Harris Bernadette E, Rice Kylie, Murray Clara V, Thorsteinsson Einar B
School of Psychology, University of New England, Armidale, NSW, 2351, Australia.
Biopsychosoc Med. 2023 Jan 25;17(1):2. doi: 10.1186/s13030-022-00259-w.
Evidence suggests that up to 30% of cancer patients may meet the criteria for adjustment disorder. However, no assessment instruments have been validated for use with cancer patients. The Adjustment Disorder New Module (ADNM)-8 and ADNM-4 are brief screening tools for adjustment disorder mapped directly to the new ICD-11 criteria. The aim of this study was to investigate the factor structure and validity of both instruments in an Australian sample of adult oncology patients. METHODS: A total of 405 participants with a cancer diagnosis were recruited online from across Australia. Participants reported cancer-specific information, such as time since diagnosis, treatment stage, cancer stage, type of cancer, and the following questionnaires: 8-item Adjustment Disorder New Module (ADNM-8), the World Health Organisation Well-Being Index (WHO-5), and the short form Depression Anxiety and Stress Scale (DASS-21). The predictiveness of stressors was assessed using multiple regression analysis and the structure of the ADNM-8 and the ADNM-4 was tested using confirmatory factor analysis. RESULTS: Six previously tested models were examined, and the results suggested a 2-factor structure reflecting the two ICD-11 diagnostic criteria clusters of preoccupation with the stressor and failure to adapt was a good fit for both scales. The ADNM-4 outperformed the longer version of the scale on numerous fit indices though the ADNM-8 and ADNM-4 were highly correlated. Correlations of both scales with the psychological distress scale, the stress subscale, and the wellbeing index indicated good construct validity.
Our results suggest that the ADNM-8 and ADNM-4 are useful screening tools for assessing adjustment disorder symptoms in cancer patients. The prompt screening of cancer patients encourages early intervention for those at risk of adaptation difficulties and informs research and clinical decisions regarding appropriate treatments.
有证据表明，高达30%的癌症患者可能符合适应障碍的标准。然而，尚无经验证可用于癌症患者的评估工具。适应障碍新模块（ADNM）-8和ADNM-4是直接根据新的国际疾病分类第11版（ICD-11）标准制定的适应障碍简短筛查工具。本研究的目的是在澳大利亚成年肿瘤患者样本中调查这两种工具的因子结构和效度。
通过网络从澳大利亚各地招募了405名癌症诊断患者。参与者报告了癌症特异性信息，如确诊后的时间、治疗阶段、癌症分期、癌症类型，并填写了以下问卷：8项适应障碍新模块（ADNM-8）、世界卫生组织幸福指数（WHO-5）以及抑郁焦虑压力量表简版（DASS-21）。使用多元回归分析评估应激源的预测性，并使用验证性因子分析测试ADNM-8和ADNM-4的结构。
检查了六个先前测试的模型，结果表明反映ICD-11关于对应激源的过度关注和适应失败这两个诊断标准集群的二因子结构与两个量表都非常契合。尽管ADNM-8和ADNM-4高度相关，但ADNM-4在众多拟合指数上优于该量表的较长版本。两个量表与心理困扰量表、压力子量表和幸福指数的相关性表明其具有良好的结构效度。
我们的结果表明，ADNM-8和ADNM-4是评估癌症患者适应障碍症状的有用筛查工具。对癌症患者进行快速筛查有助于对有适应困难风险的患者进行早期干预，并为有关适当治疗的研究和临床决策提供依据。
