Outcome for adjustment disorder with depressed mood: comparison with other mood disorders

doi:10.1016/S0165-0327(98)00202-X

Journal of Affective Disorders

Volume 55, Issue 1, September 1999, Pages 55-61

https://doi.org/10.1016/S0165-0327(98)00202-X Get rights and content

Abstract

Background: A review of the research literature on the diagnostic category of adjustment disorder indicates that its construct validity has not been established. Nevertheless, the diagnosis is made frequently, with an estimated incidence of 5–21% in psychiatric consultation services for adults. Methods: Retrospective data was used to evaluate the construct validity of the adjustment disorder diagnostic category. The data primarily consisted of SF-36 Health Status Survey responses by a large group of adult psychiatric outpatients before treatment and again six months after beginning treatment. Subjects were divided into five diagnostic groups, and MANOVA, MANCOVA and chi square were used to clarify relationships among diagnoses, sociodemographic data and SF-36 scores. Results: Diagnostic categories were significantly different at baseline, but did not differ in terms of outcome at six-months follow-up. There was a significant gender difference at baseline and a significant difference in gender distribution across diagnostic categories. Limitations: Structured interviews were not used for initial diagnoses, nor is there an estimate of the reliability of diagnoses among the clinicians. The patient attrition rate for six-months follow-up data was about 50%. Finally, patients received individualized treatment, with some patients receiving both medication and psychotherapy. Conclusions: Female patients were significantly more likely to be diagnosed with major depression or dysthymia than with an adjustment disorder. Females were also more likely than males to score lower on the mental health related scales of the SF-36 at admission. Patients diagnosed with an adjustment disorder scored higher on all SF-36 scales than did the other diagnostic groups at baseline and again at follow-up. There was no significant difference among diagnostic groups with regard to treatment outcome, suggesting that the adjustment disorder group can benefit as much as the other groups from treatment.

Section snippets

Methods, subject selection

Beginning in the latter part of 1995, adults seeking treatment at the Laureate Outpatient Psychiatric Clinic in Tulsa, Oklahoma were asked to participate in a quality assurance program which consisted of completion of a baseline SF-36 (cf. below) and a follow-up SF-36 at six months after admission. For administrative reasons, not all patients were approached, and of course not all patients agreed to participate. However, we have no evidence of a selection bias in the kinds of patients who were

Measures

The primary psychometric measure for this study was the 36-item Short-Form Health Status Survey (SF-36). This survey is a self-report measure that was adapted from the Medical Outcomes Study long-form measure. This measure is considered a measure of health status and functioning, well being and quality of life. The SF-36 contains eight multi-item subscales including: social functioning, emotional well-being, role limitation due to emotional health problems, energy or fatigue, physical

Statistical analysis

In order to detect possible differences between patients who completed six-month follow-up questionnaires and those who did not, a discriminate analysis was performed on the following variables: gender, age, marital status, employment status, and admission scores on the PCS and MCS. Employment status was coded as a dichotomous variable, either employed or unemployed. Marital status was re-coded into two dichotomous variables, the first as married vs. not married, and the second as divorced or

Results

The discriminate analysis resulted in statistically significant differences between patients who completed the six-month follow-up and those who did not on two of the variables: age and MCS. At baseline, patients' average score on the MCS was 24.99 and their average age was 37.90; at follow-up the average score on the MCS was 23.16 and the average age was 38.93. The MANOVA on the eight SF-36 scales at baseline indicated that the five diagnostic categories were significantly different (P<0.001).

Conclusions

The SF-36 data at baseline and at the six-month follow-up both support the separate construct validity of the adjustment disorder diagnostic category. Both MANOVAS were significant (P<0.001), and in both analyses, deviation contrasts indicated that the adjustment disorder group scores were significantly different (P<0.05) from the overall mean for all five categories. Furthermore, the results of the MANCOVA indicating that there were no differences in six-month outcome scores among the five

References (23)

J.N Despland et al.
Clinical relevance of adjustment disorder in DSM-III-R and DSM-IV
Comprehensive Psychiatry
(1995)
D.P Cantwell et al.
Stability and natural history of DSM-III childhood diagnoses
J. Am. Acad. Child Adolesc. Psychiatry
(1989)
J.H Newcorn et al.
Adjustment disorder in children and adolescents
J. Am. Acad. Child Adolesc. Psychiatry
(1992)
S Snyder et al.
Differentiating major depression from adjustment disorder with depressed mood in the medical setting
Gen. Hosp. Psychiatry
(1990)
M Kovacs et al.
Criterion and predictive validity of the diagnosis of adjustment disorder: A prospective study of youths with new-onset insulin-dependent diabetes mellitus
Am. J. Psychiatry
(1995)
N.C Andreasen et al.
Adjustment disorders in adolescents and adults
Arch. Gen. Psychiatry
(1980)
N.C Andreasen et al.
The predictive value of adjustment disorders: A follow-up study
Am. J. Psychiatry
(1982)
H Fabrega et al.
Adjustment disorder as a marginal or transitional illness category in DSM-III
Arch. Gen. Psychiatry
(1987)
M Kovacs et al.
A controlled prospective study of DSM-III adjustment disorder in childhood: Short-term prognosis and long-term predictive validity
Arch. Gen. Psychiatry
(1994)
H Fabrega et al.
Descriptive validity of DSM-III depressions
J. Nerv. Ment. Dis.
(1986)

J.G Looney et al.

Transient situational disturbances: Course and outcome

Am. J. Psychiatry

(1978)

Cited by (58)

Adjustment disorders. Grief
2023, Medicine (Spain)
Los trastornos adaptativos constituyen un diagnóstico fronterizo que ofrece importantes dudas en cuanto al diagnóstico y abordaje por parte de los profesionales sanitarios. Mención aparte merece el duelo como fenómeno con reciente entidad diagnóstica, ya que, aun guardando relación con los trastornos adaptativos y pudiendo conceptualizar la pérdida como posible factor estresante, pueden darse complicaciones particulares en el proceso de elaboración que requieren un abordaje específico.
Adjustment disorders are a borderline diagnosis that raises important questions in regard to its diagnosis and approach by healthcare professionals. Grief merits special mention as a new diagnosis given that, even though it is related to adjustment disorders and loss can be understood as a possible stressor, it can entail particular complications that require a specific approach.
Outcomes and prognosis of adjustment disorder in adults: A systematic review
2022, Journal of Psychiatric Research
Citation Excerpt :
AD participants in experimental groups (yoga meditation) improved more in measures of global functioning, clinical global severity, and clinical global improvement than did those in the control (general counselling) conditions (Srivastava et al., 2011). Following treatment, AD and depressive disorder participants exhibited similar levels of improvement in mental functioning and lack of improvement in physical functioning (Jones et al., 1999). More than half of cancer patients with AD had clinical global improvement of at least much improved in response to MH treatment (Shimizu et al., 2011).
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.
Remission factors of adjustment disorders: The patients’ view. A qualitative study
2018, Annales Medico-Psychologiques
Le trouble d’adaptation (TA) est défini par une dimension réactionnelle du sujet à un facteur externe et sa réversibilité, raisons pour lesquelles les facteurs de rémission du TA sont particulièrement intéressants à étudier.
Des entretiens ont été menés avec des patients diagnostiqués d’un TA, ayant évolué favorablement. L’analyse des entretiens permettait d’identifier et catégoriser des facteurs rapportés.
Nous avons identifié : (i) les facteurs relationnels (46 items), (ii) les facteurs personnels (36 items) et (iii) les facteurs liés à des évènements externes (19 items). Aucun patient ne rapportait des facteurs d’une seule catégorie.
La rémission du TA est un processus complexe, composé des éléments de différentes catégories, notamment relationnelles, interagissant de manière complexe, et dont nous avons pu construire une grille de réflexion.
Adjustment disorder (AD) is a frequent clinical diagnosis defined by the patient's reaction to an external factor and reversibility. While it is known that the prevalence of AD varies depending on setting and diagnostic tools utilized, the literature is rather scarce when it comes to AD's investigation or remission factors. Unlike other psychiatric disorders, the fact that there is a factor triggering AD makes it especially suitable to learn more about triggering elements, reversibility and factors of remission.
To study the evolution of AD, to identify and categorize AD remission factors from the patient's perspective.
We interviewed by means of semi-structured approach patients (n = 11) who consulted the emergency and crisis psychiatric unit of Lausanne University Hospital (CHUV) for an AD and who presented a positive evolution in the following four months. Interviews were transcribed and then analyzed to identify and categorize the remission factors evoked by the patients; categorization was then confirmed by a consensus within the research group.
We identified three main categories of remission factors (aggregated from 11 subcategories and 101 items) based on the interviews: (i) relational factors (5 subcategories, 46 items), (ii) personal factors (5 subcategories, 36 items) and (iii) factors related to life events (3 subcategories, 19 items). No patient explained his remission by factors of one single category. On the contrary, our study reveals that a variety of remission factors exists, with 4 to 14 different factors having been reported to play a crucial role in remission of AD.
Relationships play an important role in remission of AD, but personal and life events also contribute in a complex way. According to the patients, mental health professionals are part of a favorable evolution of AD, especially by means of their containing presence, their neutrality and their invitation to “think with the patient”. Our observations call for a therapeutic intervention with a particular focus on the therapeutic relationship – therapeutic alliance – in which the clinician is aware that remission of AD is multifactorial and dynamic.
Adjustment disorder: Prevalence, sociodemographic risk factors, and its subtypes in outpatient psychiatric clinic
2017, Asian Journal of Psychiatry
Citation Excerpt :
It lies within the range (5–20%) which reported by (American Psychiatric Association, 2000) and the range (10–30%) which stated by (Sadock et al., 2015). A similar range was pointed out in (Jones et al., 1999) study (5–21%). The result too, is very close to the range reported in (Bisson and Sakhuja, 2006) study (12–23%).
This study aims at assessing the prevalence and risk factors of Adjustment disorder (AD), the AD subtypes, and the common causing stressors.
A cross sectional study was conducted at outpatient psychiatric clinic in Duhok City from July 2008 to July 2009. 637 patients equal and above 18 of both genders were selected randomly. SCID-I/P (Version 2.0) was adopted to diagnose patients with AD. SPSS (version 21), was used for data analysis.
The study showed that the prevalence of AD was 11.5%. It was more common among youngest age group (15–25 years) with a rate 69.9% (p = 0.001) while lowest educational level (illiterate and primary) 53.5% (p = 0.040), single 54.8% (p < 0.001), students 39.7 (p < 0.001) and from urban areas 71.2% (p = 0.012) with statistically significant association. Although AD was more common among females (61.6%), no significant association was found between AD and gender (p = 0.380). The most common subtype of AD was AD with mixed anxiety and depressed mood (34.2%) and was the commonest among females (19.2%) followed by AD with Anxiety subtype 30.1% which was the commonest among males (13.7%). The commonest psychosocial stressor was the illnesses (28.8%) followed by love affairs (26%) and domestic problems (16.4%).
The prevalence of AD was found to be high. The risk factors included young, low educational level, single, students, and those from urban areas. The most common subtype was AD with mixed anxiety and depressed mood and the commonest psychosocial stressor was the illnesses followed by love affairs and domestic problems.
Adjustment disorder and DSM-5: A review
2017, Encephale
Le trouble de l’adaptation est considéré comme un trouble secondaire et invisible selon certains cliniciens. La méconnaissance de la symptomatologie, sa proximité avec le syndrome dépressif ou anxieux et le diagnostic d’exclusion évoqué au sein du DSM-IV permettent d’expliquer ce relatif désintérêt de la part des médecins. Cet article vise, d’une part, à rendre compte des spécificités de ce trouble après avoir parcouru la littérature et, d’autre part, à faire apparaître les premières réactions liées à la nouvelle catégorisation proposée par le DSM-5. Un diagnostic de trouble de l’adaptation bien posé permet un traitement (psychothérapie) adapté et une revalidation rapide.
This paper exposes the complexity and discrete characteristic of the adjustment disorder with reference to its clinical and scientific diagnosis. Even though the disorder occurs in frequent clinical circumstances after important life events, such as mobbing, burn-out, unemployment, divorce or separation, pregnancy denial, surgical operation or cancer, the adjustment disorder is often not considered in the diagnosis since better known disorders with similar symptoms prevail, such as major depression and anxiety disorder. Ten years ago, Bottéro had already noticed that the adjustment disorder diagnosis remained rather uncommon with reference to patients he was working with while Langlois assimilated this disorder with an invisible diagnosis.
In order to maximize the data collection, we used the article review below and challenged their surveys and results: National Center for Biotechnology Information (NBCI – Pubmed) for international articles and Cairn.info for French literature. Moreover, we targeted the following keywords on the search engine and used articles, which had been published from 1 February 1975 to 31 January 2015: “adjustment”, “adjustment disorder” and the French translation “trouble de l’adaptation”.
One hundred and ninety-one articles matched our search criteria. However, after a closer analysis, solely 105 articles were selected as being of interest. Many articles were excluded since they were related to non-psychiatric fields induced by the term “adaptation”. Indeed, the number of corresponding articles found for the adjustment disorder literally pointed-out the lack of existing literature on that topic in comparison to more known disorders such as anxiety disorder (2661 articles) or major depression (5481 articles). This represents up to 50 times more articles in comparison to the number of articles we found on adjustment disorder and up to 20 times more articles for the eating disorder (1994), although the prevalence is not significantly higher than for the adjustment disorder. According to their relevance and their content, we have split the articles into seven subcategories: 1. General description: most scientific articles generally describe the adjustment disorder as being a transition diagnosis, which is ambiguous, marginal and difficult to detect. The findings claim that only a few studies have been conducted on the adjustment disorder despite a high prevalence in the general population and in the clinical field. 2. Classification: the DSM-5 defined the adjustment disorder as a set of different outcomes and syndromes induced by stress after a difficult life event. While the link to other disorders has not been mentioned, the diagnosis of this disorder is no longer excluded or perceived as a secondary diagnosis. The DSM-5 faced criticism from three points of view: the operationalization of the concept of stress, the differential diagnosis and the description. 3. Prevalence: different samples have shown a significantly high prevalence of the adjustment disorder within the population. In addition to the psychiatric pain induced by difficult life events we need to emphasize the fact that 12.5 to 19.4 percent of the patients faced heavy and severe pathologies and depended on clinical care and treatment. 4. Etiology, comorbidity or associated symptomatology: the literature identified the tendency to commit suicide and stressful life events as being two fundamental characteristics of adjustment disorder. The third one is the personality profile. 5. Differential diagnosis: that motivates researchers to focus on the adjustment disorder: the differentiation approach as to the major depression. Indeed, the aetiology, the symptomatology and the treatment differ from the adjustment disorder. 6. Assessment: very recently, Dutch researchers have developed and validated the Diagnostic Interview Adjustment Disorder (DIAD). 7. Treatment: in 2014, no data or meta-analysis recommended drug treatment in addition to therapy. In fact, several authors have demonstrated the ineffectiveness of drug therapy. The literature suggests a psychotherapeutic approach to treat adjustment disorder.
Emotional reactions triggered by life events are responsible for full therapy agendas and for the rush in emergency rooms and hospitals. The reflex when faced with crying, insomnia or suicidal thoughts to give a diagnostic of major depressive disorder s is generally accepted by everyone. The elevated risk to commit suicide and the approved success of remission or healing through treatment (psychotherapy) are two major reasons why several studies promote the importance and the need to identify the adjustment disorder of our patients.
A Preliminary Assessment of Adjustment Disorder Among First-Year College Students
2009, Archives of Psychiatric Nursing
Using Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (American Psychiatric Association, 2000) criteria, we investigated whether the diagnosis adjustment disorder (AD) described first-year college students' adjustment problems. We found that a substantial portion of students experienced a set of adjustment symptoms meeting the AD criteria. Another portion of students reported adjustment concerns that were problematic but did not meet the AD diagnosis threshold. Female students tended to report more symptoms than do male students. College counseling implications are presented.

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Journal of Affective Disorders

Abstract

Section snippets

Methods, subject selection

Measures

Statistical analysis

Results

Conclusions

References (23)

Clinical relevance of adjustment disorder in DSM-III-R and DSM-IV

Comprehensive Psychiatry

Stability and natural history of DSM-III childhood diagnoses

J. Am. Acad. Child Adolesc. Psychiatry

Adjustment disorder in children and adolescents

J. Am. Acad. Child Adolesc. Psychiatry

Differentiating major depression from adjustment disorder with depressed mood in the medical setting

Gen. Hosp. Psychiatry

Criterion and predictive validity of the diagnosis of adjustment disorder: A prospective study of youths with new-onset insulin-dependent diabetes mellitus

Am. J. Psychiatry

Adjustment disorders in adolescents and adults

Arch. Gen. Psychiatry

The predictive value of adjustment disorders: A follow-up study

Am. J. Psychiatry

Adjustment disorder as a marginal or transitional illness category in DSM-III

Arch. Gen. Psychiatry

A controlled prospective study of DSM-III adjustment disorder in childhood: Short-term prognosis and long-term predictive validity

Arch. Gen. Psychiatry

Descriptive validity of DSM-III depressions

J. Nerv. Ment. Dis.

Transient situational disturbances: Course and outcome

Am. J. Psychiatry

Cited by (58)

Adjustment disorders. Grief

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

Remission factors of adjustment disorders: The patients’ view. A qualitative study

Adjustment disorder: Prevalence, sociodemographic risk factors, and its subtypes in outpatient psychiatric clinic

Adjustment disorder and DSM-5: A review

A Preliminary Assessment of Adjustment Disorder Among First-Year College Students

Brief reportOutcome for adjustment disorder with depressed mood: comparison with other mood disorders

Abstract

Section snippets

Methods, subject selection

Measures

Statistical analysis

Results

Conclusions

Comprehensive Psychiatry

J. Am. Acad. Child Adolesc. Psychiatry

J. Am. Acad. Child Adolesc. Psychiatry

Gen. Hosp. Psychiatry

Criterion and predictive validity of the diagnosis of adjustment disorder: A prospective study of youths with new-onset insulin-dependent diabetes mellitus

Am. J. Psychiatry

Adjustment disorders in adolescents and adults

Arch. Gen. Psychiatry

The predictive value of adjustment disorders: A follow-up study

Am. J. Psychiatry

Adjustment disorder as a marginal or transitional illness category in DSM-III

Arch. Gen. Psychiatry

A controlled prospective study of DSM-III adjustment disorder in childhood: Short-term prognosis and long-term predictive validity

Arch. Gen. Psychiatry

Descriptive validity of DSM-III depressions

J. Nerv. Ment. Dis.

Transient situational disturbances: Course and outcome

Am. J. Psychiatry

Brief report
Outcome for adjustment disorder with depressed mood: comparison with other mood disorders