The network structure of ICD-11 Adjustment Disorder: A cross-cultural comparison of three African countries

Levin, Yafit; Bachem, Rahel; Karatzias, Thanos; Shevlin, Mark; Maercker, Andreas; Ben-Ezra, Menachem

Abstract

Background: Adjustment disorder (AjD) is one of the most widespread mental disorders worldwide. In ICD-11, AjD is characterized by two main symptom clusters; preoccupation with the stressor and failure to adapt. The network analytic approach has been applied to most ICD-11 stress related disorders. However, no study to date explored the relations between symptoms of AjD using network analysis.
Aims: We aimed to explore AjD symptoms network and whether its structure replicates across questionnaire versions and samples.
Methods: A network analysis was conducted on AjD symptoms as assessed by the Adjustment Disorder–New Module (ADNM-8) and an ultra-brief version (ADNM-4) using data from 2,524 participants in Nigeria (n = 1006), Kenya (n = 1018), and Ghana (n = 500).
Results: There were extensive connections between items across all samples in both ADNM versions. Results highlight that preoccupation symptoms seem to be more prominent in terms of edges strengths and had the highest centrality in all networks across samples and ADNM versions. Comparisons of network structure invariance revealed one difference between Nigeria and Ghana in both ADNM versions. Importantly, the ADNM-8 global strength was similar in all networks whereas in the ADNM-4 Kenya had a higher global strength score compared to Nigeria
Conclusions: Results provide evidence of the coherence of AjD in the ICD-11 as assessed by the ADNM questionnaire. The prominence of preoccupation symptoms in AjD highlight a possible therapeutic target to alleviate distress. There is a need to further replicate the network structure of AjD in non-African samples.

• Journal Article Type: Article
• Acceptance Date: Mar 16, 2021
• Online Publication Date: Apr 19, 2021
• Publication Date: 2021-10
• Deposit Date: Mar 24, 2021
• Publicly Available Date: Oct 20, 2021
• Print ISSN: 0007-1250
• Publisher: Royal College of Psychiatrists
• Peer Reviewed: Peer Reviewed
• Volume: 219
• Issue: 4
• Pages: 557-564
• DOI: https://doi.org/10.1192/bjp.2021.46
• Keywords: ICD-11 Adjustment Disorder; Statistical Methodology; Trauma; Individual Psychotherapy
• Public URL: http://researchrepository.napier.ac.uk/Output/2755318