Measuring the ICD‐11 adjustment disorder concept: Validity and sensitivity to change of the Adjustment Disorder – New Module questionnaire in a clinical intervention study

Abstract

Adjustment disorder (AjD) is a frequent but under-researched diagnosis due in part to a lack of specific symptom criteria and adequate tools of measurement. The ICD-11 for the first time proposes a positive symptom catalogue to define AjD. This study presents a validation of the Adjustment Disorder - New Module (ADNM), the first symptom severity measure for AjD according to the ICD-11 concept. Validity and sensitivity to change were investigated in a sample of 190 individuals with a DSM-IV diagnosis of AjD. The ADNM scales demonstrated convergent and discriminant validity for anxiety symptoms (Hamilton Anxiety Scale; psychic anxiety r = 0.18-0.31), functional impairment (Sheehan Disability Scale; r = 0.18-0.47), and depression (Montgomery-Asberg Depression Scale; r = 0.13-0.30). At baseline 78% of the individuals with a DSM-IV diagnosis of AjD were also classified so by the ADNM. Repeated-measures ANOVA indicated significant ADNM-symptom decrease during treatment, replicating the patterns of the Hamilton Anxiety Scale, Sheehan Disability Scale, and Clinical Global Impression Scale. This article presents the first use of the ADNM as a measure for ICD-11 AjD in a randomized-controlled intervention study of AjD. It provides support for the construct validity and sensitivity to symptom change of this scale during pharmacological treatment.

A scoping review of ICD-11 adjustment disorder research

“…At baseline, 78% of individuals diagnosed with DSM-IV AjD diagnosis were also classified as having AjD based on the ADNM scores. AjD symptoms measured with ADNM-20 significantly declined during treatment, parallel to the decline of the depression ( r  = .13–.30), anxiety symptoms ( r  = .18–.31), and functional impairment ( r  = .18–.47) measured with other measures (Bachem et al, 2016). …”

“…The stressor list of the ADNM was used in nine reviewed studies. However, the number of stressors in the first part of the ADNM ranged considerably across different studies: 10 stressors (Bachem & Maercker, 2016; Bachem, Perkonigg, Stein, & Maercker, 2016), 13 stressors (Horn & Maercker, 2016), 15 stressors (Zelviene, Kazlauskas, Eimontas, & Maercker, 2017), 16 stressors (Glaesmer, Romppel, Brähler, Hinz, & Maercker, 2015), 17 stressors (Eimontas et al, 2017), and 19 stressors (Lorenz, Bachem, & Maercker, 2016). …”

“…Six of the reviewed studies used the 20-item ADNM-20 scale, which included the 20 symptom items comprising six subscales: preoccupation (four items), failure to adapt (three items), avoidance (four items), depression (three items), impulsivity (three items), anxiety (two items) (Glaesmer et al, 2015; Lorenz, Hyland, Perkonigg, & Maercker, 2017; Lorenz et al, 2016; Mahat-Shamir et al, 2017; Zelviene et al, 2017). The 29-item ADNM-29 was used in one study (Bachem et al, 2016). However, the authors of this study reduced number of items to 20 in the analysis of data.…”

“…However, the specificity of the ADNM-20 was rather low (74%), and positive predictive value for AjD diagnosis was poor (57%) (Lorenz et al, 2016). The ADNM-20 sensitivity to change, and convergent and discriminant validity, was tested in psychopharmacological (Etifoxine and Alprazolam) AjD treatment study in South Africa (Bachem et al, 2016). The ADNM-20 was administered to outpatients diagnosed with the DSM-IV AjD diagnosis ( N  = 190).…”

A socio-interpersonal approach to adjustment disorder: the example of involuntary job loss

“…Recent studies provided evidence for the proposed stress-response conceptualization for ICD-11 regarding its reliability and clinical utility (Bachem, Perkonigg, Stein, & Maercker, 2016; Glaesmer, Romppel, Brähler, Hinz, & Maercker, 2015; Keeley et al, 2016; Zelviene, Kazlauskas, Eimontas, & Maercker, 2017). However, little is known about predictive factors or models for the development of this disorder.…”