A scoping review of ICD-11 adjustment disorder research

Figures & data

Table 1. Empirical studies of ICD-11 adjustment disorder (N = 10).

Authors	Study focus	Study design	Sample and stressor	Sample size	Country	Measures	Main findings
Bachem et al. (2016)	Measure validation	Secondary analysis of the previous RCT	Clinical sample diagnosed with DSM-IV AjD, various stressors	190	Republic of South Africa	ADNM-29, HAM-A, MADRS, SDS	AjD symptoms decreased significantly in treatment group; convergent and divergent validity was supported using HAM-A, SDS, MADRS
Bachem and Maercker (2016)	Treatment	RCT	Burglary victims	54	Switzerland	ADNM-20, CSQ-8, DASS-21, PTSD-ICD-11	AjD symptoms decreased significantly in treatment group; between-group effect size at three-month follow-up compared to waiting list for AjD preoccupation was d = 0.67, failure to adapt d = 0.34
Eimontas et al. (2017)	Treatment	RCT	Self-referred with high levels of AjD symptoms, various stressors	1077	Lithuania	ADNM-8, WHO-5	Symptoms of AjD decreased significantly with moderate effect sizes d = 0.53–0.64; additional support from therapist did not significantly improve the outcomes
Glaesmer et al. (2015)	Symptom structure	Cross-sectional	Representative national sample, various stressors	2512	Germany	ADNM-20	Six-symptom first-order correlated AjD CFA model had the best fit with two core AjD symptoms: preoccupation, failure to adapt, and four additional symptoms: Avoidance, depression, anxiety, and impulsivity
Horn and Maercker (2016)	Predictors of AjD	Dyadic	Couples exposed to various major stressors over the last 12 months	146	Switzerland	ADNM-8, CES-D, ERQ, IER, RSQ	Dyadic regression analysis revealed importance of interpersonal emotion regulation strategies on AjD
Lorenz et al. (2017)	Symptom structure	Cross-sectional	Individuals who lost their jobs during the last nine months prior to the study	333	Switzerland	ADNM-20, BSI-18, SFQ, OcSe, SOC-R	CFA showed that unrestricted bifactor model with a dominant general AjD factor consisting of preoccupation, failure to adapt, avoidance, affective reaction and impulsivity provided the best fit of data
Lorenz et al. (2016)	Measure validation	Cross-sectional	Burglary victims	80	Switzerland	ADNM-20, DASS-21, PTSD-ICD-11	Cluster analysis revealed three groups of individuals with low, moderate, and high AjD symptoms; cut-off score of the ADNM-20 was proposed
Maercker et al. (2015)	Treatment	Case study	Burglary victims	1	Switzerland	ADNM-6, DAAS-21	AjD symptoms decreased in AjD self-help intervention study
Mahat-Shamir et al. (2017)	Predictors of AjD	Cross-sectional	Individuals after the shooting attack in Tel Aviv	379	Israel	ADNM-20, PCL-C	Previous exposure to stressful or traumatic events during the past month were significantly positively associated with AjD; physical proximity to the traumatic event was a significant predictor for PTSD, but not for AjD
Zelviene et al. (2017)	Symptom structure	Cross-sectional	Representative national sample, various stressors over the last two years	831	Lithuania	ADNM-20	Two-factor AjD structure with preoccupation and failure to adapt symptoms was supported using CFA

ADNM = Adjustment Disorder New Module; BSI-18 = Brief Symptom Inventory, Short Form; CES-D = Center for Epidemiological Studies–Depression; CFA = Confirmatory Factor Analysis; CSQ-8 = Client Satisfaction Questionnaire; DASS-21 = Depression Anxiety Stress Scales; ERQ = Emotion Regulation Questionnaire; HAM-A = Hamilton Anxiety Rating Scale; IER = Interpersonal Emotion Regulation; LCA = Latent Class Analysis; MADRS = Montgomery–Asberg Depression Rating Scale; OsCe = Occupational Self-Efficacy Scale; PCL-C = Post-traumatic Stress Disorder Checklist–Civilian Version; PTSD-ICD-11 = ICD-11 Post-traumatic Stress Symptoms; RSQ = Response Style Questionnaire; SFQ = Social Functioning Questionnaire; SDS = Sheehan Disability Scale; SOC-R = Sense of Coherence Scale–Revised; WHO-5 = Well-being Index.

Bachem, R., Perkonigg, A., Stein, D. J., & Maercker, A. (2016). Measuring the ICD-11 adjustment disorder concept: Validity and sensitivity to change of the adjustment disorder – New module questionnaire in a clinical intervention study. International Journal of Methods in Psychiatric Research, 1–9. doi:10.1002/mpr.1545

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Bachem, R., & Maercker, A. (2016). Self-help interventions for adjustment disorder problems: A randomized waiting-list controlled study in a sample of burglary victims. Cognitive Behaviour Therapy, 45(5), 1–8.

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Eimontas, J., Gegieckaite, G., Dovydaitiene, M., Mazulyte, E., Rimsaite, Z., Skruibis, P., … Kazlauskas, E. (2017). The role of therapist support on effectiveness of an internet-based modular self-help intervention for adjustment disorder: A randomized controlled trial. Anxiety, Stress, & Coping, 1–13. doi:10.1080/10615806.2017.1385065

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Glaesmer, H., Romppel, M., Brähler, E., Hinz, A., & Maercker, A. (2015). Adjustment disorder as proposed for ICD-11: Dimensionality and symptom differentiation. Psychiatry Research, 229(3), 940–948.

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Horn, A. B., & Maercker, A. (2016). Intra- and interpersonal emotion regulation and adjustment symptoms in couples: The role of co-brooding and co-reappraisal. BMC Psychology, 4, 51.

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Lorenz, L., Hyland, P., Perkonigg, A., & Maercker, A. (2017). Is adjustment disorder unidimensional or multidimensional? – Implications for ICD-11. International Journal of Methods in Psychiatric Research, e1591. doi:10.1002/mpr.1591

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Lorenz, L., Bachem, R. C., & Maercker, A. (2016). The adjustment disorder–new module 20 as a screening instrument: Cluster analysis and cut-off values. The International Journal of Occupational and Environmental Medicine, 7(4), 215–220.

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Maercker, A., Bachem, R. C., Lorenz, L., Moser, C. T., & Berger, T. (2015). Adjustment disorders are uniquely suited for eHealth interventions: Concept and case study. JMIR Mental Health, 2(2), e15.

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Mahat-Shamir, M., Ring, L., Hamama-Raz, Y., Ben-Ezra, M., Pitcho-Prelorentzos, S., David, U. Y., … Lavenda, O. (2017). Do previous experience and geographic proximity matter? Possible predictors for diagnosing adjustment disorder vs. PTSD. Psychiatry Research, 1–6. doi:10.1016/j.psychres.2017.08.085

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Zelviene, P., Kazlauskas, E., Eimontas, J., & Maercker, A. (2017). Adjustment disorder: Empirical study of a new diagnostic concept for ICD-11 in the general population in Lithuania. European Psychiatry, 40, 20–25.

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