Effectiveness and mediators of change of an online CBT intervention for students with adjustment disorder-study protocol for a randomized controlled trial.

BACKGROUND: Adjustment problems and disorders are highly prevalent among university students worldwide. These problems can cause significant interference in academic and social functioning and increase vulnerability to other mental health disorders. Unfortunately, only half of students in need receive psychological help. Furthermore, few studies have evaluated psychological interventions for adjustment disorders in students. New, more scalable forms of treatment for students with an adjustment disorder need to be developed, evaluated, and implemented. The study aims to determine the effectiveness of an online transdiagnostic cognitive behavioural intervention for students experiencing adjustment disorder and to assess mediators of change. METHOD/DESIGN: In this three-arm randomized controlled trial, we plan to recruit 214 Polish students diagnosed with an adjustment disorder. Participants who meet initial eligibility criteria will be randomly assigned to one of three 6-week conditions: (1) online cognitive behavioural therapy intervention based on an existing, empirically supported transdiagnostic protocol, the unified protocol; (2) online progressive muscle relaxation training as an active control group; or (3) waiting-list control group. Both interventions are asynchronous, interactive, and include minimal amount of therapist support. Assessments will consist of self-report questionnaires, daily diary measures, and neurocognitive tasks for evaluating cognitive functioning. These will be conducted at baseline, post-treatment, and 1-month follow-up. Daily diary measures will be taken during the first and last week of treatment (or waitlist period). Primary outcome measures will include adjustment disorder severity; secondary outcome measures will consist of other negative (psychopathology: depression, anxiety, and stress) and positive (life satisfaction) indexes of mental health as well as process measures (e.g. mindfulness, experiential avoidance, cognitive fusion). DISCUSSION: To our knowledge, the current study is the first to evaluate the effectiveness of a psychological intervention for students with adjustment disorder. Therefore, it may have important practical implications for students with this disorder. It can potentially guide the development of a scalable, validated treatment option. TRIAL REGISTRATION: Clinical Trials, NCT05768308, registered 14 March 2023, https://www. CLINICALTRIALS: gov/ct2/show/NCT05768308.

Trastornos adaptativos y su manejo desde atención primaria / Adaptive disorders and their management in primary care

Introducción: El trastorno de adaptación describe una respuesta emocional y conductual desproporcionada a uno o más estresores psicosociales identificables. Existen múltiples situaciones capaces de generarnos una situación de estrés agudo. Sin embargo, uno de los requisitos necesarios para poder hablar de trastorno adaptativo es que ese o esos factores estresantes supongan un deterioro en el funcionamiento normal del individuo. Objetivos: El objetivo principal de este trabajo es analizar, mediante una revisión bibliográfica, el diagnóstico y abordaje de los trastornos adaptativos dentro del ámbito de Atención Primaria. El objetivo secundario es destacar la importancia de la detección y el tratamiento precoces, así como de la gestión multidisciplinar y la promoción de la salud mental. Resultados: Los principales factores de riesgo de los trastornos adaptativos son el desempleo, los bajos ingresos,el escaso apoyo social, las enfermedades físicas y la salud mental. La prevalencia es mayor en jóvenes,especialmente entre las mujeres, y existe un riesgo aumentado de suicidio en el subtipo de estado de ánimo depresivo. El Cuestionario Internacional de Trastornos Adaptativos es actualmente la principal herramienta diagnóstica, por establecer sus criterios diagnósticos en base a la definición teórica establecida por la CIE-11. El manejo de estos trastornos se realiza principalmente mediante terapia cognitivo-conductual. Conclusiones: Los trastornos de adaptación surgen como respuestas anormales ante ciertas situaciones estresantes. El papel de los médicos de Atención Primaria en el abordaje de este trastorno es primordial, siendo necesaria su detección y manejo precoz para disminuir los niveles de ansiedad disfuncionales que presentan los pacientes.(AU)

Introduction: Adjustment disorder describes a disproportionate emotional and behavioral response to one or more identifiable psychosocial stressors. There are multiple situations capable of generating an acute stressful situation. However, one of the requirements to be able to speak of an adaptive disorder is that the stressor(s) in question should lead to an impairment of the individual's normal functioning.Objectives: The main objective of this work is to analyze , through a literature review, the diagnosis and approach to the diagnosis and management of adaptive disorders in the Primary Care setting. The secondary objective is toemphasize the importance of early detection and treatment, as well as multidisciplinary management and mentalhealth promotion. Results: The main risk factors for adjustment disorders are unemployment, low income, low social support, physical illness, and personal history of mental health. The International Questionnaire of Adaptive Disorders is currently the principal diagnostic tool, as it establishes its diagnostic criteria based on the theoretical definition established by the ICD-11. The management of these disorders is mainly through cognitive behavioural therapy.Conclusions: Adjustment disorders arise as abnormal responses to certain stressful situations. The role of primary care physicians in dealing with this disorder is essential, and early detection and management are necessary to reduce the levels of dysfunctional anxiety that patients present.(AU)

ICD-11 adjustment disorder following diagnostic procedures of prostate cancer: A 12-month follow-up study.

OBJECTIVE: The medical procedures in diagnosing or treating prostate cancer may impair adjustment and quality of life. The current prospective study aimed to evaluate the trajectories of symptoms of ICD-11 adjustment disorder in patients diagnosed vs. non-diagnosed with prostate cancer before (T1), after diagnostic procedures (T2), and at 12-month follow-up (3). METHODS: In total, 96 male patients were recruited before prostate cancer diagnostic procedures. The mean age of the study participants at baseline was 63.5 (SD = 8.4), ranging from 47 to 80 years; 64% were diagnosed with prostate cancer. Adjustment disorder symptoms were measured using the Brief Adjustment Disorder Measure (ADNM-8). RESULTS: The prevalence of ICD-11 adjustment disorder was 15% at T1, 13% at T2, and 3% at T3. The effect of cancer diagnosis was not significant on adjustment disorder. A medium main effect for time was detected on adjustment symptom severity, F(2, 134) = 19.26, p < .001, partial η2 = 0.223, with symptoms significantly lower at 12-month follow-up, compared to T1 and T2, p < .001. CONCLUSIONS: The study's findings reveal the increased levels of adjustment difficulties in males undergoing the diagnostic process of prostate cancer.

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.

Diagnostic and functional outcomes of adjustment disorder in U.S. active duty service members.

BACKGROUND: Adjustment disorder (AD) is a commonly diagnosed psychiatric disorder. However, little is known about its course, predictors of its diagnostic outcomes, or its association with functional impairment. Our primary aim was to examine diagnostic transitions of service members with an incident AD diagnosis (IADx) to one of three states: 1) another psychiatric diagnosis, 2) chronic AD, or 3) no psychiatric diagnosis. Secondary outcomes included predictors of diagnostic course and functional outcomes associated with follow-up diagnoses. METHODS: Health records of a random sample of 10,720 service members with an IADx were analyzed using multinomial logit regression and hazard rate model with competing risks. RESULTS: IADx transitions were 24.3 % to another psychiatric diagnosis, 8.9 % with chronic AD, and 43.7 % without a diagnosis. Nearly a quarter (23.1 %) separated from service. Deployment was the strongest predictor of transitioning to another diagnosis. Those who transitioned to another diagnosis separated at an increased rate and with more adverse outcomes. LIMITATIONS: Diagnostic findings are based on data in the electronic health record, and we could not specifically identify the stressor that precipitated an AD diagnosis. These findings describe the course of AD in military personnel and may not generalize to civilians. CONCLUSIONS: AD, as initially diagnosed, represents a heterogeneous disorder with an enduring impact across the military career for a considerable proportion of service members. As an early indicator of more severe psychiatric outcomes, an IADx may signal an opportunity for early intervention and screening, particularly in service members with a history of deployment.

Outcomes and prognosis of adjustment disorder in adults: A systematic review.

Adjustment disorder (AD) is one of the most commonly diagnosed mental health disorders and is generally conceptualized to be mild and short-lived. Despite the frequent use of AD in clinical settings, little is known about the prognosis of this condition. Our goal was to systematically review research on a range of AD outcomes in order to provide a broad characterization of AD prognosis. We conducted searches in MEDLINE, EMBASE, and PsycINFO. We included 31 cohort or randomized controlled trials with a total of 1,385,358 participants. Many patients maintained an AD diagnosis or were diagnosed with another mental health disorder months to years after initial diagnosis. Patients with AD tended to show symptom improvement at higher rates and to utilize less treatment than did patients with other disorders. AD-diagnosed groups experienced subsequent development of numerous physical conditions, such as infection, cancers, Parkinson's disease, and cardiovascular events, at higher rates than did control groups. Results were mixed regarding suicidality and occupational impairment. We rated most studies as having a moderate risk of bias. Based on limited findings, AD appears to progress as a milder disorder than do other disorders, but it not uncommonly transitions to more severe mental health states and may predict the development of future health issues, both mental and physical. Future prospective research that conforms to prognosis study guidelines is needed to better understand the course of this common disorder.

The network structure of ICD-11 adjustment disorder: A comparison of clinical and nonclinical samples.

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.

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.

PTSD is not the emblematic disorder of the COVID-19 pandemic; adjustment disorder is.

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.

The Network Structure of ICD-11 Disorders Specifically Associated with Stress: Adjustment Disorder, Prolonged Grief Disorder, Posttraumatic Stress Disorder, and Complex Posttraumatic Stress Disorder.

INTRODUCTION: The ICD-11 includes a new grouping for "disorders specifically associated with stress" that contains revised descriptions of posttraumatic stress disorder (PTSD) and adjustment disorder (AjD) and new diagnoses in the form of complex PTSD (CPTSD) and prolonged grief disorder (PGD). These disorders are similar in that they each require a life event for the diagnosis; however, they have not yet been assessed together for validity within the same sample. We set out to test the distinctiveness of the four main ICD-11 stress disorders using a network analysis approach. METHODS: A population-based, cross-sectional design. A nationally representative sample of adults from the Republic of Ireland aged 18 years and older (N = 1,020) completed standardized measures of PTSD, CPTSD, AjD, and PGD. A network analysis was conducted at the symptom level. Outcome measures included the International Trauma Questionnaire, the Inventory of Complicated Grief, and the International Adjustment Disorder Questionnaire. RESULTS: Consistent with the taxonomic structure of the ICD-11, our results showed that although the four conditions clustered independently at the disorder level, the specific symptoms of PTSD, CPTSD, PGD, and AjD clustered together very strongly but more strongly than with symptoms of the other disorders. The majority (61%) of the variation in each symptom could be explained by its neighboring symptoms. The strongest transdiagnostically connecting symptom was "startle response." DISCUSSION/CONCLUSION: Mental health professionals caring for people who have experienced a range of stressors and traumatic life events can be confident in diagnosing these conditions that have clear diagnostic boundaries. Interventions addressing stress-associated disorders should be based on diagnostic assessment to ensure close fit between symptoms and treatment.

Systematic review and meta-analysis of predictors of adjustment disorders in adults.

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.

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.

Psychiatric disorders among children with acute lymphoblastic leukemia in South Korea: a nationwide population-based longitudinal study.

OBJECTIVE: Children with acute lymphoblastic leukemia (ALL) may be at increased risk of psychiatric disorders. This study analyzed the incidence of psychiatric disorders in children with ALL in South Korea. METHODS: Using nationwide claims data for January 2009 to March 2016, we identified three major psychiatric disorders (depression, anxiety and stress/adjustment disorder) among children diagnosed with ALL. We analyzed the incidence of psychiatric disorders before and after ALL diagnosis. RESULTS: Overall, 2160 children diagnosed with ALL were identified. Seventy-five children (3.5%) were diagnosed with at least one major psychiatric disorder from 1 year before ALL diagnosis to the last follow-up point (range: 42.5-111.5 months). Of these, 70 (93.3%) patients were identified after ALL diagnosis, with the incidence peaking 1 year after ALL diagnosis. Depression, anxiety and stress/adjustment disorders were diagnosed in 30 (1.4%), 15 (0.7%) and 30 (1.4%) patients, respectively. CONCLUSIONS: Among pediatric patients with ALL, most psychiatric disorders were identified after the diagnosis of leukemia, and psychiatric disorder incidence differed according to patient age and time since ALL diagnosis. Timely screening for and proper management of mental disorders are needed during all stages of ALL treatment.

Adjustment disorders: A research gaps analysis.

Adjustment disorders are among the most commonly diagnosed mental health disorders in both civilian and military clinical settings. Despite their high prevalence, adjustment disorders have received little research attention. The many gaps in our understanding of this group of disorders hinder the development of adequate, evidence-based treatment protocols. This study utilizes a systematic methodology to identify and prioritize research gaps in adjustment disorders. We used authoritative source reports to identify gaps in research domains from foundational science to services research. Subject-matter experts conducted literature searches to substantiate and refine research gaps, and stakeholders assessed the importance and impact of this work for researchers and policy-makers. We identified 254 possible research-needs statements, which were ultimately reduced to 11 final, prioritized research gaps. Two gaps addressed prevention and screening and three addressed treatment and services research. Six gaps addressed foundational science, epidemiology, and etiology research domains, highlighting the need for basic research. Until some of the basic science questions are resolved (e.g., diagnostic clarity, valid screening, and assessment measures) about adjustment disorders, we may not be able to develop adequate evidence-based interventions for the disorders, and it will be difficult to understand the trajectory of these disorders throughout treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Preoccupation as psychopathological process and symptom in adjustment disorder: A scoping review.

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.

Duelo complicado: Una revisión sistemática de la prevalencia, diagnóstico, factores de riesgo y de protección en población adulta de España / Complicated grief: A systematic review of the prevalence, diagnosis, risk and protective factors in the adult population of Spain

El objetivo principal de este trabajo fue revisar el estado de la investigación psicopatológica del duelo complicado en población adulta de España. Una búsqueda sistemática en PsycINFO, PsycArticles, PTSDpubs y PSICODOC identificó 13 estudios en los que, en conjunto, se había evaluado a 1,655 adultos. Los resultados de esta revisión ponen de manifiesto que no existe consenso en el diagnóstico de duelo complicado, en el uso de instrumentos de detección ni en los factores de riesgo y protección del duelo complicado. La prevalencia media ponderada basada en 6 de los estudios revisados fue de 21,53%. Tomando en consideración el tipo de instrumento de medida del duelo utilizado, se obtuvo una prevalencia de 7,67-10,68% en aquellos estudios que utilizaban instrumentos diagnósticos y de 28,77% en los instrumentos sintomáticos. Los resultados indican que el duelo complicado se relaciona con: un menor nivel socioeconómico y situación laboral desfavorable, la pérdida de un hijo o cónyuge, menor edad del fallecido, vulnerabilidad psicológica previa, consumo de psicofármacos y comorbilidad con otros trastornos. El apoyo social, los cuidados paliativos, las estrategias de afrontamiento centradas en el problema, el empleo de actividades agradables y la trascendencia o espiritualidad se presentan como factores protectores

The main objective of this research was to review the status of the psychopathological research of complicated grief in adult population of Spain, specifically the prevalence and risk factors. A systematic review of PsycINFO, PsycArticles, PTSDpubs, and PSICODOC databases identified 12 studies in which, overall, 1.627 adults had been evaluated. The results of this review show that there is no consensus about the diagnosis of complicated grief, the use of detection instruments, or the risk and protective factors for complicated grief. The weighted mean prevalence based on 6 of the reviewed studies was 21.53%. Taking into account the type of grief measurement used, a prevalence of 7.67 - 10.68% was obtained in those studies that used diagnostic instruments, and 28.77% in those using symptomatic instruments. The results indicate that complicated grief is related to: a lower socioeconomic level and unfavorable work situation, the loss of a child or spouse, younger age of the deceased, previous psychological vulnerability, the use of psychotropic medication, and comorbidity with other disorders. Social support, palliative care, problem-centered coping strategies, the use of pleasant activities, and transcendence or spirituality are shown as protective factors

[Symptoms of Adjustment Disorder after an accidental injury: risk and protective factors]. / Symptome einer Anpassungsstörung nach einer Unfallverletzung: Risiko- und Schutzfaktoren.

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 (ß = -.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.

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

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.

Characteristics and outcomes of COVID-19 inpatients who underwent psychiatric consultations.

Patients hospitalized with COVID-19 are at risk of developing many neuropsychiatric disorders, due to the effects of the disease on the brain and the psychosocial pressures of having the disease. The aim of the present study was to evaluate the characteristics and outcomes of patients who were hospitalized with a diagnosis of COVID-19, who underwent psychiatric consultations. The medical records of 892 patients hospitalized due to COVID-19 and the 89 among them who requested psychiatric consultations were analyzed retrospectively. After the psychiatric consultations, patients were most frequently diagnosed with delirium (38.2 %), adjustment disorder (27.0 %), depressive disorder (19.1 %) and anxiety disorder (11.2 %). Patients with delirium had longer hospital stays (p < 0.001), were transferred more frequently to intensive care units (p < 0.001), and had higher mortality rates during their hospital stays (p < 0.001), than all other patients. The need for oxygen (p < 0.001) and mechanical ventilation (p < 0.001) was also significantly higher in delirium patients, as well as in patients who received other psychiatric diagnoses. Neuropsychiatric disorders develop in patients receiving inpatient treatments in COVID-19 wards, and these disorders negatively affect the prognosis of COVID-19. Our findings suggest that the presence of neuropsychiatric disorders in in-patients with COVID-19 might be associated with the negative outcomes of the disease.

Network structure of ICD-11 adjustment disorder: a cross-cultural comparison of three African countries.

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.