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

ABSTRACT

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.

HIGHLIGHTS

• 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.

Antecedentes: La pandemia por COVID-19 fue causa de múltiples factores estresantes que puedan haber condicionado un trastorno de adaptación.

Objetivo: Se evaluó de forma longitudinal la relación entre factores protectores y factores de riesgo, factores estresantes asociados a la pandemia y síntomas del trastorno de adaptación durante la pandemia por COVID-19. Además, se evaluó si estas relaciones variaban según la temporalidad de la evaluación.

Métodos: El estudio ADJUST de la Sociedad Europea para el Estudio de Estrés Traumático incluyó a N = 15.169 participantes de 18 años o más. Se reclutó a participantes de 11 países europeos y fueron evaluados tres veces en intervalos de 6 meses desde junio del 2020 hasta enero del 2022. Las asociaciones entre los factores protectores (e. g. género) y de riesgo, los factores estresantes (e. g. miedo a contagiarse), los síntomas del trastorno de adaptación (AjD por sus siglas en inglés; empleando el Cuestionario para el Trastorno de Adaptación – Nuevo Módulo 8 o ADNM-8 por sus siglas en inglés) y sus interacciones según la temporalidad de la evaluación fueron analizados mediante una regresión linear mixta.

Resultados: Se asociaron con niveles significativamente mayores de síntomas del AjD los siguientes: género femenino o diverso; edad avanzada; consumo de noticias relacionadas con la pandemia mayor a 30 minutos al día; trastorno mental actual o previo; exposición a trauma antes o durante la pandemia; estado de salud bueno, satisfactorio o pobre (en comparación con uno muy bueno); carga asociada al manejo y comunicación gubernamentales de la crisis; miedo a infectarse; contacto social restringido; problemas laborales; actividad restringida; y dificultades asociadas a la vivienda. Se asociaron con menores niveles de síntomas del AjD los predictores siguientes: trabajo autónomo o condición de jubilado; trabajo en el sector salud; contacto en persona más de una vez por semana con amigos o seres queridos. Los efectos sobre los niveles de los síntomas del AjD que cambiaron según la temporalidad de la evaluación durante la pandemia fueron los siguientes: Trastorno mental actual o previo; carga relacionada con el manejo gubernamental de la crisis; reducción de ingresos; exposición actual al trauma.

Conclusiones: Se identificaron factores protectores y de riesgo predictores de niveles de síntomas del AjD en diferentes momentos de la pandemia. Para algunos predictores, los efectos sobre la salud mental impresionan cambiar en diferentes etapas de una pandemia.

KEYWORDS:

• COVID-19
• pandemic
• coronavirus
• adjustment disorder
• mental health
• stressors
• stress-related disorders
• post-traumatic stress
• risk factors
• protective factors

PALABRAS CLAVE:

• COVID-19
• pandemia
• coronavirus
• trastorno de adaptación
• salud mental
• factores estresantes
• trastornos relacionados con el estrés
• estrés postraumático
• factores de riesgo
• factores protectores

Acknowledgments

The authors thank the collaborators for their support and contribution to the present paper: Ozan Demirok (team Austria); Marina Ajdukovic, Helena Bakic, Ines Rezo Bagaric, Tanja Franciskovic (team Croatia); Nino Makhashvili and Sophio Vibliani (team Georgia); Eleftheria Eugeniou, George Fevgas, Kostas Messas, Marianna Philippidou, Eleni Papathanasiou, Anastasia Selidou (team Cyprus/Greece); Ilaria Cinieri, Alessandra Gallo and Chiara Marangio (team Italia); Monika Kvedaraite and Auguste Nomeikaite (team Lithuania); Joanne Mouthaan, Suzan Soydas, Marloes Eidhof, Marie José van Hoof and Simon Groen (team the Netherlands); Magdalena Skrodzka and Monika Folkierska-Żukowska (team Poland); Aida Dias, Camila Borges, Diana Andringa, Guida Manuel, Joana Beker and João Veloso, Francisco Freitas (team Portugal); Kristina Bondjers, Josefin Sveen, Rakel Eklund, Kerstin Bergh Johannesson and Ida Hensler (team Sweden). We greatly thank the study team of the coordinating site at University Medical Center Hamburg-Eppendorf (team Germany) that conducted the overall data management: Laura Kenntemich, Leonie von Huelsen, Sven Buth, Eike Neumann-Runde, Ronja Ketelsen, Lennart Schwierzke, Julia Groß, Laura Gutewort, and Emily Price.

Author contributions

AL designed the study in cooperation with all members of the ADJUST consortium formed by the representatives of the ESTSS countries. All authors recruited study participants and contributed to the data management of the respective site. KS conducted the data analysis. AL drafted the first version of the manuscript. All authors revised sections of the manuscript and approved the final version of the manuscript.

Data protection and quality assurance

The dataset for the data analysis was stored on a server of the coordinating site (Centre for Interdisciplinary Addiction Research, CIAR, University of Hamburg). Data handling followed the EU General Data Protection Regulation (DSGVO); data will be stored for at least 10 years.

Data availability

The detailed sociodemographic information of the dataset does not fully protect the anonymity of the respondents. For this reason, the entire dataset cannot be made publicly available. However, excerpts of the data on a higher aggregation level can be provided upon justified request by the first author.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics, consent, and permissions

Each country obtained ethical approval of the study: Ethics Committee of the University of Vienna, 00554. Ethics Committee of the University of Urbino ‘Carlo Bo’, 34, 22 July 2020. Ethics Committee of the Department of Psychology, Faculty of Humanities and Social Sciences, University of Zagreb, 21 May 2020. Ethics Review Board of the Faculty of Social and Behavioural Sciences, Utrecht University, 20-360. Ilia State University Faculty of Arts and Science Research Ethics Committee, 12 June 2020. Local Psychological Ethics Committee at the Centre for Psychosocial Medicine, LPEK-0149. Social Sciences Ethics Review Board (SSERB), University of Nicosia, SSERB 00109. The Swedish Ethical Review Authority, 2020-03217. Vilnius University Ethics Committee of Research in Psychology, 44. Ethics Committee of the Faculty of Psychology, University of Warsaw, 6 July 2020. Ethics Committee of the Medical Faculty, University of Porto and Centro Hospitalar São João, Porto, CE 201-20. The National Ethical Review Board in Sweden, 2020-03217. All participants provided informed consent before taking part in the study. Participants were informed that they were under no obligation to participate and that they could withdraw at any time from the study without consequences.

Additional information

Funding

The data assessment in Poland was supported by the Faculty of Psychology, University of Warsaw, from the funds awarded by the Ministry of Science and Higher Education, Poland in the form of a subsidy for the maintenance and development of research potential in 2020 (501-D125-01-1250000 zlec.5011000248, 501-D125-20-0004318). The data assessment in the Netherlands was supported by Two Dutch insurance companies: DSW and CZ . The remaining countries did not receive specific funding for this research.