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Am J Psychiatry 1995; 152:523-528
Copyright © 1995 by American Psychiatric Association
Criterion and predictive validity of the diagnosis of adjustment disorder: a prospective study of youths with new-onset insulin- dependent diabetes mellitus
M Kovacs, V Ho and MH Pollock
Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213.
OBJECTIVE: The authors examined the criterion and predictive validity of
the diagnosis of adjustment disorder in a pediatric study group. METHOD:
Ninety-two school-age children with new-onset insulin-dependent diabetes
mellitus were evaluated repeatedly and were diagnosed by using DSM-III. The
criteria for adjustment disorder were further operationalized by requiring
four clinically significant symptoms or signs; the time frame for its onset
was extended to 6 months after the diagnosis of insulin-dependent diabetes.
Predictive validity was assessed in terms of new psychiatric disorders
other than adjustment disorder during the next 5 years. RESULTS: Of the 92
children, 33 developed adjustment disorder and five developed other
psychiatric disorders in response to the diagnosis of insulin-dependent
diabetes mellitus. Mean time from diabetes diagnosis to onset of adjustment
disorder was 29 days, the average episode length was 3 months, and the
recovery rate was 100%. Among youths with adjustment disorder in response
to the medical diagnosis, the 5-year cumulative probability of a new
psychiatric disorder was 0.48, compared to 0.16 among the other youths.
CONCLUSIONS: The findings generally support the criterion validity of the
diagnosis of adjustment disorder. However, episode duration and the
predictive validity of the diagnosis appear to be functions of the study
group being examined. In nonpsychiatrically referred pediatric patients,
early problems in adaptation to the stress of changed health status, as
evidenced by adjustment disorder, appear to signal vulnerability to later
psychopathology.
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