Prevalence and predictors of adjustment disorder in patients with an implantable cardioverter-defibrillator

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). 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.