Military Healthcare Providers' Intent to Diagnose Adjustment Disorder

This study explored healthcare providers' intentions to diagnose Adjustment Disorder (AjD) in Active Duty Service Members (ADSMs) within the U.S. military, utilizing the Theory of Planned Behavior (TPB) as a guiding framework.

Focusing on 3 key TPB constructs-attitudes, subjective norms, and perceived behavioral control-we conducted interviews with fifty healthcare providers experienced in caring for ADSMs. Initial coding involved categorizing data according to these theoretical constructs. This was followed by inductive and deductive thematic analysis to identify emergent themes within each construct.

Under the Attitudes construct, themes included patient-focused attitudes, clinician-focused attitudes, and an overarching spectrum of attitudes. Perceived Behavioral Control themes consisted of diagnostic criteria, military policies, and command involvement. Finally, Subjective Norms themes included formal and informal training, patient motivation, and military duty.

Our aim was to enhance understanding of diagnostic practices for AjD in this unique context. Recognizing the inherent adjustment that is required for military service, providers demonstrated confidence in diagnosing AjD, but also expressed a clear need for ongoing education and training surrounding this disorder. Providers identified younger, enlisted individuals at their first duty station as the most frequently diagnosed demographic, with adaptation to military expectations as a primary stressor. Varying perspectives on AjD's diagnostic validity were observed, with some viewing it as a necessary diagnosis, while others considered it an overused placeholder diagnosis. Providers underscored the complexity of AjD's diagnostic criteria, the impact of military policies on accession and retention, and the influence of military leadership as key factors in their intent to diagnose AjD. Moreover, while confident in their ability, providers valued peer review and discussions for accurate diagnosis and consideration of ADSMs' career implications. Overall, our findings highlight the nuanced considerations within military mental health, particularly regarding AjD diagnosis.