COMPARISON OF SYMPTOM SCALES IN OUTPATIENTS WITH ADJUSTMENT DISORDER AND POSTTRAUMATIC STRESS DISORDER
Authors: Kim *Daeho , Park Taejin 
Published: February 2025

Abstract

Objectives
Clinical assessment tools and rating scales tailored specifically for adjustment disorders are scarce, with many clinicians relying on scales designed for depression or PTSD. This study aimed to evaluate whether there are significant score differences between patients diagnosed with PTSD and those diagnosed with adjustment disorders using a PTSD symptom scale and to explore the appropriateness of existing scales for identifying adjustment disorder patients.

Methods
We used data cohort from an outpatient psychiatric clinic at Hanyang University Guri Hospital, Gyeonggi Province, South Korea. Of these, 109 were diagnosed with PTSD, and 61 were diagnosed with adjustment disorders. After excluding 18 respondents with unreliable responses, data from 101 PTSD patients and 51 adjustment disorder patients were analyzed. The Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) and the National Stressful Events Survey PTSD Short Scale (NSESSS) were used as assessment tools. Chi-square test, student's t-test, and the Mann-Whitney test were used to compare variables between two groups.

Results
Among those diagnosed with adjustment disorders, the most common stressor was workplace conflicts (n=15, 29.4%), followed by family conflicts (n=8, 15.7%), significant personal losses (n=4, 7.9%), divorce/separation (n=3, 5.9%), and various other events, including conflicts with neighbors, serious accidents, and assaults (each at 3.9%). Among PTSD-diagnosed individuals, the most common traumatic event was traffic accidents (n=38, 37.6%), followed by experiences of childhood abuse (n=19, 18.8%), major personal losses (n=12, 11.9%), physical assaults (n=11, 10.9%), and domestic violence (n=9, 8.9%). Other events such as work-related injuries, sexual assaults, and natural disasters were also reported.There were no significant demographic differences between the PTSD and adjustment disorder groups. PCL-5 scores showed a significant difference with an average score of 52.0 (SD=16.1) for the PTSD group and 41.3 (SD=19.3) for the adjustment disorder group (p &lt;0.001). NSESSS scores also revealed a statistically significant difference, with average scores of 24.7 (SD=6.9) for the PTSD group and 20.0 (SD=8.7) for the adjustment disorder group (p &lt;0.05). Mann-Whitney test results indicated a significant difference in severity between the two groups.

Conclusions
This study found that both the PCL-5 and NSESSS scales, developed for evaluating PTSD symptoms, showed higher average scores in the PTSD group compared to the adjustment disorder group. However, considering that the average score for adjustment disorder patients in this study was 41.25, it may be inappropriate to use these scales for initial assessment or screening purposes for adjustment disorder patients, especially when using the suggested clinical cutoff score for PTSD of 31-33. Therefore, the development of a reliable and valid scale for assessing the severity of adjustment disorders is needed, which requires a comprehensive analysis of the construct of adjustment disorders.