavioural therapy (CBT) treatment. The aims of this study were (a) to analyse whether there was meaning-making during the application of the CBT, (b) to analyse whether meaning-making was a mediator of anxiety psychopathology and (c) to analyse whether meaning-making was a mediator of depressive symptoms. The sample was composed of 115 patients who satisfied the full Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria for adjustment disorder as their primary diagnosis and completed CBT treatment in a primary care mental health service: 74.78% women, n = 86, and 25.22% men, n = 29, with a mean age of 41.89 (standard deviation [SD] = 10.39) years. The diagnosis was established using the Structured Clinical Interview for DSM-5 (SCID-5), and participants filled out the Beck Anxiety Inventory, the Beck Depression Inventory and Purpose in Life questionnaires. The therapists were clinical psychologists with experience in clinical assessment. A repeated-measures analysis of variance (ANOVA) and two mediation analyses using the bootstrap method were performed. The results indicated that (a) There was meaning-making during the CBT because the treated sample showed a statistically significant improvement in meaning in life, and (b) meaning-making during the CBT was a partial mediator between anxiety symptoms and depressive symptoms before and after the treatment. The present study suggests that meaning in life could be an important variable in the psychopathology of adjustment disorders.

Factors Associated with Adjustment Disorder - the Different Contribution of Daily Stressors and Traumatic Events and the Mediating Role of Psychological Well-Being.

The definition of adjustment disorder (AjD) was recently revised by the 11th version of the International Classification of Diseases. Thus far, only two studies explored stressors associated with symptoms of AjD according to the new definition, revealing that there might be a difference in associations with daily stressors compared to traumatic events. The present study aims at examining the associations of AjD with both types of stressors as well as the mediating role of psychological well-being that was previously suggested as a buffer against mental illness. Four hundred and 19 participants completed questionnaires assessing the prevalence of daily stressors and traumatic events experienced in the last 2 years, psychological well-being and the diagnostic criteria of AjD. Results revealed a direct effect of the prevalence of daily stressors on the diagnosis of AjD as well as the mediating effect of psychological well-being of this association. However, no effect was found for traumatic events on AjD or psychological well-being. Given these findings, psychological well-being should be regarded as a means to reduce the prevalence of AjD among individuals coping with multiple and continuous daily stressors.

ICD-11 posttraumatic stress disorder, complex PTSD and adjustment disorder: the importance of stressors and traumatic life events.

Background: Although ICD-11 adjustment (AjD), posttraumatic stress (PTSD) and complex posttraumatic stress (CPTSD) are commonly diagnosed disorders following exposure to stressful or traumatic life events, their dimensional structure and co-occurrence has never been tested in a single study. The present study explored the latent structure of AjD, PTSD, and CPTSD symptoms and their relationship to stressful and traumatic life events to determine the degree of distinctiveness between these constructs.Methods: Participants were clinical patients (N = 331) who completed self-report measures of stressful and traumatic life events, AjD (The Adjustment Disorder - New Module 8 (ADNM-8)) and PTSD / CPTSD (The International Trauma Questionnaire - ITQ).Results: Using confirmatory factor analysis, a second-order model comprised of correlated latent variables of AjD, PTSD, and CPTSD provided the best fit of the data. It was also found that stressors and traumatic life events were positively associated with all of these conditions although childhood trauma was only associated with CPTSD.Conclusions: The current findings support the ICD-11 model of related-but-distinct stress-related disorders. We discuss the existence of a stress-response continuum and how the current findings impact the development of clinical interventions that may be shared across, or unique to, each stress-related disorder.

Reliability and Validity of a German Standardized Diagnostic Interview Module for ICD-11 Adjustment Disorder.

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.

Qualidade de vida e risco de depressão em idosos institucionalizados / Quality of life and risk of depression in institutionalized elderly / Calidad de vida y riesgo de depresión en personas institucionalizadas

Objetivo: verificar a prevalência de sintomas depressivos e associação com qualidade de vida em idosos institucionalizados. Métodos: estudo descritivo realizado com idosos de duas instituições de longa permanência do Paraná. Os dados foram coletados entre junho e setembro de 2018, mediante entrevista estruturada, utilizando o The World Health OrganizationQualityof Life (WHOQOL ­ bref) e a Escala de Depressão Geriátrica. Os dados foram analisados por meio de estatística descritiva e inferencial no software R. Resultados: a maioria dos idosos (62%) tinha algum grau de sintomas depressivos - leve ou severo. A qualidade de vida apresentou correlação com características sociodemográficas, condição de saúde, estilo de vida e presença de sintomas depressivos. Conclusão: a prevalência de sintomas depressivo na amostra estudada foi alta, o que indica a necessidade de maior atenção para a saúde mental de idosos residentes em instituições de longa permanência

Objective: to verify the prevalence of depressive symptoms and to evaluate the quality of life in institutionalized elderly. Methods: descriptive study carried out with elderly people from two long-term institutions in Paraná. Data were collected between June and September 2018, through a structured interview, using The World Health Organization Quality of Life (WHOQOL ­ bref ) and the Geriatric Depression Scale - GDS. The data were analyzed using descriptive and inferential statistics in the R software. Results: most of the elderly (62%) had some degree of depressive symptoms ­ mildor severe. Quality of life was correlated with sociodemographic characteristics, health condition, life style and presence of depressives ymptoms. Conclusion: the prevalence of depressive symptoms in the sample studied was high, which indicates the need for greater attention to the mental healt hof elderly people living in long-term institutions

Objetivo: verificar La prevalencia de sintomas depresivos y evaluar La calidad de vida em ancianos institucionalizados. Métodos: Estudio descriptivo realizado con personas mayores de dos instituciones de larga duración en Paraná. Los datos se recopilaron entre junio y septiembre de 2018, através de una entrevista estructurada, utilizando La Calidad de vida de La Organización Mundial de La Salud (WHOQOL) y la Escala de depresión geriátrica (GDS). Los datos se analizaron mediante estadísticas descriptivas e inferencial esen el software R. Resultados: La mayoría de losancianos (62%) tenían algún grado de sintomas depresivos, leves o graves. La calidad de vida se correlaciono com las características sociodemográficas, el estado de salud, el estilo de vida y la presencia de sintomas depresivos. Conclusión: la prevalencia de sintomas depresivos em La muestra estudiada fue alta, lo que indica La necesidad de una mayor atención a La salud mental de las personas mayores que viven em instituciones a largo plazo

Psychometric properties of the Chinese version of adjustment disorder new module-20 in breast cancer patients.

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.

Psychiatric Morbidity and Personality Characteristics of Detained Adolescents With Delinquent Behavior: A Cross-Sectional Analytical Study.

The current study was undertaken with the aim of assessing the psychopathological symptoms, personality profile, and hostility in detained adolescents with delinquent behavior. A cross-sectional analytical study was carried out on 50 admitted adolescent delinquents in correctional institutes in the Greater Cairo region of Egypt. Results for delinquent adolescents were compared with age-equivalent adolescents with no history of delinquency. Both groups were subjected to the Adolescent and Adult Psychological State Inventory, Eysenck Personality Questionnaire, Locus of Control scale, and the Hostility and Direction of Hostility Questionnaire (HDHQ). Results concluded that adolescents with delinquent behavior displayed increased rates of psychiatric disorders over the comparative group. Significantly higher scores on the psychoticism, neuroticism, extraversion, and psychopathic deviation subscales and the Locus of Control scale were evident among the adolescent delinquent group compared with their nondelinquent peers. The delinquent group obtained, in general, higher overall scores on the HDHQ questionnaire when compared with the nondelinquent adolescents, while also obtaining higher scores on the paranoid hostility subscale of HDHQ. Acting out hostility scores correlated positively with neuroticism and psychoticism in delinquents. Psychiatric morbidity, extraversion, neuroticism, psychoticism, and increased hostility were found to contribute as major psychosocial factors underlying the psychopathology in detained juvenile delinquents.

Exploring the Impact of Religion and Spirituality on Mental Health and Coping in a Group of Canadian Psychiatric Outpatients.

Research has shown that religious/spiritual (R/S) beliefs can impact mental health. In addition, individual attachment impacts R/S views and mental health. Still, clinical studies are lacking. This study explores the presence of R/S beliefs and attachment insecurity in psychiatric outpatients and the implication for mental health. Ninety psychiatric outpatients reported their R/S beliefs and were categorized into two groups: religious/spiritual (+R/S) or nonreligious/spiritual (-R/S). The groups were compared on attachment, psychiatric symptoms, religious coping, and life satisfaction. Multivariate linear regression was also performed. The +R/S group had significantly higher religious coping and lower attachment insecurity, depression severity, and social anxiety. Attachment insecurity was associated with negative religious coping. Higher attachment avoidance was associated with lower life satisfaction and higher social anxiety. Many patients in psychiatric care hold R/S views and use religious coping. Their R/S beliefs and attachment characteristics might influence each other and impact their mental illness.

Public stigma towards prolonged grief disorder: Does diagnostic labeling matter?

The recent introduction of prolonged grief disorder (PGD) as a diagnostic category may cause negative social reactions (i.e. public stigma). Vignette experiments demonstrate that persons with both PGD symptoms and a PGD diagnosis elicit more public stigma than persons who experience integrated grief. However, the strength of the influence of the diagnosis itself remains unclear: We aimed to clarify if the diagnostic label PGD produces additional public stigma beyond PGD symptoms. We further compared whether public stigma varies between the label PGD and the label major depressive episode (MDE) (when PGD symptoms are present) and if gender of the bereaved person influences public stigma or moderates the aforementioned effects. Eight-hundred fifty-two participants (77% female; Mage = 32.6 years, SD = 13.3) were randomly assigned to read online one of eight vignettes describing either a bereaved male or female, with PGD symptoms and PGD diagnosis; PGD symptoms and MDE diagnosis; PGD symptoms and no diagnosis, or no PGD symptoms and no diagnosis (i.e., integrated grief). Following the vignettes, participants indicated which negative characteristics they ascribed to the person, their emotional reactions, and preferred social distance from the person. People with PGD symptoms and PGD (or MDE) diagnosis were attributed more negative characteristics, and elicited more negative emotions and a stronger desire for social distance than people with integrated grief. However, public stigma did not differ for people with both PGD symptoms and diagnosis compared to people only experiencing PGD symptoms. Gender of the bereaved only had an influence on desired social distance, which was larger towards men. Helping severely distressed bereaved people (regardless of diagnostic status) cope with negative social reactions may help them adapt to bereavement. Results demonstrate that the experience of severe grief reactions, yet not a diagnostic label per se, causes public stigma.