The ICD-11 includes a new definition of adjustment disorder (AjD). The present study aimed to examine interrater reliability, internal consistency, and construct validity of a new diagnostic interview module to assess ICD-11 AjD. Data from two studies that used a standardized diagnostic interview assessment (i.e., DIA-X/M-CIDI and updated DIA-X-5) were used. For interrater reliability, agreement indicators (i.e., κ) were calculated using data from the DIA-X-5 test-retest study (N = 60). To examine internal consistency and construct validity, Cronbach's alpha values and the Kuder-Richardson correlation coefficient were computed along with confirmatory factor and latent class analyses (LCA), using data from the Zurich Adjustment Disorder Study (N = 330). Interrater reliability analyses found an adjusted kappa of 0.807 for the ICD-11 AjD diagnosis. Few items from the impairment criterion of the diagnostic algorithm performed poorly. The internal consistency was acceptable, Cronbach's αs = .43-.80; the lower-bound estimate resulted from the two-item preoccupation symptom pattern. However, both items were significantly associated, OR = 3.14, 95% CI [1.97, 4.99]. Regarding LCA results, a two-class model was favored. We found that 94.3% of all ICD-11 AjD cases belonged to Class 2, OR = 23.69, 95% CI [7.15, 79.54], which was associated with subjectively rated distress, OR = 2.18, 95% CI [1.57, 3.02], and the external measure of the Brief Symptom Inventory global severity index, OR = 2.18, 95% CI [1.57, 3.02]. Overall, the new AjD interview module provided a reliable, valid assessment of the ICD-11 diagnosis; confirmation by other studies is needed.

Background: Adjustment disorder (AjD) was redefined for ICD-11 with core symptoms of preoccupation with a stressor and failure to adapt. The socio-interpersonal framework model for stress-response syndromes suggests that interpersonal factors, besides intrapersonal processes, substantially contribute to the development of AjD. Objective: The current study aimed to identify predictive factors in the development of AjD symptoms by the application of a framework model for stress-response syndromes. Method: N = 321 recently laid-off participants (47.7% female) were assessed with a newly developed standardized clinical diagnostic interview section on ICD-11 AjD. Self-report questionnaires measured AjD symptom severity, and interpersonal and intrapersonal predictors. Path analysis was used to model the associations between AjD symptom severity and the predictor variables. We conducted logistic regression to identify associated characteristics of diagnostic status. Results: AjD symptoms were highly prevalent and 25.6% of participants met the diagnostic criteria. Higher loneliness, higher dysfunctional disclosure, and lower self-efficacy were associated with both higher symptom severity and higher likelihood of meeting the diagnostic criteria for AjD. Higher perceived social support was associated with higher likelihood for AjD diagnosis. Conclusions: Research on risk factors for AjD is still sparse. This study provided empirical evidence on the role of interpersonal factors supporting the socio-interpersonal model for stress-response syndromes.

In preparation for ICD‐11, the adjustment disorder (AjD) diagnosis has undergone considerable revisions; however, the latent structure of AjD remains uncertain. It is unclear whether AjD is best represented as a unidimensional or multidimensional construct. This study performed a comprehensive assessment of the latent structure of AjD symptomatology and assessed its concurrent and discriminant validity. Individuals who experienced involuntary job loss (N = 333) completed a self‐report measure of AjD symptoms. Seven alternative models of AjD were tested using confirmatory factor analysis. General psychological distress, impairment in social functioning, occupational self‐efficacy, and sense of coherence were used as criterion variables for construct validity. In the confirmatory factor analysis, a bifactor solution with one dominant general AjD factor and 5 correlated group factors (preoccupation, failure‐to‐adapt, avoidance, affective reaction, and impulsivity) provided optimal fit. As expected, the AjD factor showed strong positive associations with general psychological distress and impairments in social functioning and moderately negative associations with occupational self‐efficacy and sense of coherence. With regard to unidimensionality or multidimensionality of AjD symptoms, the current results indicate the plausibility of a unidimensional conceptualization. Future research should focus on essential key characteristics and a reduction of symptoms for the AjD definition.

Adjustment disorders (AjDs) usually resolve after the precipitating life event and its consequences are terminated. However, they bear the risk for the development of severe mental illness. The present study investigates the natural course of AjD as defined for International Classification of Diseases, 11th version (ICD-11). A total of 303 individuals who involuntarily lost their jobs were assessed initially after the job loss and 6 months later. Latent class latent change analysis and multinomial logistic regression were performed. Two groups showed low (n = 149, 49.2%) and medium (n = 108, 35.6%) symptom severity at initial assessment that declined over time. The third group (n = 46, 15.2%) showed a high initial response and a small effect of worsening of symptoms. Female gender, higher age, first dismissal, impaired social functioning, dysfunctional disclosure, less social support, and less social acknowledgment were associated with belonging to the latter group. It might be beneficial to target individuals at high risk with interventions that aim at the improvement of skills relevant for stress management.

Background/Objective: The 11th revision of the International Classification of Diseases (ICD-11) will provide a new definition of adjustment disorder (AjD). The aim of the present study is to report on prevalence and correlates of ICD-11 AjD in a high-risk sample. Method: Three hundred thirty persons who had lost their job involuntarily were sampled by local job centres. The Munich Composite International Diagnostic Interview was administered with a new AjD module. Associations between AjD and correlates were investigated with logistic regression analyses. Results: 27.3% of the participants reported the AjD core symptom pattern. 13.8% men and 17.2% women met diagnostic guidelines of ICD-11 AjD. Prevalence increased with age and exposure to multiple stressors. The AjD core symptom pattern was associated with various sociodemographic correlates (e. g., lower financial household budget), whereas the full ICD-11 diagnosis including the exclusion algorithm was not. Regarding work-related factors, AjD occurred with a lower probability if the last job position had higher responsibilities and more general confidence for the future. Conclusions: ICD-11 AjD has a high prevalence among persons who lost their jobs involuntarily. Healthcare professionals should be aware of this problem. Research to investigate the ICD-11 AjD concept in the general populations and other subpopulations is needed.

BACKGROUND:Few strictly prospective-longitudinal community studies examined the role of traumatic events for risk of developing a broad range of incident mental disorders over several years.METHOD:A representative community sample of adolescents and young adults (n = 2797, baseline age 14-24) was prospectively examined in up to three assessment waves over up to 10 years. Traumatic events and DSM-IV mental disorders were assessed at each wave using the DIA-X/M-CIDI. Associations between traumatic events (meeting the DSM-IV A1-criterion for posttraumatic stress disorder, PTSD) or qualifying traumatic events (meeting the DSM-IV A2-criterion) at baseline and incident disorders at follow-up were tested with logistic regressions adjusted for gender and age.RESULTS:While traumatic and qualifying traumatic events at baseline were related to various baseline disorders, considerably fewer associations were found in strictly prospective analyses with incident disorders at follow-up as outcomes. After adjustment for baseline disorders, only (a) the association of traumatic events with incident specific phobias (Odds Ratio, OR = 1.6) and (b) the associations of qualifying traumatic events with incident specific phobias (OR = 1.6), PTSD (OR = 2.5) and major depressive episodes (OR = 1.4) remained significant.CONCLUSION:Targeted prevention and early intervention among traumatized individuals may be particularly beneficial to lower the incidence of specific phobias and MDE besides PTSD.LIMITATIONS:Associations between traumatic events and incident mental disorders might be underestimated, as cases developing psychopathology immediately after trauma exposure prior to baseline were excluded in our strictly prospective analyses.

Adjustment disorder (AjD) is a frequent but under‐researched diagnosis due in part to a lack of specific symptom criteria and adequate tools of measurement. The ICD‐11 for the first time proposes a positive symptom catalogue to define AjD. This study presents a validation of the Adjustment Disorder – New Module (ADNM), the first symptom severity measure for AjD according to the ICD‐11 concept. Validity and sensitivity to change were investigated in a sample of 190 individuals with a DSM‐IV diagnosis of AjD. The ADNM scales demonstrated convergent and discriminant validity for anxiety symptoms (Hamilton Anxiety Scale; psychic anxiety r = 0.18–0.31), functional impairment (Sheehan Disability Scale; r = 0.18–0.47), and depression (Montgomery–Asberg Depression Scale; r = 0.13–0.30). At baseline 78% of the individuals with a DSM‐IV diagnosis of AjD were also classified so by the ADNM. Repeated‐measures ANOVA indicated significant ADNM‐symptom decrease during treatment, replicating the patterns of the Hamilton Anxiety Scale, Sheehan Disability Scale, and Clinical Global Impression Scale. This article presents the first use of the ADNM as a measure for ICD‐11 AjD in a randomized‐controlled intervention study of AjD. It provides support for the construct validity and sensitivity to symptom change of this scale during pharmacological treatment.

For the 11th revision of the International classification of diseases, a general category of posttraumatic stress disorders has been proposed with two distinct sibling disorders: posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD). General population data are examined on evidence for these two disorders. Data were drawn from a 10-year prospective longitudinal, epidemiological study with a representative community sample (N = 3021, 14–24 years at baseline) in Germany. Mixture modelling on latent classes was conducted in a subset of all reported episodes with exposure to interpersonal traumas. Associations between class membership, symptom criteria, and other mental disorders were investigated. Four distinctly interpretable latent classes were found. Class 1 episodes (N = 181) typically included core PTSD symptoms associated with strong impairment (OR 11.68; 95 % CI 4.54–30.05). 18.3 % of these episodes matched the criteria of ICD-11 PTSD. Class 2 episodes (N = 78) had a high probability of PTSD core symptoms and disturbances in self-organization and were associated with strong impairment (OR 38.47; 95 % CI 15.77–93.86). Half of them (49.4 %) matched the proposed ICD-11 criteria of CPTSD. Class 3 (N = 79) was typically characterized by episodes with disturbances in self-organization but a low probability of PTSD core symptoms and impairment. Class 4 (N = 633) was related to a relatively low probability of symptom reports. Membership in class 2 was associated with lower educational attainment, a lower social class, and more other mental disorders. Findings support the ICD-11 proposal to differentiate between PTSD and CPTSD. Further studies should extend exploration to other types of traumatic events in samples covering the full age range.

As part of the development of the Eleventh Revision of International Classification of Diseases and Related Health Problems (ICD-11), the World Health Organization Department of Mental Health and Substance Abuse is conducting a series of case-controlled field studies using a new and powerful method to test the application by clinicians of the proposed ICD-11 diagnostic guidelines for mental and behavioural disorders. This article describes the case-controlled field study for Disorders Specifically Associated with Stress. Using a vignette-based experimental methodology, 1,738 international mental health professionals diagnosed standardized cases designed to test key differences between the proposed diagnostic guidelines for ICD-11 and corresponding guidelines for ICD-10. Across eight comparisons, several proposed changes for ICD-11, including the addition of Complex PTSD and Prolonged Grief Disorder, produced significantly improved diagnostic decisions and clearer application of diagnostic guidelines compared to ICD-10. However, several key areas were also identified, such as the description of the diagnostic requirement of re-experiencing in PTSD, in which the guidelines were not consistently applied as intended. These results informed specific revisions to improve the clarity of the proposed ICD-11 diagnostic guidelines. The next step will be to further test these guidelines in clinic-based studies using real patients in relevant settings.

AIM OF THE STUDY:For the 11th revision of the International Classification of Diseases and Related Health Problems (ICD-11) attitudes of psychologists towards classificatory diagnostics should be considered.METHOD:A survey was conducted via the Internet in 22 countries. 1985 psychologists participated with N=170 from Germany and N=37 from Switzerland.RESULTS:The German participants preferred the ICD. Classificatory diagnostics should inform on treatment as well as serve for communication. The majority argued for a flexible use and guidance towards strict criteria. In contrast to respondents from other countries, a functional status as part of the diagnostic criteria was not considered but in line with them, a dimensional component was endorsed.CONCLUSION:Responses of the German psychologists partially differ to those of participants from other countries. Differences and implications are discussed.

Background: There is little prospective-epidemiological information on symptoms of DSM-IV-alcohol use disorder (alcohol abuse and dependence; AUD) that may be typical for early AUD stages or the developmental periods of adolescence and early adulthood. Aims: To investigate AUD symptoms (AUDS) cross-sectionally at three subsequent assessment waves regarding prevalence rates, symptom counts, associated drinking patterns, positive predictive values (PPV) for DSM-IV-alcohol dependence (AD), and AUDS stability over time.Methods: N=2039 community subjects (baseline age 14-24 years) participated in a baseline and two follow-up assessment(s) over up to ten years. DSM-IV-AUDS, DSM-IV-AUD and craving were assessed with the DSM-IV/M-CIDI.Results: Over the assessment waves, tolerance and much time were most and role obligations and withdrawal least frequent. Most subjects with DSM-IV-AUDS reported only one symptom (47.2-55.1%). PPV for DSM-IV-AD only exceeded 70% for activities, problem, withdrawal, and desired control; PPV were lowest for tolerance and hazardous use. For most AUDS, AUDS report compared to non-report was associated with elevated drinking frequency and amounts. Stability of baseline AUDS at four-year and ten-year follow-up did not exceed 36.4% for any symptom.Conclusions: The overall pattern of most/least frequent AUDS reported in adolescence and early adulthood resembles findings in older adults and does not suggest a developmentally specific symptom pattern. Moderate AUDS-stability and considerable remission rates indicate that AUDS in this age group are transient for a considerable proportion of subjects. However, the associations with elevated consumption indicate that AUDS reports early in life need to be taken seriously in prevention and intervention. (C) 2013 Elsevier Ireland Ltd. All rights reserved.

BACKGROUND: In 2005, findings of the first “cost of disorders of the brain in Europe” study of the European Brain Council (EBC) showed that these costs cause a substantial economic burden to the Swiss society. In 2010 an improved update with a broader range of disorders has been analysed. This report shows the new findings for Switzerland and discusses changes. METHODS: Data are derived from the EBC 2010 census study that estimates 12-month prevalence of 12 groups of disorders of the brain and calculates costs (direct health-care costs, direct non-medical costs and indirect costs) by combining top-down and bottom up cost approaches using existing data. RESULTS: The most frequent disorder was headache (2.3 million). Anxiety disorders were found in 1 million persons and sleep disorders in 700,000 persons. Annual costs for all assessed disorders total to 14.5 billion Euro corresponding to about 1,900 EUR per inhabitant per year. Mood, psychotic disorders and dementias (appr. 2 billion EUR each) were most costly. Costs per person were highest for neurological/neurosurgery-relevant disorders, e.g. neuromuscular disorders, brain tumour and multiple sclerosis (38,000 to 24,000 EUR). CONCLUSION: The estimates of the EBC 2010 study for Switzerland provide a basis for health care planning. Increase in size and costs compared to 2005 are mostly due to the inclusion of new disorders (e.g., sleep disorders), or the re-definition of others (e.g., headache) and to an increase in younger cohorts. We suggest coordinated research and preventive measures coordinated between governmental bodies, private health-care and pharmaceutical companies.

Background: Numerous studies have documented an association between mental disorders and onset of cigarette smoking. Yet, there is little understanding of the potential impact of mental disorders on trajectories of smoking over time. The objective of this study was to investigate this relationship among adolescents over a 10-year span.Methods: Data were drawn from the Early Developmental Stages of Psychopathology Study, a 10-year prospective investigation of youth in Germany. Growth mixture modeling was used to identify smoking trajectories and logistic regression analyses were used to examine relationships between mental disorders and subsequent trajectories.Results: Four trajectories were identified: non-users; increasing use; decreasing use; persistent use. Alcohol/drug use disorders, stress disorders, anxiety disorders, somatoform disorder and nicotine dependence were associated with nicotine use (as compared to the non-smoker class). However, comparisons between trajectories of nicotine use showed that any stress disorder predicted only decreasing use compared to the other two trajectories; nicotine dependence, alcohol/illicit drug use disorders as well as panic disorder and somatoform disorders were inversely associated with increasing use; nicotine dependence and alcohol/drug use disorders were associated with persistent use.Conclusions: Several mental disorders appear to be non-specific markers of the range of smoking trajectories while others predict specific trajectories. Numerous disorders (e.g., alcohol/drug use disorders) do not appear to occur only prior to and predict increased smoking trajectory as had been previously suggested, but rather they also occur concurrently, with high levels of smoking and in some cases smoking persists at a steady level over time. (C) 2012 Elsevier Ireland Ltd. All rights reserved.