Network structure of ICD-11 Adjustment Disorder: A cross-cultural comparison of three African countries

Yafit Levin, Rahel Bachem, Thanos Karatzias, M Shevlin, Andreas Maercker, Menachem Ben‐Ezra

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6 Citations (Scopus)
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Background: Adjustment disorder (AjD) is one of the most widespread mental
disorders worldwide. In ICD-11, AjD is characterized by two main symptom clusters; preoccupation with the stressor and failure to adapt. The network analytic approach has been applied to most ICD-11 stress related disorders. However, no study to date explored the relations between symptoms of AjD using network analysis.
Aims: We aimed to explore AjD symptoms network and whether its structure
replicates across questionnaire versions and samples.
Methods: A network analysis was conducted on AjD symptoms as assessed by the Adjustment Disorder–New Module (ADNM-8) and an ultra-brief version (ADNM-4) using data from 2,524 participants in Nigeria (n = 1006), Kenya (n = 1018), and Ghana (n = 500).
Results: There were extensive connections between items across all samples in both ADNM versions. Results highlight that preoccupation symptoms seem to be more prominent in terms of edges strengths and had the highest centrality in all networks across samples and ADNM versions. Comparisons of network structure invariance revealed one difference between Nigeria and Ghana in both ADNM versions. Importantly, the ADNM-8 global strength was similar in all networks whereas in the ADNM-4 Kenya had a higher global strength score compared to Nigeria
Conclusions: Results provide evidence of the coherence of AjD in the ICD-11 as
assessed by the ADNM questionnaire. The prominence of preoccupation symptoms in AjD highlight a possible therapeutic target to alleviate distress. There is a need to further replicate the network structure of AjD in non-African samples.
Original languageEnglish
Pages (from-to)557-564
Number of pages8
JournalBritish Journal of Psychiatry
Issue number4
Early online date19 Apr 2021
Publication statusPublished (in print/issue) - 31 Oct 2021

Bibliographical note

Funding Information:
An internal research grant was awarded to M.B.-E. from Ariel University (grant no. RA1700000037). The sponsor had no involvement in study design, data collection, analysis, interpretation of the results, writing of the report or the decision to submit the article for publication.

Publisher Copyright:
Copyright © The Author(s), 2021. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.


  • ICD-11
  • Adjustment Disorder
  • Statistical Methodology
  • Trauma
  • Individual Psychotherapy
  • statistical methodology
  • trauma
  • ICD-11 adjustment disorder
  • individual psychotherapy


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