Adjustment disorders after severe life-events in four postconflict settings

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 361:2128-2130, 2003). AD were diagnosed according to the new stress-response-model of AD (Maercker et al. in Psychopathology 40(3):135-146, 2007).

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 144:1567-1572, 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 10:3-16, 1997).

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.

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.