A longitudinal study of adjustment disorder after trauma exposure
O'Donnell, ML and Alkemade, N and Creamer, M and McFarlane, AC and Silove, D and Bryant, RA and Felmingham, K and Steel, Z and Forbes, D, A longitudinal study of adjustment disorder after trauma exposure, American Journal of Psychiatry, 173, (12) pp. 1231-1238. ISSN 0002-953X (2016) [Refereed Article]
Copyright 2016 American Psychiatric Publishing, Inc.
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 morelikely to meet criteria for a psychiatric disorder at 12 months (odds ratio=2.67, 95% CI=1.5924.49). Latentprofile 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.