Adjustment disorders: prevalence in a representative nationwide survey in Germany
Open accessAbstract
Objectives This is the first study to estimate the prevalence of adjustment disorder (AjD) in the general population. A new conceptualisation of AjD as a stress response syndrome was applied, which allowed AjD to be assessed directly from its symptom profile, including intrusive, avoidance and failure-to-adapt symptoms (Maercker et al., Psychopathology 40:135-146, 2007).Methods Prevalence rates of distressing life events and AjD were estimated from a representative sample of the German general population (n = 2,512) with a broad age range (14-93 years). A questionnaire including a life events checklist and self-rating questions that assessed AjD symptoms and symptom duration were personally handed out by an interviewer.Results The prevalence of AjD fulfilling the criterion of clinically significant impairment was 0.9%; a further 1.4% of the sample was diagnosed with AjD without fulfilling the impairment criterion. In ~72.5% of AjD cases, symptoms had developed 6-24 months prior to assessment. AjD was most often associated with acute events such as moving or chronic stressors such as serious illness, conflicts at the respondent's job or with friends or neighbours (with ~5% conditional probability each).Conclusions The results correspond with the few other studies that have examined the prevalence of AjD, even though a new conceptualisation of the disorder was used. Explorative results regarding the duration of AjD syndromes and symptoms call for further redefinition and empirical investigation of this under-researched mental condition.
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Differentiation of adjustment disorder from other psychiatric disorders such as major depression and generalised anxiety is a problem because the criteria are underdeveloped and rudimentary.
“The differentiation from other psychiatric disorders such as major depression and generalised anxiety is a further problem since the criteria are underdeveloped and rudimentary.”
From Adjustment disorder: Implications for ICD-11 and DSM-5 (2012) · cites this paper as [5]
The Introduction identifies unresolved validity problems with adjustment disorder, including the criterion excluding diagnoses of other disorders. The Discussion says its diagnostic criteria lack specific symptoms, supporting the concern about underdeveloped criteria. However, the paper does not specifically establish that these criteria make differentiation from major depression or generalised anxiety difficult; it says no other clinical diagnoses were assessed. (LLM, conf=0.84)
Experimental — accuracy not yet measuredICD-10 and DSM-IV-TR state that the diagnosis of adjustment disorder cannot be made when the symptom threshold for another condition is reached.
“Instead, ICD-10 4 and DSM-IV-TR 5 state that the diagnosis cannot be made when the symptom threshold for another condition is reached.”
From Adjustment disorder: Implications for ICD-11 and DSM-5 (2012) · cites this paper as [5]
In DSM-IV-TR, the threshold for major depression is reached after 2 weeks.
“In the case of major depression in DSM-IV-TR, that threshold is reached after 2 weeks”
From Adjustment disorder: Implications for ICD-11 and DSM-5 (2012) · cites this paper as [5]
The AjD criteria section discusses DSM-IV impairment criteria and measures symptom duration in month-long ranges, while the Discussion addresses the duration of adjustment disorder. Neither states a two-week DSM-IV-TR threshold for major depression; searches for that threshold and for major depressive episode criteria found no supporting passage in our copy. (LLM, conf=0.73)
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MODERN APPROACHES TO THE STUDY OF ADJUSTMENT DISORDERS (LITERATURE REVIEW)
PIDKORYTOV, V., & SKRYNNIK, O. (2025) · Ukrains kyi Visnyk Psykhonevrolohii · doi:10.36927/2079-0325-v33-is1-2025-13 · Cited by 1 · see citing works
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Diagnostik und Risikofaktoren der ICD-11 Anpassungsstörung
Lorenz, L., Makowski, L., & Maercker, A. R. A. (2019) · Trauma und Gewalt · doi:10.21706/tg-13-1-6 · Cited by 1 · see citing works
Self-citationLearning how to recover from stress-related disorders via internet-based interventions
Asplund, R. P. (2021) · Linköping studies in behavioural science · doi:10.3384/diss.diva-172685 · Cited by 1 · see citing works
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King Lear by William Shakespeare: first performed 1606
Richards, J. (2012) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.111.106195
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Cadre conceptuel et controverses dans les troubles de l’adaptation
Strain, J. J., Casey, P. R., & Psych, F. R. C. (2018) · Elsevier eBooks · doi:10.1016/b978-2-294-75659-7.00003-7
Storr, C. L., Lakin, D. P., & Tol, W. A. (2019) · Oxford University Press eBooks · doi:10.1093/oso/9780190916602.003.0013
Prevalence of mental disorders by sex among Hera General Hospital patients over the past 10 years
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Relationship between Traumatic and Stressful Experiences and Psychological Well-Being
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Self-citationAdjustment Disorder: Evolution of the Concept and Suggestions for ICD-11
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Kausalitätsbegutachtung bei psychischen Störungen
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“9 % festgestellt [3], was mit einer früheren europäischen Untersuchung anhand der ICD-10 Kriterien (1 %) übereinstimmt.”
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Körperliche Aktivität bei der Behandlung psychischer Erkrankungen
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Grundlagen der Diagnostik und Therapie
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“11,14 This study has several notable strengths.”
Kausalitätsbegutachtung bei psychischen Störungen
Widder, B. (2025) · Springer Reference Medizin · doi:10.1007/978-3-662-60980-4_122
Spezifisch Belastungs-assoziierte Störungen
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“Critics caution against pathologizing normative stress responses (Casey, 2014; Maercker et al., 2012), whereas others argue that AjD captures clinically meaningful distress and dysfunction that fall short of criteria for other diagnoses (Lorenz et al., 2018; Zelviene & Kazlauskas, 2017).”
InfluentialSpezifisch Belastungs-assoziierte Störungen
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Almaghrebi, A. H., AlHajjar, L. M., Alkusayer, A., Zahrani, S. A., & Jumah, M. A. (2026) · The Egyptian Journal of Neurology Psychiatry and Neurosurgery · doi:10.1186/s41983-026-01232-y
- Authors
- Maercker, A., Forstmeier, S., Pielmaier, L., Spangenberg, L., Brähler, E., & Glaesmer, H.
- Affiliations
- University of Zurich (CH)
- Leipzig University (DE)
- Venue
- Social Psychiatry and Psychiatric Epidemiology
- Published
- 2012-03-11
- Volume
- 47
- Issue
- 11
- Pages
- 1745-1752
- ISSN
- 0933-7954 (ISSN-L)
- 1433-9285
- OpenAlex
- W1969050509
- Cited by
- 92
- References
- 20
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 3 · 2023: 8 · 2022: 10 · 2021: 9 · 2020: 9 · 2019: 6 · 2018: 8 · 2017: 6 · 2016: 7 · 2015: 6 · 2014: 3 · 2013: 4 · 2012: 2
- FWCI
- 5.43
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Social Psychiatry and Psychiatric Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- reroDoc Digital Library (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- Arts and Humanities Research Council (AH/J001554/1)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- adjustment disorder, prevalence, stress response syndromes, life events, intrusion symptoms, avoidance symptoms, symptom duration, chronic stressors, serious illness, interpersonal conflict, general population
- MeSH terms
- Adjustment Disorders, Adolescent, Adult, Aged, Aged, 80 and over, Mental Disorders, Female, Germany, Health Surveys, Humans, Interviews as Topic, Life Change Events, Male, Middle Aged, Population Surveillance, Surveys and Questionnaires, Socioeconomic Factors, Stress Disorders, Post-Traumatic, Prevalence, Age Distribution, Sex Distribution, Young Adult
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