Search

Background: Prompts offer a promising strategy to promote client engagement in internet-delivered cognitive behavioral therapy (ICBT). However, if the prompts do not meet the needs of clients, they can potentially be more obtrusive rather than helpful., Objective: The aim of this study was to test if prompts tailored based on timing and frequency, aligned with preintervention goal setting, can increase usage and the efficacy of a therapist-supported ICBT stress recovery intervention for health care workers., Methods: The 2-arm randomized controlled trial included 87 health care workers (99% female, aged 19-68 years: mean 39.61, SD 11.49): 43 in the standard intervention group and 44 in the tailored prompts group. The primary outcome measure was the Recovery Experiences Questionnaire, and the secondary outcomes were the Perceived Stress Scale-4, the Patient Health Questionnaire-4, and the World Health Organization-5 Well-Being Index. The self-report data were collected before the intervention (September 2022), postintervention (October 2022), and 6-month follow-up (May 2023)., Results: The results showed that tailored prompts, although appreciated by the majority (39/40, 98%), did not improve intervention usage indicators, such as the number of logins (t 85 =-0.91; P=.36), modules opened (t 83.57 =-1.47; P=.15), modules completed (t 85 =-0.71; P=.48), exercises completed (t 85 =-1.05; P=.30), or the time spent using the program (χ 2 2 =1.1; P=.57). Similarly, tailored prompts did not increase the effects of the intervention in terms of stress recovery skills (Cohen d ranging from 0.31 to 0.85), perceived stress (d=-0.08; -0.70), depression (d=-0.11; -0.38), anxiety (d=-0.32; -0.64), or psychological well-being (d=0.26; 0.46). In addition, the standard intervention group showed greater long-term stress recovery effects than the group using the internet-delivered intervention supplemented by tailored prompts (β=-0.24, P=.03)., Conclusions: Although the study confirmed the efficacy of the program, the merits of tailored prompts in ICBT for stress recovery were not supported. Future research is needed to test the effects of the stress recovery intervention supplemented by goal setting and tailored prompts., Trial Registration: ClinicalTrials.gov NCT05553210; https://clinicaltrials.gov/study/NCT05553210., (©Auguste Nomeikaite, Odeta Gelezelyte, Maria Böttche, Gerhard Andersson, Evaldas Kazlauskas. Originally published in JMIR Mental Health (https://mental.jmir.org), 28.01.2025.)

Background: Posttraumatic stress disorder (PTSD) is a common mental disorder. However, many cases of PTSD remain untreated because of limited healthcare resources and other treatment-seeking barriers. Effective internet-based interventions could help to improve access to PTSD treatments. Therefore, the main objective of the planned randomized controlled trial is to evaluate the efficacy of the Lithuanian version of the guided internet-based self-help programme (Spring) in reducing ICD-11 PTSD symptoms., Methods: The planned sample size is 50 participants exposed to different traumatic experiences. Participants eligible for the study will be randomized into two study groups: the immediate treatment group and the delayed treatment control group. Both groups will receive guided trauma-focused ICBT intervention, but the delayed treatment group will receive access to the programme five months after randomization. The International Trauma Interview (ITI) will be used for the assessment of ICD-11 PTSD symptoms at pre-treatment, post-treatment, and at a 3-month follow-up. Changes in disturbances in self-organization, depression and anxiety levels, as well as posttraumatic cognitions and trauma-related shame, will also be evaluated. In addition, associations between changes in symptoms of PTSD and readiness for treatment, treatment expectations and working alliance will be explored. Changes in treatment outcomes will be evaluated using multiple Latent Change Models., Discussion: This study is expected to contribute to valuable knowledge on the efficacy of internet-based interventions for posttraumatic stress disorder., Trial Registration: ClinicalTrials.gov NCT06475716. Registered on 25 June 2024., (© 2024. The Author(s).)

Objectives: The study aimed to assess the mental health and well-being of Lithuanian healthcare workers by gathering demographic information, identifying common stressors affecting the work environment, evaluating mental health, and exploring directions for psychosocial care. Additionally, the research explored the prevalence of considering a career change among respondents., Material and Methods: The study included 1618 responders who completed an online survey in December 2021 - January 2022. Participants included in this study: physicians, nurses, residents and other healthcare workers. It evaluated their demographics, most common stressors affecting their work environment and mental health on the Depression, Anxiety and Stress Scale - 21 (DASS-21) scale. Lastly, all responders asked if they had considered changing their occupation to a non-medical job. Univariate analysis was performed using χ2 and Student's t test, and binary logistic regression evaluated career change predictors., Results: Career change was considered by 1081 (66.8%) responders. The main career change predictors were poor working conditions (OR 1.91, p < 0.001), direct contact with patients (OR 1.84, p < 0.001), lack of career perspectives (OR 1.95, p < 0.001), mobbing (OR 1.67, p = 0.001) and exhaustion (OR 1.51, p = 0.005). After evaluating DASS-21 scores, it was found that 23% of respondents had severe and extremely severe depression symptoms, 27.4% severe and extremely severe anxiety, and 21.4% had severe and extremely severe stress levels., Conclusions: Lithuanian healthcare workers are in high distress and have poor mental health. They are in need psychosocial assistance to avoid burnout and staff loss. Int J Occup Med Environ Health. 2024;37(3):287-99., (This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.)

Background: The COVID-19 pandemic caused multiple stressors that may lead to symptoms of adjustment disorder. Objective: We longitudinally examined relationships between risk and protective factors, pandemic-related stressors and symptoms of adjustment disorder during the COVID-19 pandemic, as well as whether these relationships differed by the time of assessment. Method: The European Society for Traumatic Stress Studies (ESTSS) ADJUST Study included N = 15,169 participants aged 18 years and above. Participants from 11 European countries were recruited and screened three times at 6-month intervals from June 2020 to January 2022. Associations between risk and protective factors (e.g. gender), stressors (e.g. fear of infection), and symptoms of adjustment disorder (AjD, ADNM-8) and their interaction with time of assessment were examined using mixed linear regression. Results: The following predictors were significantly associated with higher AjD symptom levels: female or diverse gender; older age; pandemic-related news consumption >30 min a day; a current or previous mental health disorder; trauma exposure before or during the pandemic; a good, satisfactory or poor health status (vs. very good); burden related to governmental crisis management and communication; fear of infection; restricted social contact; work-related problems; restricted activity; and difficult housing conditions. The following predictors were associated with lower AjD levels: self-employment or retirement; working in healthcare; and face-to-face contact ≥ once a week with loved ones or friends. The effects of the following predictors on AjD symptoms differed by the time of assessment in the course of the pandemic: a current or previous mental disorder; burden related to governmental crisis management; income reduction; and a current trauma exposure. Conclusions: We identified risk factors and stressors predicting AjD symptom levels at different stages of the pandemic. For some predictors, the effects on mental health may change at different stages of a pandemic.

Internet-delivered cognitive behavioral therapy (ICBT) interventions can be as effective as traditional face-to-face therapy for various mental health conditions. However, a significant challenge these online interventions face is the high rate of people who start but then stop using the program. This early discontinuation can be seen as incomplete treatment and can reduce the potential benefits for users. By exploring why people stop using ICBT programs, we can better understand how to address this problem. This study aimed to examine the experiences of healthcare workers who had stopped using a therapist-guided internet-delivered stress recovery program to gain deeper insights into usage attrition. We conducted semi-structured interviews with twelve participants who were female healthcare workers ranging in age from 24 to 68 years ( M  = 44.67, SD  = 11.80). Telephone interviews were conducted and the data were transcribed and analyzed using thematic analysis. Qualitative data analysis revealed that most participants had multiple reasons for discontinuing the program. They identified both barriers and facilitators to using the program, which could be categorized as either personal or program related. Personal aspects included life circumstances, personal characteristics, and psychological responses to the program. Program-related aspects encompassed technical factors, program content, and the level of support provided. The findings of this study can enhance our understanding of why people stop using guided internet-delivered programs. We discuss the practical and research implications, with the ultimate aim of improving the design and efficacy of internet interventions., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Objective: A lack of training in PTSD assessment and treatment can cause nonrecognition, misdiagnosis, or mistreatment of trauma-exposed patients in clinical practice. To fill the gap of the measures of trauma care-related competencies, the current study aimed to test psychometric properties of the novel Readiness to Work with Trauma-Exposed Patients Scale (RTEPS) in a sample of clinicians., Method: The study sample comprised 279 Lithuanian mental health professionals (91% psychologists and 9% psychiatrists). The mean age of study participants was 41.09 ( SD = 10.68), 93.9% were female. Almost half of the participants (49.1%) had more than 10 years of work experience in the field of mental health, and 61.3% of clinicians reported routinely seeing trauma-exposed patients in their clinical practice., Results: Exploratory structural equation modeling and confirmatory factor analysis revealed that a three-factor, first-order model of the 10-item self-report RTEPS comprising competencies of assessment, treatment, and affect tolerance showed the best fit for the data. Additionally, previous trauma-focused training experience but not work experience was significantly associated with perceived readiness to work with trauma-exposed patients while controlling for the rates of depression and anxiety of mental health professionals., Conclusions: The findings of the study provide evidence of the RTEPS validity based on test content, internal structure, relations to other variables as well as internal consistency. The RTEPS scale is a brief and easily administered instrument that could be used in the context of training or clinical setting to evaluate the trauma care competencies among professionals. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Internet-delivered CBT interventions effectively improve different aspects of mental health, although the therapist's role remains unclear. The aim of this trial was to evaluate the efficacy of a therapist-supported 6-week internet-delivered intervention in improving stress recovery among healthcare workers compared to a group with optional therapist support. A total of 196 participants were recruited and randomly allocated to regular therapists' support or optional therapists' support groups. The primary outcome measure was the Recovery Experiences Questionnaire (REQ), developed to assess four components of stress recovery: psychological detachment, relaxation, mastery, and control. Secondary outcomes measured perceived stress (PSS-10), anxiety (GAD-7), depression (PHQ-9), and psychological well-being (WHO-5). All four stress recovery skills improved significantly after participating in the intervention at a 3-month follow-up, with small to medium effects (0.27-0.65) in both groups. At follow-up, we also found a significant reduction in perceived stress, depression, and anxiety in both groups, as well as an improvement in psychological well-being. The results indicate that ICBT can be effective in improving stress recovery skills among healthcare workers with optional support from the therapist, provided at the participants' request. This RCT suggests that optional therapist support could meet participants' needs and reduce resources needed in routine care.

Background: The four-item Patient Health Questionnaire-4 (PHQ-4) is a widely used screening measure for depression and anxiety., Objectives: This study aimed to test factor structure and measurement invariance in an adult sample of the general population across seven European countries., Method: A total sample of 9230 adults, 71.3 % female, M age  = 44.35 (SD = 14.11) from seven countries (Austria, Croatia, Georgia, Germany, Lithuania, Portugal, and Sweden) participated in the study. We applied confirmatory factor analysis (CFA) to examine the factor structure and measurement invariance testing to evaluate measurement equivalence across countries, gender, and age groups., Results: The CFA yielded that a two-factor PHQ-4 model with separate depression and anxiety factors had the best fit. Partial scalar measurement invariance was established across different groups based on gender, age, and country., Conclusions: The PHQ-4 is a valid and reliable measure that can be applied to screen for depression and anxiety in the general population., Limitations: The limitation of the study includes the sampling, which resulted in the sample structure with the majority of females, predominantly of high education and from urban communities., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Healthcare workers (HCWs) often experience high levels of stress, anxiety, and depression due to high workloads and responsibilities in their professional activities. Therefore, recovery from work-related stress is highly important in HCWs. The Recovery Experience Questionnaire (REQ) is a 16-item self-reported measure covering four stress recovery domains: psychological detachment from work, relaxation, mastery, and control. The current study aimed to test the REQ's psychometric properties in a sample of Lithuanian HCWs. In total, 471 HCWs from various healthcare institutions participated in this study. Confirmatory factor analysis (CFA) was used to test the structure of the REQ. We also used the Brief Patient Health Questionnaire (PHQ-4) and the World Health Organization Psychological Well-Being Index (WHO-5) to assess the mental health of the study participants. The CFA analysis supported the correlated four-factor structure of the REQ. Furthermore, we found significant correlations between the levels of REQ and anxiety, depression, and well-being. We conclude that the REQ is a valid measure that could be a useful tool in research on HCWs' mental health. It could also be used in healthcare settings for the evaluation of well-being among healthcare staff.

Background: The current definitions of resilience can be addressed as a process, an outcome, or a trait. Empirical studies should be carried out to determine the most appropriate definition for it. Therefore, the main aim of the current study was to investigate changes in adolescents' resilience over two years and explore the links between resilience and different forms of child maltreatment., Methods: The three-wave longitudinal study "Stress and resilience in adolescence" (STAR-A) sample was comprised of a general school-based sample of Lithuanian adolescents [baseline N = 1295, 56.7% females; M(SD) age  = 14.24 (1.26)]. Resilience was measured using the 14-item Resilience Scale (RS-14), lifetime exposure to maltreatment was measured at wave 1 using a questionnaire developed by the Norwegian Center for Violence and Traumatic Stress Studies (NKVTS), risk of psychopathology-using the Strengths and Difficulties Questionnaire (SDQ). The changes in resilience scores over the period of two years were investigated using the latent growth modeling approach., Results: The analyses revealed two classes of resilience-stable higher and stable lower. We found that experience of at least one form of abuse was significantly more prevalent in the lower resilience group in comparison to the higher resilience group. Also, adolescents with lower resilience had a higher probability of psychopathology., Conclusions: This study provided meaningful insights into the stability of resilience over time in adolescence and its relation to various types of child maltreatment. Experiences of maltreatment, as well as risk for psychopathology, were linked to lower resilience in adolescence., (© 2023. The Author(s).)

Background: Further developments in trauma care training for mental health staff are needed to ensure that trauma survivors are recognised and get the most effective care. The evaluation of the effects of trauma care training programs would enable the untangling of the most efficient ways of building the competence of clinicians who encounter trauma-exposed patients in their routine clinical practice., Objective: We aimed to analyse longitudinal changes in mental health professionals' perceived trauma care competencies after a brief online trauma care training, and to examine associations between these changes and specific work-related characteristics., Method: In total, 223 mental health professionals, 96.4% women, 42 years on average, and 51.6% with more than 10 years of clinical practice, participated in a brief online trauma care training programme. The Readiness to Work with Trauma-Exposed Patients Scale (RTEPS) was used to measure perceived trauma care competencies at the pre-training, post-training, and at a 3-month follow-up., Results: Training had a significant effect on all measured perceived trauma care competencies of assessment, treatment and affect tolerance at post-training and 3-month follow-up. We also found that many years of unspecific clinical practice did not contribute to perceived trauma care competencies, and the training was perceived equally beneficial by professionals with more or less clinical practice., Conclusions: Our study indicates that brief training can have lasting effects on clinicians' self-confidence in trauma care. Further investigation of factors associated with the effects of training might help to increase the effectiveness of the training programs.

Background: After the inclusion of a novel diagnosis of Complex Posttraumatic Stress Disorder (CPTSD) in the 11th edition of the International Classification of Diseases (ICD-11), there is a growing need for research focused on not only studying the underlying risk factors of this disorder but also differentiating the risk factors of Posttraumatic Stress Disorder (PTSD) and CPTSD to understand better the factors leading to CPTSD onset and symptom maintenance., Aims: This study aimed to explore the prevalence of traumatic experiences, trauma-related disorders and risk factors associated with ICD-11 PTSD and CPTSD in a population-based Lithuanian sample using the International Trauma Questionnaire (ITQ)., Methods: The study sample included 885 participants (age M [ SD ] = 37.96 [14.67], 63.4% female). The Life Events Checklist was used to measure trauma exposure, PTSD and CPTSD symptoms were measured by the Lithuanian ITQ version. The Disclosure of Trauma Questionnaire (DTQ) was used to measure the urge or reluctance to talk about trauma., Results: The prevalence of at least one traumatic experience in the study sample was 81.4%. The prevalence of PTSD and CPTSD among the general population in Lithuania was 5.8% and 1.8%, respectively. Accumulative lifetime trauma exposure, sexual assault and assault with a weapon were significant predictors for both PTSD and CPTSD. Participants from the CPTSD group reported greater reluctance to disclose trauma and stronger emotional reactions than no diagnosis and PTSD groups. Results also indicate that the Lithuanian ITQ version is a valid measure for screening PTSD and CPTSD in the general population., Conclusion: Previous history of trauma and interpersonal trauma were associated with posttraumatic stress disorders but did not differentiate between PTSD and CPTSD in our study. However, social trauma-related factors, such as trauma disclosure, were associated with stronger CPTSD symptoms.

Background: The COVID-19 pandemic had an impact on many risk and protective factors associated with suicide. Aims: The aim of this study was to identify pandemic-related factors associated with suicidal ideation in the two European countries, Lithuania and Poland, amid the COVID-19 pandemic. Method: The sample comprised 2,459 participants in both countries; 57.2% of the respondents were female. The M age of the participants was 43.45 years ( SD = 15.91). Pandemic-related stressors and adjustment problems were measured to assess associations with suicidal ideation. Results: High levels of adjustment problems, loneliness, and burden due to staying at home more during the COVID-19 pandemic were significantly associated with suicide ideation in both Lithuania and Poland. Limitations: This was a cross-sectional online study with different recruitment approaches in the two countries. Conclusion: Adjustment problems, loneliness, and stressors related to staying at home more could be important targets for suicide prevention amid the pandemic.

Highlights: N  =  4,607 trauma-exposed adult participants were recruited from the general population during the first year of the COVID-19 pandemic.The prevalence for probable posttraumatic stress disorder was 17.7%.We identified risk factors (e.g. poor health condition) and protective factors (e.g. social contact) associated with posttraumatic stress disorder.

Background: The 11th revision of the International Classification of Diseases (ICD-11) included two distinct trauma-related diagnoses-Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD). The initial diagnostic factor for both disorders is exposure to a traumatic event. This study aimed to explore whether exposure to different traumatic experiences distinguish risk for PTSD and CPTSD., Methods: The study sample comprised 158 trauma-exposed participants, M (SD) age  = 33.61(9.73). The Life Events Checklist-Revised (LEC-R) was used to evaluate trauma exposure, and the International Trauma Questionnaire (ITQ) was used to assess risk for ICD-11 PTSD and CPTSD. Multinomial logistic regression was used to determine traumatic events as predictors of risk for PTSD and CPTSD., Results: Analysis revealed that sexual abuse experienced in childhood or adulthood was associated with both PTSD and CPTSD. History of other unwanted sexual experiences and childhood physical abuse predicted CPTSD compared to PTSD, whereas exposure to natural disasters predicted PTSD compared to CPTSD., Conclusions: The results showed that experiences of certain traumatic events, such as sexual trauma, childhood physical abuse or natural disasters, might help distinguish risk for PTSD and CPTSD. Nevertheless, future studies on specific aspects of trauma exposure are necessary., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kairyte, Kvedaraite, Kazlauskas and Gelezelyte.)

Background: The 11th revision of the International Classification of Diseases (ICD-11) includes a new diagnosis of complex posttraumatic stress disorder (CPTSD). There has been very little research investigating associations between CPTSD symptoms and suicide risk following sexual abuse. This and questions concerning similarities and differences between CPTSD and borderline personality disorder (BPD), led to the current study that aimed to explore indirect associations between sexual abuse and suicide risk through the symptoms of CPTSD and borderline traits., Methods: The study sample comprised 103 adults with a history of traumatic experiences (M age = 32.64, SD age = 9.36; 83.5% female). In total, 26.3% of the participants reported experiencing sexual abuse during their lifetime. The clinician-administered International Trauma Interview (ITI) was used for the assessment of ICD-11 CPTSD symptoms. Self-report measures were used for the evaluation of borderline pattern (BP) symptoms and suicide risk. Mediation analyses were performed to evaluate the mediating effects of CPTSD and BP symptoms for the association between sexual trauma and suicide risk., Results: In a parallel mediation model, CPTSD and BP symptoms mediated the association between sexual abuse and suicide risk, following adjustment for the covariates of age, gender, and whether the traumatic experience occurred in childhood or adulthood. Around 73% of participants who met diagnostic criteria for CPTSD reported previous suicide attempt(s)., Conclusions: Suicide risk assessment and intervention should be an important part of the management of victims of sexual abuse with CPTSD and BP symptoms., (© 2022. The Author(s).)

Aim: Suicide ideation has increased since the outbreak of Covid-19 in many countries. The present longitudinal study investigated potential predictors of suicide ideation., Subject and Methods: Data of 406 participants from Germany (age M  = 27.69, SD  = 6.88) were assessed via online surveys in spring 2020 (baseline, BL) and in spring 2021 (follow-up, FU)., Results: The current results reveal a significant increase in symptoms of depression, anxiety, and stress between 2020 and 2021. Positive mental health (PMH), sense of control, and physical health significantly decreased. Depression symptoms (BL), PMH (BL), and consciously enhanced physical activity since the pandemic outbreak (FU) significantly predicted 12-month suicide ideation (FU). In a moderated mediation analysis, the positive relationship between depression and suicide ideation was significantly mediated by PMH. Consciously enhanced physical activity significantly moderated the negative association between PMH and suicide ideation., Conclusion: The context of Covid-19 could negatively impact mental health and physical health. This might increase the risk for suicide ideation. However, PMH and physical activity might serve as protective factors. The protective effect of physical activity could be especially important in people with high depression symptoms and low PMH, such as clinical patients. Potential ways of how PMH and physical activity could be enhanced in the Covid-19 context to prevent suicide ideation are discussed., Competing Interests: Conflicts of interestThe authors declare that they have no conflicts of interest., (© The Author(s) 2022.)

Background: The 11 th revision of the International Classification of Diseases (ICD-11) includes a new diagnosis of complex posttraumatic stress disorder (CPTSD). The International Trauma Interview (ITI) is a novel clinician-administered diagnostic interview for the assessment of ICD-11 PTSD and CPTSD., Objective: The aim of this study was to evaluate the psychometric properties of the ITI in a Lithuanian sample in relation to interrater agreement, latent structure, internal reliability, as well as convergent and discriminant validity., Method: In total, 103 adults with a history of various traumatic experiences participated in the study. The sample was predominantly female (83.5%), with a mean age of 32.64 years ( SD  = 9.36). For the assessment of ICD-11 PTSD and CPTSD, the ITI and the self-report International Trauma Questionnaire (ITQ) were used. Mental health indicators, such as depression, anxiety, and dissociation, were measured using self-report questionnaires. The latent structure of the ITI was evaluated using confirmatory factor analysis (CFA). In order to test the convergent and discriminant validity of the ITI we conducted a structural equation model (SEM)., Results: Overall, based on the ITI, 18.4% of participants fulfilled diagnostic criteria for PTSD and 21.4% for CPTSD. A second-order two-factor CFA model of the ITI PTSD and disturbances in self-organization (DSO) symptoms demonstrated a good fit. The associations with various mental health indicators supported the convergent and discriminant validity of the ITI. The clinician-administered ITI and self-report ITQ had poor to moderate diagnostic agreement across different symptom clusters., Conclusion: The ITI is a reliable and valid tool for assessing and diagnosing ICD-11 PTSD and CPTSD., Competing Interests: Neil Roberts, Marylene Cloitre, Jonathan Bisson and Chris Brewin are co-authors of the ITI. The remaining co-authors of the current publication have no conflict of interest to disclose., (© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

We aimed to identify patterns of changes in suicidal ideation among university students six months after the COVID-19 outbreak, in comparison to the pre-pandemic suicidal ideation. Furthermore, we explored the links among these patterns and mental health indicators. 474 university students participated in the study in October-December 2019 and October-December 2020. The latent class change analysis revealed four groups: no-ideation (68.1%), stable low ideation (16.2%), increased ideation (8.9%), and decreased ideation (6.8%). Increased, in comparison to decreased ideation, was positively linked to changes in depression, stress, and anxiety. More loneliness during the pandemic was related to higher suicidal ideation.

Multiple empirical studies have revealed significant pandemic effects of COVID-19 on mental health in various populations. This study aimed to analyze the incidences of posttraumatic stress disorder (PTSD) and adjustment disorder (AjD) in national healthcare in 2018-2020 in one of the European countries-Lithuania-and estimate the effect of the COVID-19 pandemic on PTSD and AjD incidences in 2020. The national healthcare registry was used for estimations of diagnosis of PTSD, AjD, and major depressive disorder (MD). The study revealed that stress-related disorders PTSD and AjD are diagnosed rarely, resulting in a considerable gap between the expected prevalence and incidences of these diagnoses in healthcare in Lithuania. Moreover, a significant decline in mental disorders incidence in healthcare in 2020, in comparison to 2018 and 2019, was found, revealing that the COVID-19 pandemic had a negative impact on access to healthcare services and increased barriers for mental disorders treatment. The study indicates that major developments in building up knowledge about the effects of trauma and life stressors on mental health are needed in Lithuania and other countries to increase awareness about stress-related disorders and improve care for trauma survivors, in particular in the context of the pandemics or other large-scale disasters.

Background: The COVID-19 pandemic exposes individuals to multiple stressors, such as quarantine, physical distancing, job loss, risk of infection, and loss of loved ones. Such a complex array of stressors potentially lead to symptoms of adjustment disorder., Objective: This cross-sectional exploratory study examined relationships between risk and protective factors, stressors, and symptoms of adjustment disorder during the first year of the COVID-19 pandemic., Methods: Data from the first wave of the European Society of Traumatic Stress Studies (ESTSS) longitudinal ADJUST Study were used. N =  15,563 participants aged 18 years and above were recruited in eleven countries (Austria, Croatia, Georgia, Germany, Greece, Italy, Lithuania, the Netherlands, Poland, Portugal, and Sweden) from June to November 2020. Associations between risk and protective factors (e.g. gender, diagnosis of a mental health disorder), stressors (e.g. fear of infection, restricted face-to-face contact), and symptoms of adjustment disorder (ADNM-8) were examined using multivariate linear regression., Results: The prevalence of self-reported probable adjustment disorder was 18.2%. Risk factors associated with higher levels of symptoms of adjustment disorder were female gender, older age, being at risk for severe COVID-19 illness, poorer general health status, current or previous trauma exposure, a current or previous mental health disorder, and longer exposure to COVID-19 news. Protective factors related to lower levels of symptoms of adjustment disorder were higher income, being retired, and having more face-to-face contact with loved ones or friends. Pandemic-related stressors associated with higher levels of symptoms of adjustment disorder included fear of infection, governmental crisis management, restricted social contact, work-related problems, restricted activity, and difficult housing conditions., Conclusions: We identified stressors, risk, and protective factors that may help identify individuals at higher risk for adjustment disorder., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial interests that could be perceived as a potential conflict of interest., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)