Bley Stephanie, Einsle Franziska, Maercker Andreas, Weidner Kerstin, Joraschky Peter
Universitätsklinikum Carl Gustav Carus Dresden, Klinik und Poliklinik für Psychotherapie und Psychosomatik, Dresden.
Psychother Psychosom Med Psychol. 2008 Dec;58(12):446-53. doi: 10.1055/s-2007-986294. Epub 2007 Dec 19.
Diagnoses of adjustment disorders are frequent in clinical settings, although diagnostic criteria are not very reliable or valid. This has led to a neglection of this topic in research. This article presents and applies a new concept (Maercker et al., 2007) for diagnosing adjustment disorders.
96 patients of a psychosomatic policlinic were examined regarding their emotional well-being with a new questionnaire (Adjustment Disorder--New Module | ADNM). Furthermore, according to the new concept, adjustment disorders were assessed with a structured interview. Coping behaviour (CISS) as well as general self efficacy (SWE) in patients with scores within a normal range and patients with elevated scores in ADNM, respectively, were examined. The following statistical measures were used: cluster analysis, cross tables, non-metrical and metrical test procedures.
The theory-guided evaluation of the ADNM questionnaire divided the whole sample into patients with elevated (49 %) and with normal (51 %) scores. A cluster analysis of patients with elevated scores showed two groups, so that a total of three groups were compared: patients with scores in a normal range; patients with elevated scores and a low number of symptoms; patients with elevated scores and a high number of symptoms. Patients with elevated scores showed significantly more emotion-oriented coping strategies (t = - 6.338; p = 0.000) and reported, referring to present stress, on being less able to cope with it (Z = - 4.445; p = 0.000). Patients with elevated scores and a high number of symptoms named more stress factors (Z = - 2.634; p = 0.008) and reported on being more impulsive and irritable (Z = - 3.406; p = 0.003). The comparison of the ADNM questionnaire and the clinical main diagnoses shows a separation between emotional and non-emotional disturbances according to ICD-10 (chi2(2, n = 96) = 6.928; p = 0.031).
The results show that the ADNM questionnaire according to the new diagnostic concept of adjustment disorders (Maercker et al., 2007) identifies patients who experience a high degree of stress caused by adverse life events of life conditions. The ADNM reliably differentiates non-emotional from emotional ICD-10 diagnoses. Further studies should examine, whether the new concept as well as the questionnaire are able to assess adjustment disorders in a valid and reliable way.
尽管适应障碍的诊断标准并非十分可靠或有效，但在临床环境中对其诊断却很常见。这导致该主题在研究中被忽视。本文介绍并应用一种用于诊断适应障碍的新概念（Maercker等人，2007年）。
使用一份新问卷（适应障碍——新模块|ADNM）对一家身心科门诊的96名患者的情绪健康状况进行检查。此外，根据新概念，通过结构化访谈对适应障碍进行评估。分别对ADNM得分在正常范围内的患者和得分升高的患者的应对行为（CISS）以及一般自我效能感（SWE）进行检查。使用了以下统计方法：聚类分析、交叉表、非度量和度量检验程序。
对ADNM问卷进行理论指导评估后，将整个样本分为得分升高的患者（49%）和得分正常的患者（51%）。对得分升高的患者进行聚类分析显示分为两组，因此总共比较了三组：得分在正常范围内的患者；得分升高且症状较少的患者；得分升高且症状较多的患者。得分升高的患者表现出明显更多的以情绪为导向的应对策略（t = -6.338；p = 0.000），并且提及当前压力时，表示更难以应对（Z = -4.445；p = 0.000）。得分升高且症状较多的患者指出更多的压力因素（Z = -2.634；p = 0.008），并报告更冲动和易怒（Z = -3.406；p = 0.003）。ADNM问卷与临床主要诊断的比较显示，根据国际疾病分类第10版（ICD - 10），情绪障碍和非情绪障碍之间存在区分（χ2(2, n = 96) = 6.928；p = 0.031）。
结果表明，根据适应障碍的新诊断概念（Maercker等人，2007年）制定的ADNM问卷能够识别出因生活条件中的不良生活事件而经历高度压力的患者。ADNM能够可靠地区分ICD - 10中的非情绪性诊断和情绪性诊断。进一步的研究应考察新概念以及该问卷是否能够以有效且可靠的方式评估适应障碍。
