A longitudinal study of risk and protective factors for symptoms of adjustment disorder during the COVID-19 pandemic.

Background: The COVID-19 pandemic caused multiple stressors that may lead to symptoms of adjustment disorder.Objective: We longitudinally examined relationships between risk and protective factors, pandemic-related stressors and symptoms of adjustment disorder during the COVID-19 pandemic, as well as whether these relationships differed by the time of assessment.Method: The European Society for Traumatic Stress Studies (ESTSS) ADJUST Study included N = 15,169 participants aged 18 years and above. Participants from 11 European countries were recruited and screened three times at 6-month intervals from June 2020 to January 2022. Associations between risk and protective factors (e.g. gender), stressors (e.g. fear of infection), and symptoms of adjustment disorder (AjD, ADNM-8) and their interaction with time of assessment were examined using mixed linear regression.Results: The following predictors were significantly associated with higher AjD symptom levels: female or diverse gender; older age; pandemic-related news consumption >30 min a day; a current or previous mental health disorder; trauma exposure before or during the pandemic; a good, satisfactory or poor health status (vs. very good); burden related to governmental crisis management and communication; fear of infection; restricted social contact; work-related problems; restricted activity; and difficult housing conditions. The following predictors were associated with lower AjD levels: self-employment or retirement; working in healthcare; and face-to-face contact ≥ once a week with loved ones or friends. The effects of the following predictors on AjD symptoms differed by the time of assessment in the course of the pandemic: a current or previous mental disorder; burden related to governmental crisis management; income reduction; and a current trauma exposure.Conclusions: We identified risk factors and stressors predicting AjD symptom levels at different stages of the pandemic. For some predictors, the effects on mental health may change at different stages of a pandemic.

We longitudinally examined predictors of symptoms of adjustment disorder in 15,563 adults during the COVID-19 pandemic.We found stressors, risk, and protective factors predicting adjustment disorder symptom levels at different stages of the pandemic.For some predictors, the effects appear to change in different phases of a pandemic.

Piloting a scalable, post-trauma psychosocial intervention in Tuvalu: the Skills for Life Adjustment and Resilience (SOLAR) program.

Background: The Skills for Life Adjustment and Resilience (SOLAR) programme is a brief, scalable, psychosocial skill-building programme designed to reduce distress and adjustment difficulties following disaster. Objectives: We tested the feasibility, acceptability, efficacy and safety of a culturally adapted version of SOLAR in two remote, cyclone-affected communities in the Pacific Island nation of Tuvalu. Method: This pilot adopted a quasi-experimental, control design involving 99 participants. SOLAR was administered to the treatment group (n = 49) by local, non-specialist facilitators (i.e. 'Coaches') in a massed, group format across 5 consecutive days. The control group (n = 50) had access to Usual Care (UC). We compared group differences (post-intervention vs. post-control) with psychological distress being the primary outcome. We also examined whether changes were maintained at 6-month follow-up. Results: Large, statistically significant group differences in psychological distress were observed after controlling for baseline scores in favour of the SOLAR group. Mean group outcomes were consistently lower at 6-month follow-up than at baseline. SOLAR was found to be acceptable and safe, and programme feedback from participants and Coaches was overwhelmingly positive. Conclusions: Findings contribute to emerging evidence that SOLAR is a flexible, culturally adaptable and scalable intervention that can support individual recovery and adjustment in the aftermath of disaster. RCTs to strengthen evidence of SOLAR's efficacy are warranted.

Antecedentes: El programa de Destrezas para la Adaptación a la Vida y Resiliencia (SOLAR en sus siglas en inglés) es un programa breve, escalable y de desarrollo de destrezas psicosociales diseñado para reducir el malestar y las dificultades de adaptación después de un desastre.Objetivos: Probamos la viabilidad, aceptabilidad, eficacia y seguridad de una versión de SOLAR culturalmente adaptada en dos comunidades remotas afectadas por ciclones en la nación Insular de Tuvalu en el Pacífico.Método: Este piloto adoptó un diseño de control cuasiexperimental, involucrando n = 99 participantes. Se administró SOLAR al grupo de tratamiento (n = 49) por facilitadores locales no especialistas (es decir 'Entrenadores') en un formato de grupo masivo durante cinco días consecutivos. El grupo control (n = 50) tuvo acceso a la Atención Habitual (AH). Comparamos las diferencias entre los grupos (post-intervención versus post-control) siendo el resultado primario el malestar psicológico. Examinamos también si los cambios se mantuvieron a los 6 meses de seguimiento.Resultados: Se observaron diferencias grandes estadísticamente significativas entre los grupos en el malestar psicológico después de controlar los puntajes basales a favor del grupo SOLAR. Los resultados promedio del grupo fueron consistentemente más bajos a los 6 meses de seguimiento que al inicio. Se encontró que SOLAR era aceptable y seguro, y la retroalimentación del programa por los participantes y entrenadores fue extremadamente positiva.Conclusiones: Los hallazgos contribuyen a la evidencia emergente que SOLAR es una intervención flexible, culturalmente adaptable y escalable que puede apoyar la recuperación individual y la adaptación después de un desastre. Se justifica la realización de ECAs para fortalecer la evidencia de la eficacia de SOLAR.

Uso del tratamiento acupuntural en los trastornos de adaptación a forma depresiva / Use of the acupunctural treatment in depressive adjustment disorders

Se realizó un estudio experimental, abierto y controlado durante el período comprendido entre diciembre de 2009 a junio de 2010 en pacientes con trastorno de adaptación a forma depresiva en el Centro Comunitario Provincial de Salud Mental de Las Tunas. El universo estuvo constituido por todos los pacientes que acudieron a la consulta de MNT de la entidad antes mencionada y que fueron diagnosticados clínicamente según la CIE-10. La muestra quedó constituida por el 100 por ciento de los pacientes que cumplieron los criterios diagnósticos y de inclusión, establecidos para la investigación, a los que se le aplicó tratamiento acupuntural y se comparó con el tratamiento convencional con amitriptilina para determinar la eficacia de la acupuntura, con validación estadística, a través del sistema epinfo 6,0. Inicialmente la depresión leve fue predominante con el 88 per cent y el insomnio fue el síntoma asociado más frecuente. Al terminar el tratamiento se encontró que la depresión se eliminó en la totalidad de los pacientes que recibieron acupuntura con solo 21 sesiones de tratamiento, los síntomas asociados desaparecieron en casi la totalidad de los pacientes y las reacciones adversas fueron mínimas. Por lo que se concluye que este tratamiento constituye una terapia efectiva en el trastorno de adaptación a forma depresiva (AU)

An experimental, open and controlled study was carried out during the period comprised between December, 2009 and June 2010 on patients with depressive adjustment disorders at the Provincial Community Mental Health Center of Las Tunas. The universe was constituted by all the patients who attended the Natural and Traditional Medicine consultation of the afore-mentioned institution and who were clinically diagnosed according to the 10th International Classification of Mental and Behavioural Disorders. The sample was constituted by 100 per cent of the patients who followed the diagnosis and inclusion criteria established for the investigation. The patients were applied the acupuntural treatment that was compared with the conventional treatment with amitriptyline to determine the efficacy of acupuncture, with statistical ratification through the epinfo 6,0 system. At the beginning, mild depression was predominant with 88 per cent and insomnia was the most frequent associated symptom. At the end of the treatment, it was found that depression was eliminated in all the patients who were treated with acupuncture with only 21 sessions of treatment, the associated symptoms disappeared in almost all the patients and the adverse reactions were minimal. At the end of the study it was concluded that this treatment constitutes an effective therapy for depressive adjustment disorders (AU)

Estresores psicosociales y depresión mayor recurrente / Psychosocial stressors and major recurrent depression

En este trabajo se examinan los estresores psicosociales y la depresión recurrente a través de la revisión de la literatura básica en la materia. Se define el estrés y se clasifica desde diferentes perspectivas. El estrés es una causa de tensión y exigencia o mecanismo de adaptación.El estrés y la presentación del primer episodio depresivo están directamente relacionados, sin embargo cuando se presentan recurrencias el estrés significativo pierde fuerza dentro de los factores que lo desencadenan. Los estresores, especialmente los psicosociales, están relacionados con la presentación de recurrencias. Entre estos se destacan estresores internos y externos, por sucesos vitales, estrés de rol y las contrariedades cotidianas, la alta exigencia y el perfeccionismo. El no cumplimiento de metas es otro factor provocador de crisis en la transición del ciclo vital. El neuroticismo y el perfeccionismo, como actitudes disfuncionales provocan aislamiento y falta de soporte social. Los esquemas cognitivos disfuncionales conducen a un procesamiento erróneo de la información. La depresión es una pauta de relación que no permite encontrar formas adaptativas de enfrentar la vida y conducir las relaciones interpersonales. Aunque hay nuevas visiones que la consideran como un esfuerzo adaptativo. La comorbilidad puede hacer recurrir la depresión. Se ha sugerido que patrones maladaptativos cognitivos, en particular en interacción con estresores, podrían llevar a pobres resultados en el tratamiento de sujetos con trastorno depresivo mayor en comorbilidad con trastornos de personalidad. Estos, independientemente del estado de la depresión, han sido asociados con elevadas actitudes disfuncionales.

This paper examines psychosocial stressors and recurrent depression through a review of the basic literature on the subject. Stress is defined and classified from different perspectives. Stress is a cause of tension and demand or an adaptive mechanism. Stress and the presentation of the first episode of depression are directly related, however when recurrences are present significant stress loses strength among the factors that trigger it. Stressors, especially the psychosocial, are related to recurrences. Chief among these are internal and external stressors, and life events, role stress and annoyances of daily living, high demands and perfectionism. Failure to accomplish goals is another factor provoking crisis in the life cycle transition. Neuroticism and perfectionism, and dysfunctional attitudes lead to isolation and lack of social support. Dysfunctional cognitive schemes lead to erroneous information processing. Depression is a pattern of relationship failing to find adaptive ways of coping with life and conduct relationships, although there are new visions that consider it as an adaptive effort. Comorbidity can lead the recurrence of depression. It has been suggested that maladaptive cognitive patterns, in particular in interaction with stressors, could lead to poor results in the treatment of patients with major depressive disorder comorbidity with personality disorder. These, regardless of the state of depression have been associated with high dysfunctional attitudes.