[Triggers of ICD-11 adjustment disorder: differences in symptom progression and socio-medical prognosis]

Background. In ICD-11, adjustment disorder (AjD) is defined as a psychological response to identifiable stressors following stressful life events, characterized by preoccupation and failure to adapt. The aim of this study was to examine whether different trigger domains of AjD (occupational, familial, or somatic) differ with regard to symptom severity, changes in psychopathology during rehabilitation, and socio-medical outcomes. It was hypothesized that work-related AjD would be associated with a less favorable socio-medical course. Methods. A clinical sample of inpatients undergoing psychosomatic rehabilitation (N=1028) completed self-report questionnaires at the beginning and end of rehabilitation (ADNM-20, BDI-II, HEALTH-49). Socio-medical parameters were additionally assessed. Participants were grouped according to the primary trigger domain (work, family, own severe illness). Group comparisons were conducted for symptom severity, symptom change over the course of rehabilitation, and socio-medical evaluations. Results. Occupational stressors were the most frequent triggers of AjD (32.8%), followed by one's own severe illness (22.7%) and family conflicts (14.5%). Overall symptom burden differed only marginally between groups. Family-related AjD was associated with particularly low perceived social support, whereas AjD triggered by severe somatic illness was characterized by more pronounced anxiety symptoms. Patients with somatically triggered AjD showed a slightly less favorable socio-medical prognosis. Conclusions. The type of trigger appears to affect specific psychosocial domains but does not systematically influence rehabilitation outcomes. For somatically triggered AjD, a differentiated assessment of illness processing seems particularly relevant for socio-medical evaluation.