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Soc Psychiat Epidemiol (2010) 45:3946 DOI 10.1007/s00127-009-0039-z
ORIGINAL PAPER
Adjustment disorders after severe life-events in four postconict settings
Martin Dobricki Ivan H. Komproe Joop T. V. M. de Jong Andreas Maercker
Received: 29 July 2008 / Accepted: 12 March 2009 / Published online: 31 March 2009 Springer-Verlag 2009
AbstractBackground The present study explores whether severe life-events are associated with adjustment disorders (AD) by reanalyzing the data of a multisite epidemiological survey (de Jong et al. in Lancet 361:21282130, 2003). AD were diagnosed according to the new stress-response-model of AD (Maercker et al. in Psychopathology 40(3):135146, 2007).
Method Data from 3048 persons from four different refugee settings in Ethiopia, Algeria, Gaza, and Cambodia were reanalyzed. Life events were assessed by an adapted version of the Life Events and Social History Interview (Mollica et al. in Am J Psychiatry 144:15671572, 1987). The current study focuses on non-directly life threatening events related to AD (e.g. loss of property) in contrast to life-threatening events related to Posttraumatic Stress Disorders (PTSD). AD Symptom measures were obtained from available psychopathology assessments: composite international diagnostic interview (WHO in CIDI, Geneva, 1997) and structured interview for disorders of extreme stress (Pelcovitz et al. J Trauma Stress 10:316, 1997). Results The majority of the subjects had experienced one or more AD-related life event. Most common AD-related life events varied across the four sites with bad shelter
conditions most prevalent in Ethiopia (100%) and Gaza (32%), forced social isolation in Algeria (61%), and lack of food in Cambodia (41%). Prevalences of AD diagnoses ranged from 6% (Ethiopia) to 40% (Algeria). The highest rates of comorbidity were between AD and PTSD, followed by anxiety disorders.
Conclusion The present study shows that the new concept of AD can be of use for psychiatric epidemiology, e.g., in migration contexts. The high-comorbidity rates could indicate that AD and PTSD are parts of a stress response spectrum.
Keywords Adjustment disorders
Stress-related disorders Psychopathology
Severe life events Postconict countries
Introduction
In clinical practice the diagnosis of adjustment disorders (AD) is being widely used. AD are dened as maladaptive reactions to one or more identiable psychosocial stressors (e.g. divorce, unemployment, migration). Consequently, AD can be regarded as a stress-response disorder [12, 14].
Whereas the symptom criteria for PTSD are quite clearly dened...