title: STRESSORS, SYMPTOM PROFILE, AND PREDICTORS OF ADJUSTMENT DISORDER IN CANCER PATIENTS. RESULTS FROM AN EPIDEMIOLOGICAL STUDY WITH THE COMPOSITE INTERNATIONAL DIAGNOSTIC INTERVIEW, ADAPTATION FOR ONCOLOGY (CIDI-O).
abstract: BACKGROUND
  We aimed to investigate type and frequency of stressors, predominant symptom profiles, and predictors of adjustment disorders (AD) in cancer patients across major tumor entities.
  
  
  METHODS
  In this epidemiological study, we examined 2,141 cancer patients out of 4,020 screened with the Composite International Diagnostic Interview, adaptation for oncology (CIDI-O). AD were operationalized as subthreshold disorders according to DSM-IV criteria.
  
  
  RESULTS
  In our sample, 265 out of 2,141 patients (12.4%) met all criteria for AD (unweighted 4-week prevalence). The disclosure of the cancer diagnosis, relapse or metastases, and cancer treatments were most frequently described as stressors associated with depressive or anxious symptoms. With regard to AD symptom profiles, patients showed high prevalence rates of affective symptoms according to the DSM-IV criteria of Major Depression: The highest prevalence rates were found for cognitive disturbances (concentration and memory problems) (88%), sleeping disturbances (86%), and depressive mood (83%). We found sex, education, and metastasis as significant predictors for AD. Higher education was the most influential predictor. Men were half as likely to report symptoms fulfilling the AD criteria as women. Patients with metastasized tumors had a more than 80% higher risk of AD than those without metastasis. However, the explained variance of our model is very small (Nagelkerke's R² = 0.08).
  
  
  CONCLUSIONS
  Patients with AD can be identified using a standardized instrument and deserve clinical attention, as they often show severe clinical symptoms and impairments. Improving the clinical conceptualization of AD by the adding-on of potential stress-response-symptoms is necessary to identify severe psychological strain.
authors.affiliation: Rhein-Jura-Klinik, Bad Säckingen, Germany.|Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Bianca
authors.initials: B
authors.lastname: Hund
authors.affiliation: Department of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Reuter
authors.affiliation: Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Härter
authors.affiliation: Department of Medical Psychology and Medical Sociology, Division of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany.|Department of Psychosomatic Medicine and Psychotherapy, Universal Medical Center Mainz, Mainz, Germany.
authors.forename: Elmar
authors.initials: E
authors.lastname: Brähler
authors.affiliation: Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Faller
authors.affiliation: Division of Psychooncology, Department for Psychosomatic and General Clinical Medicine, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Monika
authors.initials: M
authors.lastname: Keller
authors.affiliation: Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Schulz
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.affiliation: Department of Psychooncology, Tumor Biology Center, University of Freiburg, Freiburg, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Weis
authors.affiliation: Institute of Clinical Psychology and Psychotherapy and Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technical University Dresden, Dresden, Germany.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Wittchen
authors.affiliation: Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Koch
authors.affiliation: Department of Medical Psychology and Medical Sociology, Division of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Friedrich
authors.affiliation: Department of Medical Psychology and Medical Sociology, Division of Psychosocial Oncology, University Medical Center Leipzig, Leipzig, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Mehnert
mesh_terms: D000275:Adjustment Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D016021:Epidemiologic Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D055815:Young Adult
keywords: Composite International Diagnostic Interview; adjustment disorder; cancer; comorbidity; stress response syndrome