Prevalence of Adjustment Disorder and Its Predictors Among First- and Second-Year Medical Students in Madinah, Saudi Arabia.

Background The first years of college, notably the first and second, are challenging and time-intensive, frequently characterized by substantial pressure that can lead to dissatisfaction among new students. Such an environment may precipitate adjustment difficulties, potentially resulting in depression, anxiety, and stress. This phenomenon is particularly pronounced among medical students. Despite the widespread nature of these challenges, research focusing on the prevalence of adjustment disorder among medical students in Madinah, Saudi Arabia, is notably scarce in the literature. This study aims to evaluate the prevalence and identify predictors of adjustment disorder among a substantial cohort of first- and second-year medical students in Madinah. Methodology An institution-based, quantitative, cross-sectional study was conducted from April 2022 to August 2022. The study encompassed a total of 273 first- and second-year medical students from the Madinah region. To measure stressor exposure and symptoms of adjustment disorder, the Adjustment Disorder-New Module 20 (ADNM-20) scale was employed. Results Our study, comprising 273 participants from Taibah University and Al-Rayan Colleges, revealed a higher prevalence of adjustment disorder among Al-Rayan students: 54.8% (n = 63) compared to their counterparts at Taibah University 41.8% (n = 66), with a p-value of 0.033. However, no significant association was found with other demographic factors. Utilizing the ADNM-20 questionnaire, the study identified prevalent symptoms of adjustment disorder among participants. Key findings included 47.6% (n = 130) of participants feeling low and sad, 41% (n = 112) experiencing repetitive stressful thoughts, approximately one-third (n = 81) exhibiting avoidance behaviors and intrusive thoughts, 38.1% (n = 104) reducing enjoyable activities, 29.3% (n = 80) encountering increased anxiety, 30% (n = 80) reporting irritability, 31.1% (n = 85) facing concentration issues, 23.4% (n = 64) having sleep disturbances, and 28.2% (n = 77) observing impacts on personal and leisure activities. Conclusions The study concludes that adjustment disorder is prevalent among new university students, particularly at Al-Rayan University, where it manifests in various symptoms including mood disturbances and anxiety.

Trastornos adaptativos y su manejo desde atención primaria / Adaptive disorders and their management in primary care

Introducción: El trastorno de adaptación describe una respuesta emocional y conductual desproporcionada a uno o más estresores psicosociales identificables. Existen múltiples situaciones capaces de generarnos una situación de estrés agudo. Sin embargo, uno de los requisitos necesarios para poder hablar de trastorno adaptativo es que ese o esos factores estresantes supongan un deterioro en el funcionamiento normal del individuo. Objetivos: El objetivo principal de este trabajo es analizar, mediante una revisión bibliográfica, el diagnóstico y abordaje de los trastornos adaptativos dentro del ámbito de Atención Primaria. El objetivo secundario es destacar la importancia de la detección y el tratamiento precoces, así como de la gestión multidisciplinar y la promoción de la salud mental. Resultados: Los principales factores de riesgo de los trastornos adaptativos son el desempleo, los bajos ingresos,el escaso apoyo social, las enfermedades físicas y la salud mental. La prevalencia es mayor en jóvenes,especialmente entre las mujeres, y existe un riesgo aumentado de suicidio en el subtipo de estado de ánimo depresivo. El Cuestionario Internacional de Trastornos Adaptativos es actualmente la principal herramienta diagnóstica, por establecer sus criterios diagnósticos en base a la definición teórica establecida por la CIE-11. El manejo de estos trastornos se realiza principalmente mediante terapia cognitivo-conductual. Conclusiones: Los trastornos de adaptación surgen como respuestas anormales ante ciertas situaciones estresantes. El papel de los médicos de Atención Primaria en el abordaje de este trastorno es primordial, siendo necesaria su detección y manejo precoz para disminuir los niveles de ansiedad disfuncionales que presentan los pacientes.(AU)

Introduction: Adjustment disorder describes a disproportionate emotional and behavioral response to one or more identifiable psychosocial stressors. There are multiple situations capable of generating an acute stressful situation. However, one of the requirements to be able to speak of an adaptive disorder is that the stressor(s) in question should lead to an impairment of the individual's normal functioning.Objectives: The main objective of this work is to analyze , through a literature review, the diagnosis and approach to the diagnosis and management of adaptive disorders in the Primary Care setting. The secondary objective is toemphasize the importance of early detection and treatment, as well as multidisciplinary management and mentalhealth promotion. Results: The main risk factors for adjustment disorders are unemployment, low income, low social support, physical illness, and personal history of mental health. The International Questionnaire of Adaptive Disorders is currently the principal diagnostic tool, as it establishes its diagnostic criteria based on the theoretical definition established by the ICD-11. The management of these disorders is mainly through cognitive behavioural therapy.Conclusions: Adjustment disorders arise as abnormal responses to certain stressful situations. The role of primary care physicians in dealing with this disorder is essential, and early detection and management are necessary to reduce the levels of dysfunctional anxiety that patients present.(AU)

Validation of the brief Adjustment Disorder New Modules with Australian oncology patients.

BACKGROUND: Evidence suggests that up to 30% of cancer patients may meet the criteria for adjustment disorder. However, no assessment instruments have been validated for use with cancer patients. The Adjustment Disorder New Module (ADNM)-8 and ADNM-4 are brief screening tools for adjustment disorder mapped directly to the new ICD-11 criteria. The aim of this study was to investigate the factor structure and validity of both instruments in an Australian sample of adult oncology patients.  METHODS: A total of 405 participants with a cancer diagnosis were recruited online from across Australia. Participants reported cancer-specific information, such as time since diagnosis, treatment stage, cancer stage, type of cancer, and the following questionnaires: 8-item Adjustment Disorder New Module (ADNM-8), the World Health Organisation Well-Being Index (WHO-5), and the short form Depression Anxiety and Stress Scale (DASS-21). The predictiveness of stressors was assessed using multiple regression analysis and the structure of the ADNM-8 and the ADNM-4 was tested using confirmatory factor analysis.  RESULTS: Six previously tested models were examined, and the results suggested a 2-factor structure reflecting the two ICD-11 diagnostic criteria clusters of preoccupation with the stressor and failure to adapt was a good fit for both scales. The ADNM-4 outperformed the longer version of the scale on numerous fit indices though the ADNM-8 and ADNM-4 were highly correlated. Correlations of both scales with the psychological distress scale, the stress subscale, and the wellbeing index indicated good construct validity. CONCLUSIONS: Our results suggest that the ADNM-8 and ADNM-4 are useful screening tools for assessing adjustment disorder symptoms in cancer patients. The prompt screening of cancer patients encourages early intervention for those at risk of adaptation difficulties and informs research and clinical decisions regarding appropriate treatments.

The network structure of ICD-11 adjustment disorder: A comparison of clinical and nonclinical samples.

BACKGROUND: International Classification of Diseases, 11th revision (ICD-11) adjustment disorder (AjD) is characterized by two main symptom clusters: preoccupation with the stressor and failure to adapt to the stressor. The network analytic approach provides important information on the structural validity of a disorder and reveals which symptoms are most prominent. To date, no study compared the network structure of AjD symptoms in clinical and nonclinical samples, which could potentially inform our understanding of psychopathological mechanisms that underlie AjD and identify core targets for therapy. METHODS: A network analysis was conducted on AjD symptoms as assessed by the Adjustment Disorder-New Module (ADNM-8) using data from 330 clinical participants from the UK and a nonclinical sample of 699 participants from Switzerland. RESULTS: Comparisons of network structure invariance revealed differences between the network structure of the clinical and the nonclinical samples. Results highlight that in terms of both edges strength and centrality, failure to adapt symptoms was more prominent in the clinical sample, while the preoccupation symptoms were more prominent in the nonclinical sample. Importantly, global strength was similar across networks. CONCLUSIONS: Results provide evidence of the coherence of AjD in the ICD-11 as assessed by the ADNM questionnaire. They tentatively suggest that subclinical AjD may be characterized by emerging preoccupation symptoms that may result in failure to adapt and functional impairment in clinical manifestation of AjD. However, there is a need for replication and longitudinal research to further validate this hypothesis.

Psychometric evaluation of the Adjustment Disorder New Module-20 (ADNM-20): A multi-study analysis.

The Adjustment Disorder New Module (ADNM) is a self-report instrument for assessing Adjustment disorder (AjD), but uncertainties remain in evaluating factor structure and psychometric properties of ADNM in previous studies. Three studies were conducted to examine the factor structure, psychometrics properties, and clinical utility of the 20-item version of ADNM (ADNM-20) and 4-item version (ADNM-4) among samples of Hong Kong Chinese (N = 1,415). Confirmatory factor analysis demonstrated good model fitness with a bifactor model. Statistical indices indicated unidimensionality of AjD. The model-based reliability showed that the total score of ADNM-20 should be used in scoring and interpretation for capturing the construct of AjD. ADNM-4 model demonstrated full invariance between women and men and partial invariance between age groups. Receiver operating characteristic analysis revealed a cutoff score of 10 for probable AjD. The prevalence of probable AjD was 20.5 % excluding cases with probable depression among a population-representative sample of Hong Kong Chinese amid civil unrest in Hong Kong in July 2019. Cutoff scores of ADNM-20 (49) and ADNM-4 (9) were established for clinically significant common psychiatric conditions, namely PTSD, depression, and anxiety. Both ADNM-20 and ADNM-4 were reliable and valid to assess probable AjD. Implications for clinical research and practice are discussed.

Psychometric properties of the Chinese version of adjustment disorder new module-20 in breast cancer patients.

BACKGROUND: After the new definition of adjustment disorder (AjD) by the International Classification of Diseases-11(ICD-11), AjD has attracted more and more attention. Adjustment disorder new module-20 (ADNM-20), which is used to diagnose AjD, has been verified in some countries, but it has not been verified in China. As a result, the purpose of this study was to investigate the validity and reliability of the Chinese version of the Adjustment disorder new module-20 (ADNM-20) in female breast cancer patients. METHODS: The ADNM-20 translated into Chinese employed the translation and back translation technique. Three hundred fifty four newly diagnosed (< 1 year) female breast cancer patients were recruited from Tongji Hospital and Hubei Cancer Hospital in Hubei, China. The patients completed the self-report questionnaire including demographic characteristics and the scale ADNM-20. Data on psychometric properties were evaluated in terms of internal consistency, item-total correlations, test-retest reliability, and factorial validity. RESULTS: ADNM-20 core symptoms included 8 items and two factors, which were extracted by using exploratory factor analysis (EFA). It could explain 61.74% of the total variance. ADNM-20 accessory symptoms including 12 items and four factors, which were extracted by using EFA. It could explain 68.34% of the total variance. Cronbach's α coefficient for ADNM-20 was 0.93, split-half reliability was 0.87, and the test-retest correlation coefficient was 0.74. The correlation coefficient between each subscale was ranged from 0.53 to 0.71 (P < 0.01), while the correlation coefficient between the subscales and total scale was ranged from 0.79 to 0.89 (P < 0.01). CONCLUSIONS: The study verified the validity and reliability of the Chinese version of ADNM-20. It is applicable to measure the prevalence of adjustment disorder in the breast cancer population.

Revalidation of Adjustment Disorder-New Module-4 screening of adjustment disorder in a non-clinical sample: Psychometric reevaluation and correlates with other ICD-11 mental disorders.

In line with the new conceptualization of adjustment disorder (AjD) in the 11th revision of the International Classification of Diseases (ICD-11), a new 20-item self-report questionnaire was developed and validated - the Adjustment Disorder-New Module (ADNM). However, such a long research tool has the potential to become problematic for use in epidemiological and clinical settings. Therefore, an ultra-brief measure for AjD (ADNM-4) was established and validated in a recent study conducted with a representative national sample. The aim of the present study was to revalidate the ultra-brief ADNM-4 Scale, as well as to reestablish cutoff scores for clinical use. An online survey was conducted with a convenience sample of 484 Israelis aged 18-65 years, who were recruited via social media. Participants filled out self-report questionnaires dealing with diagnostic criteria of stress-related disorders, that is, AjD (the original and ultra-brief modules), prolonged grief disorder, depression, anxiety, and hypochondriasis. Construct, discriminant, and convergent validity were assessed via confirmatory factor analysis and correlation coefficients, while cutoff scores were established through receiver-operating characteristic analysis. The findings confirmed the ultra-brief module's validity. The high fit indices indicated construct validity, and the correlations with the various stress-related disorders indicated good convergent and discriminant validity. Cutoff scores resembled earlier cutoff scores calculated with a representative national sample, indicating a consistent and accurate diagnostic ability. These findings provide additional evidence for the psychometric characteristics of the ADNM-4, which seems to be a suitable brief screening tool for assessing AjD symptoms according to the ICD-11 definition. Therefore, the ADNM-4 is recommended in cases where prompt screening is required, as well as for research purposes.

El ácido desoxirribonucleico mitocondrial (ADNm) y "Las siete hijas de Eva" / Mitochondrial deoxyribonucleic acid (mRNA) and "The seven daughters of Eve"

En el año 2001, el profesor Bryan Sykes (Oxford), publicó un libro intitulado "Las Siete Hijas de Eva", tras analizar el ADN mitocondrial (ADNm) de numerosas europeas. El ADNm pasa exclusivamente a las mitocondrias de mujeres y a su vez solo las hijas lo transmiten a la suya. El estudio fue posible gracias a la Reacción en Cadena de la Polimerasa. De ese modo Sykes precisó que en Europa hay siete clanes femeninos principales, cuyas fundadoras vivieron desde hace unos 45 000 hasta hace unos 8 500 años. Palabras clave: Ácido Desoxirribonucleico Mitocondrial (ADNm). Clanes ancestros maternos y paternos. Migraciones y Genética.(AU)

In 2001, professor Bryan Sykes (Oxford), published a book in Spanish untitled "Las siete hijas de Eva", analyzing the mitochondrial DNA from numerous European women. The mDNA has the peculiarity to pass exclusively to the mitochondrias of women, and only their daughters are able to transmit it. The study was possible thanks to the availability of the Polymerase Chain Reaction. By means of the study of the mtDNA he was able to detect in Europe seven principle maternal clans from 45 000 to 8 500 years.(AU)