Adjustment disorders as a stress-related disorder: a longitudinal study of the associations among stress, resources, and mental health.
OBJECTIVE
Adjustment disorders are re-conceptualized in the DSM-5 as a stress-related disorder; however, besides the impact of an identifiable stressor, the specification of a stress concept, remains unclear. This study is the first to examine an existing stress-model from the general population, in patients diagnosed with adjustment disorders, using a longitudinal design.


METHODS
The study sample consisted of 108 patients consecutively admitted for adjustment disorders. Associations of stress perception, emotional distress, resources, and mental health were measured at three time points: the outpatients' presentation, admission for inpatient treatment, and discharge from the hospital. To evaluate a longitudinal stress model of ADs, we examined whether stress at admission predicted mental health at each of the three time points using multiple linear regressions and structural equation modeling. A series of repeated-measures one-way analyses of variance (rANOVAs) was performed to assess change over time.


RESULTS
Significant within-participant changes from baseline were observed between hospital admission and discharge with regard to mental health, stress perception, and emotional distress (p<0.001). Stress perception explained nearly half of the total variance (44%) of mental health at baseline; the adjusted R2 increased (0.48), taking emotional distress (i.e., depressive symptoms) into account. The best predictor of mental health at discharge was the level of emotional distress (i.e., anxiety level) at baseline (β= -0.23, R2corr=0.56, p<0.001). With a CFI of 0.86 and an NFI of 0.86, the fit indices did not allow for acceptance of the stress-model (Cmin/df=15.26; RMSEA=0.21).


CONCLUSIONS
Stress perception is an important predictor in adjustment disorders, and mental health-related treatment goals are dependent on and significantly impacted by stress perception and emotional distress.
Institute and Policlinic for Medical Psychology, University Medical Center, Hamburg-Eppendorf, Germany.
Rüya-Daniela
RD
Kocalevent
Department of Psychosomatic Medicine, Charité University Medicine, Berlin, Germany.
Annett
A
Mierke
Department of Psychosomatic Medicine, Charité University Medicine, Berlin, Germany.
Gerhard
G
Danzer
Department of Psychosomatic Medicine, Charité University Medicine, Berlin, Germany.
Burghard F
BF
Klapp
D000275:Adjustment Disorders / Q000209:etiology* / Q000503:physiopathology*; D000342:Affective Symptoms / Q000503:physiopathology; D000704:Analysis of Variance; D005858:Germany; D006801:Humans; D016014:Linear Models; D008137:Longitudinal Studies; D008603:Mental Health / Q000706:statistics & numerical data*; D013315:Stress, Psychological / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D013997:Time Factors