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Background There is cumulative evidence of the importance of exploring the change of dynamics between symptoms over time as reflective of consolidation of psychopathology. Aims To explore the interactions between symptoms of ICD-11 adjustment disorder before and after the second lockdown of the COVID-19 pandemic in Israel and identify the most central symptoms and their concurrent and prospective associations with probable adjustment disorder. Method This is a population-based study drawn from a probability-based internet panel. A representative sample of the adult Israeli population was assessed at two time points (T1, pre-second lockdown, n = 1029, response rate 76.17%; T2, post-second lockdown, n = 764, response rate 74.24%). Symptoms of adjustment disorder were assessed by the International Adjustment Disorder Questionnaire (IADQ). Results Although the overall strength of associations at the two measurement points was similar and two same communities were found, there was a significant change in their structure, with a more consolidated network at T2. The most central item was ‘difficult to relax’ in both networks. Cross-sectionally, all symptoms of failure to adapt significantly predicted adjustment disorder. ‘Worry a lot more’ (preoccupation) and ‘difficult to adapt to life’ (failure to adapt) at T1 significantly predicted this diagnosis at T2. Conclusions Adjustment disorder symptoms consolidated during the second lockdown of the pandemic. In line with the ICD-11 conceptualisation of adjustment disorder, both preoccupation and failure-to-adapt symptoms have prognostic validity. This highlights the importance of identifying and targeting adjustment disorder symptoms during a period of stress such as the COVID-19 pandemic.

The outbreak of the COVID-19 pandemic has confronted humanity with an ongoing biopsychosocial stressor, imposing multifaceted challenges to individuals and societies. Particularly, the pandemic reflects an ongoing, potentially life-threatening danger to self and others, which may instigate acute stress symptoms (ASS). This study utilized a network framework to assess cross-national ASS a short time following the initial COVID-19 outbreak. Three samples of adult participants from China, Israel, and Switzerland completed a self-report assessment of acute stress symptoms. Network analyses were utilized to uncover the phenotype and dynamics of different ASS in these three countries. The ASS network analyses revealed extensive connections in all networks and reflected the structure of ASS. The centrality indexes in all networks were from the hyperarousal cluster. “Feeling jumpy” was the node with the highest strength centrality in the Israeli sample and “physiological reactivity” was the item with the highest centrality in the Swiss sample. In the Chinese sample, the item with the highest centrality was “feeling alert to danger." The findings reveal that despite some variations, the overall clinical picture of ASS in response to the COVID-19 pandemic is universal. These findings highlight the centrality of hyperarousal symptoms, presumably reflecting its significance for clinical interventions.

Zusammenfassung Ziel Es ist davon auszugehen, dass eine komplexe Posttraumatische Belastungsstörung (kPTBS) nach ICD-11 die Betroffenen auch im beruflichen Bereich beeinträchtigt. Die vorliegende Arbeit untersucht daher, ob zwischen Patienten mit positivem Screening auf eine kPTBS, Patienten mit positivem Screening auf eine PTBS und Patienten mit negativem Screening auf Traumafolgestörungen Unterschiede bezüglich ihrer arbeitsbezogenen Verhaltens- und Erlebensmuster (AVEM) bestehen. Methodik Teilnehmer waren 566 Patienten einer psychosomatischen Rehabilitationsklinik (Alter M=50,96, SD 8,73 Jahre; 70,3% weiblich). Die Teilnehmer bearbeiteten zu Beginn ihres stationären Aufenthalts Selbstbeurteilungs-/ Screeninginstrumente. Univariate Varianzanalysen wurden eingesetzt, um Gruppenunterschiede in den arbeitsbezogenen Verhaltens- und Erlebensmustern zu beurteilen. Der AVEM erfasst auf 11 Dimensionen gesundheitsförderliche bzw. -gefährdende Verhaltens- und Erlebensweisen bei der Bewältigung von Arbeits- und Berufsanforderungen. Ergebnisse Auf 8 von 11 AVEM-Dimensionen zeigten sich signifikante Unterschiede zwischen den Gruppen „kein Verdacht“ und „kPTBS“. Die Gruppen „PTBS“ und „kPTBS“ unterscheiden sich signifikant auf den Dimensionen „Resignationstendenzen“, „Offensive Problembewältigung“ und „Lebenszufriedenheit“. Die Gruppen „kein Verdacht“ und „PTBS“ unterschieden sich hingegen nicht signifikant. Diskussion Patienten mit Verdacht auf kPTBS stellen im Arbeitskontext eine besonders belastete Patientengruppe dar. Es erscheint inhaltlich plausibel, dass die in der ICD-11 für die kPTBS formulierten Probleme im Bereich der Selbstorganisation zu den gefundenen problematischen Verhaltens- und Erlebensmuster führen können. Schlussfolgerung Dies spricht dafür, dass für Patienten mit kPTBS spezielle Interventionen im Rahmen der medizinisch-beruflich orientierten Rehabilitation sinnvoll sind, um diese Defizite zu kompensieren und die Teilhabe am Erwerbsleben zu erhalten.

Childhood maltreatment (CM) is linked to impairments in various domains of social functioning. Here, we argue that it is critical to identify factors that underlie impaired social functioning as well as processes that mediate the beneficial health effects of positive relationships in individuals exposed to CM. Key research recommendations are presented, focusing on: (1) identifying attachment-related alterations in specific inter- and intrapersonal processes (e.g., regulation of closeness and distance) that underlie problems in broader domains of social functioning (e.g., lack of perceived social support) in individuals affected by CM; (2) identifying internal (e.g., current emotional state) and external situational factors (e.g., cultural factors, presence of close others) that modulate alterations in specific social processes; and (3) identifying mechanisms that explain the positive health effects of intact social functioning. Methodological recommendations include: (1) assessing social processes through interactive and (close to) real-life assessments inside and outside the laboratory; (2) adopting an interdisciplinary, lifespan perspective to assess social processes, using multi-method assessments; (3) establishing global research collaborations to account for cultural influences on social processes and enable replications across laboratories and countries. The proposed line of research will contribute to globally develop and refine interventions that prevent CM and further positive relationships, which – likely through buffering the effects of chronic stress and corresponding allostatic load – foster resilience and improve mental and physical health, thereby reducing personal suffering and the societal and economic costs of CM and its consequences. Interventions targeting euthymia and psychological well-being are promising therapeutic concepts in this context.

The present study investigates whether secondary traumatization (i.e., family history of Holocaust survival and secondary exposure to captivity) is implicated in subjective age. Women exposed to different levels of secondary traumatization (N = 177) were assessed. Analyses of variance (ANOVAs) revealed that a Holocaust background and husband's captivity had a marginally significant positive effect on age appearance. Women with a Holocaust background whose husbands were held captive reported older interest age, indicating double jeopardy for older subjective age when two sources of secondary traumatization are present. A similar trend existed for behavior age. Possible explanations for these complex findings of risk and resilience are discussed.

Background Symptom network analysis has become an essential tool for researchers and clinicians investigating the structure of mental disorders. Two methods have been used; one relies on partial correlations, and the second relies on zero order correlations with forced-directed algorithm. This combination was used to examine symptom connections for ICD-11 Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) as the symptoms for these disorders have been known to be organized in a multi-dimensional and hierarchical fashion. We aimed to examine whether networks of ICD-11 CPTSD symptoms reproduced across samples from three African countries. Methods We produced network models based on data from 2524 participants in Nigeria (n = 1018), Kenya (n = 1006), and Ghana (n = 500). PTSD and CPTSD symptoms were measured using the International Trauma Questionnaire (Cloitre et al., 2018). Results The CPTSD network analysis using force-directed method alongside partial correlations based on Gaussian Graphical Models (GGM) revealed the multidimensional-hierarchal structure of CPTSD. The within-cluster symptoms of Disturbances in Self Organization (DSO) and PTSD were strongly correlated with each other in all networks, and the cross-cluster symptoms were lower. The most central symptom was ‘feelings of worthlessness’, a symptom of Negative Self-Concept that is part of the CPTSD cluster. The networks were very similar across the three countries. Conclusions Findings support the ICD-11 model of PTSD and CPTSD in three African countries.

Background In the aftermath of trauma not only the primary traumatized survivors’ mental health is affected but often also their significant others. The current study explores the specific associations of ICD-11 symptoms of posttraumatic stress disorder (PTSD) and disturbances in self organization (DSO) for secondary traumatic stress and dyadic adjustment among both spouses. Methods Male Israeli veterans and their wives (N = 216) were assessed 30 years after the war. Primary PTSD/DSO symptoms of the veterans and secondary posttraumatic stress symptoms (secondary PTSS)/DSO of the wives were assessed. Actor Partner Independence Modelling (APIM) evaluated the differential effects of PTSD and DSO for trauma transmission and dyadic adjustment. Results While veterans’ primary PTSD only related to secondary PTSS of the wives, the veterans’ DSO predicted the wives’ secondary PTSS as well as DSO. Moreover, the APIM revealed that the primary and secondary DSO of both partners were associated with dyadic adjustment while their PTSD symptoms were not. Limitations The cross-sectional data did not allow to identify directional or causal effects and DSO symptoms were not assessed with an ICD-specific instrument as such scales did not exist at the time of data collection. Conclusions ICD-11 DSO symptoms seem to drive the transmission of posttraumatic stress among spouses to a more significant extent than PTSD symptoms. As DSO are also strongly implicated in decreased dyadic adjustment, they are valuable targets for couple therapy after one spouse experienced severe trauma, both in order to prevent interpersonal trauma transfer as well as to enhance dyadic adjustment.

Background: A growing number of studies report that the COVID-19 pandemic has resulted in diverse aversive psychological reactions and created a global mental health crisis. However, the specific mechanisms underlying the negative emotional reactions as well as the differences between countries are only beginning to be explored. The present study examined the association of COVID-19-related fear and negative affect in Israel and Switzerland. The mediating roles of three control beliefs were explored, namely, fatalism, locus of control, and perceived institutional betrayal. Method: General population samples of 595 Swiss and 639 Israeli participants were recruited and completed an online self-report survey. Moderated Mediation using multigroup path analysis models for the two samples were conducted and compared using AMOS. Results: The multigroup path model had excellent fit for both samples. The different paths were moderated by country affiliation. Higher levels of COVID-19-related fear were associated with negative affect to an equal extent in both samples. COVID-19-related fear was associated with higher reports of institutional betrayal and a lower locus of control in both samples. Higher COVID-19-related fear was associated with lower fatalism in the Swiss sample only. In both samples, institutional betrayal mediated the association between COVID-19-related fear and negative affect, however, locus of control was a mediator in the Israeli sample only. Conclusion: The current results suggest that the reaction of the government was of crucial importance with regard to the emotional state of the two populations. Interestingly, while in the context of adversity fatalism is generally considered a risk factor for mental health, during the time of the pandemic it seems to have had protective qualities among the Swiss population. Interventions that strengthen the personal locus of control have the potential to mitigate the negative affect in Israel but not in Switzerland. Despite the fact that COVID-19 is a global phenomenon, prevention and intervention strategies should be adjusted to local contexts.

Background: Adjustment disorder (AjD) is one of the most frequently used diagnoses in psychiatry but a diagnostic definition for AjD was only introduced in release of the ICD-11. This study sought to develop and validate a new measure operationalizing the ICD-11's narrative description of AjD, and to determine the current rate of people meeting the symptoms indicative of AjD in the general population of the Republic of Ireland. Methods: The International Adjustment Disorder Questionnaire (IADQ) was constructed to measure the core diagnostic criteria of ICD-11 AjD: stressor exposure, preoccupations with, and failure to adapt to, the stressor, timing of symptom onset, and functional impairment. A nationally representative sample (N = 1,020) of adults from Ireland completed the IADQ. Results: Confirmatory factor analysis supported construct validity and the reliability estimates were excellent. The IADQ correlated strongly with depression, anxiety, and posttraumatic stress. The criteria were met by 7.0% of the sample, adjusted for other exclusionary disorders. Discussion: The IADQ is a measure based on the ICD-11's description and produces reliable scores, however it should not be used for clinical assessment until validated with clinical interviews.

Among the most prevalent and adverse sequalae of traumatic experiences are negative world assumptions (WAs), which describe trauma-related negative cognitions regarding the self, the world, and others. Even though a wealth of studies has shown intrapersonal associations between negative WAs and posttraumatic stress symptoms (PTSS), there has been little research on how WAs may affect family systems. This study examined the intergenerational associations between parental WAs, paternal PTSS, and maternal secondary traumatic stress (STS) on adult–children’s STS in veterans’ families. It was hypothesized that negative paternal WAs would mediate the association between parental PTSS/STS and adult–children’s STS. Three domains of WAs (benevolence of the world, meaningfulness of the world, and self-worth) and PTSS were prospectively assessed in 123 father–mother–offspring triads of former Israeli veterans of the 1973 Yom Kippur War, their wives and adult offspring. Data were collected in 2003, 2008, and 2014, and analyzed using triadic path modeling. Mothers’ STS was associated with children’s STS via negative maternal WAs on world benevolence. Fathers’ PTSS was related to children’s STS via fathers’ WAs on world benevolence and self-worth. Moreover, fathers’ WAs on world benevolence and self-worth mediated the intergenerational transmission of STS from mothers to offspring. No effects were found for meaningfulness WAs. Findings suggest that parental WAs related to world benevolence and paternal self-worth contribute to intergenerational trauma transmission. Clinical implications favor cognitive and systemic approaches to therapy that address negative benevolence and self-worth assumptions and involve the entire family system.

Objective: Long-term trajectories of posttraumatic stress disorder (PTSD) may fluctuate over time and typically conform to four heterogeneous patterns: resilience, recovery, delayed-onset, and chro...

Background Adjustment disorder is among the most frequently diagnosed mental disorders in clinical practice although it has received little academic attention and been the subject of substantial criticism over the past decades. While those suffering with adjustment disorders are often treated by mental health professionals, research interest in the origin of the disorder or the effectiveness of psychotherapeutic and medical interventions has only recently begun to emerge. This article summarizes the empirical literature published on adjustment disorder and points out current diagnostic developments in DSM-5 and ICD-11. Methods Literature for this review was identified through established online search tools, including publications in English, German, and Spanish. Results This paper reviews literature on the evolution of adjustment disorder, and highlights the current state of research with regard to genesis and treatment. Importantly, for the first time ICD-11 intends to define adjustment disorder by explicit symptom groups, unlike DSM-5. Limitations Publications without an English abstract were not included. Conclusions Key directions for future research include investigating the concordance of the ICD-11 and DSM-5 concepts and the effect that the diverging conceptualizations may have. Risk and protective factors specific to AD should be identified and the biological underpinnings of the disorder should be explored. Finally, given the high prevalence of AD in certain clinical settings effective disorder-specific interventions should be developed and evaluated.

The purpose of this study was to quantify the association between childhood traumatic experiences and geriatric depression (GDS) in a population of elderly who were exposed to severe childhood trauma. We aimed to identify the role of childhood maltreatment exposure in geriatric depression and the developmental and contextual factors that exacerbate this relationship. We interviewed 141 former indentured child laborers (58 females) about their experiences as children and their current depressive symptoms (Mage=77, SD=6.8). Participants provided their age, the year they were first indentured, duration indentured, current physical health, completed the Childhood Trauma Questionnaire (CTQ) and the Geriatric Depression Scale (GDS). Child maltreatment, specifically emotional abuse, was strongly associated with geriatric depression symptoms. These effects were specific to individuals who were removed from their biological families between the ages of 3 and 9 years, and for children who were indentured for 6-12 years. Finally, depression partially mediated the association between medical conditions and daily health impairment, but not for individuals "at risk" for depression by virtue of their maltreatment experiences. This study was conducted with a specific subpopulation of elderly and therefore may not generalize to all geriatric depression, nor to all generations or populations with exposure to childhood adversity. This study demonstrates the importance of using a developmental framework to understand how childhood maltreatment facilitates increased risk for the development of depression in late life.

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.