Citation

O'donnell ML, Alkemade N, Creamer M, McFarlane AC, Silove D, Bryant RA, Felmingham K, Steel Z, Forbes D. Am. J. Psychiatry 2016; 173(12): 1231-1238.

Affiliation

From the Phoenix Australia Centre for Posttraumatic Mental Health, Carlton, Victoria, Australia; the Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia; the School of Psychology, University of New South Wales, Sydney, New South Wales, Australia; the School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; the Centre for Traumatic Stress, University of Adelaide, Adelaide South Australia, Australia; the Mental Health Centre, Psychiatry Research and Teaching Unit, Liverpool, New South Wales, Australia; the School of Psychology, University of Tasmania, Tasmania, Australia; and St. John of God Health Care, Richmond Hospital, North Richmond, Australia.

Copyright

(Copyright © 2016, American Psychiatric Association)

DOI

10.1176/appi.ajp.2016.16010071

PMID

27771970

Abstract

OBJECTIVE: Adjustment disorder has been recategorized as a trauma- and stressor-related disorder in DSM-5. The aim of this study was to determine the prevalence of adjustment disorder in the first 12 months after severe injury; to determine whether adjustment disorder was a less severe disorder compared with other disorders in terms of disability and quality of life; to investigate the trajectory of adjustment disorder; and to examine whether the subtypes described in DSM-5 are distinguishable.

METHOD: In a multisite, cohort study, injury patients were assessed during hospitalization and at 3 and 12 months postinjury (N=826). Structured clinical interviews were used to assess affective, anxiety, and substance use disorders, and self-report measures of disability, anxiety, depression, and quality of life were administered.

RESULTS: The prevalence of adjustment disorder was 19% at 3 months and 16% at 12 months. Participants with adjustment disorder reported worse outcomes relative to those with no psychiatric diagnosis but better outcomes compared with those diagnosed with other psychiatric disorders. Participants with adjustment disorder at 3 months postinjury were significantly more likely to meet criteria for a psychiatric disorder at 12 months (odds ratio=2.67, 95% CI=1.59-4.49). Latent-profile analysis identified a three-class model that was based on symptom severity, not the subtypes identified by DSM-5.

CONCLUSIONS: Recategorization of adjustment disorder into the trauma- and stressor-related disorders is supported by this study. However, further description of the phenomenology of the disorder is required.

Language: en