Journal of psychosomatic research · 2026
Prevalence and predictors of adjustment disorder in patients with an implantable cardioverter-defibrillator.
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Sila Rahel, von Känel Roland, Attanasio Veronica, Dörner Marc, Guth Lisa, Zirngast Sina, Nager Ladina, Pazhenkottil Aju P, Menzi Anna, König Noelle, Hackl-Zuccarella Claudia, Princip Mary
Аннотация
BACKGROUND: Patients with an implantable cardioverter-defibrillator (ICD) face multiple challenges, including cardiac disease and shock discharges. Compared to anxiety, depression, and PTSD, adjustment disorder (AjD) remains under-researched. This study examined the prevalence and predictors of AjD in ICD patients using ICD-11 criteria.
METHODS: A cross-sectional sample of 245 patients completed self-report questionnaires assessing AjD (ADNM-20), anxiety (GAD-7), social support (ESSI), alexithymia (TAS-20), and number of shocks. A chi-squared test analyzed group differences in AjD-cut off based on shock experience. Hierarchical regression models tested predictors in three groups: sociodemographic variables (model a), adding psychological factors (model b), and additionally number of shocks (model c).
RESULTS: AjD prevalence was 17.6%. Participants with shock experience were more likely to exceed the AjD cut-off than those without (χ2(1) = 4.78, p = .029, φ = 0.143). All three regression models were significant; the full model explained 59.1% of variance (F(9, 235) = 37.80, p < .001, R2 = 0.59). Anxiety was the strongest predictor (B = 2.22, p < .001), followed by number of shocks (B = 0.89, p = .040). Other psychological and sociodemographic variables were not significant. Unemployment lost significance after controlling for other predictors.
DISCUSSION: AjD is a relevant condition in ICD patients, with anxiety being the primary driver. Shock experience qualifies as a stressor. Systematic screening for psychological distress is recommended before and after implantation, and especially after shocks. Longitudinal research is needed to track the trajectory over time of AjD and long-term consequences.
METHODS: A cross-sectional sample of 245 patients completed self-report questionnaires assessing AjD (ADNM-20), anxiety (GAD-7), social support (ESSI), alexithymia (TAS-20), and number of shocks. A chi-squared test analyzed group differences in AjD-cut off based on shock experience. Hierarchical regression models tested predictors in three groups: sociodemographic variables (model a), adding psychological factors (model b), and additionally number of shocks (model c).
RESULTS: AjD prevalence was 17.6%. Participants with shock experience were more likely to exceed the AjD cut-off than those without (χ2(1) = 4.78, p = .029, φ = 0.143). All three regression models were significant; the full model explained 59.1% of variance (F(9, 235) = 37.80, p < .001, R2 = 0.59). Anxiety was the strongest predictor (B = 2.22, p < .001), followed by number of shocks (B = 0.89, p = .040). Other psychological and sociodemographic variables were not significant. Unemployment lost significance after controlling for other predictors.
DISCUSSION: AjD is a relevant condition in ICD patients, with anxiety being the primary driver. Shock experience qualifies as a stressor. Systematic screening for psychological distress is recommended before and after implantation, and especially after shocks. Longitudinal research is needed to track the trajectory over time of AjD and long-term consequences.