Adjustment disorder and role change in Australian oncology patients: A longitudinal rural-urban perspective study

Purpose: Adjustment disorder is common in those experiencing cancer due to the ongoing stressors associated with diagnosis, treatment, and survivorship. These stressors include changes to the roles an individual feels able to fulfil and the support available to them. This study considers adjustment disorder in those with (or surviving) cancer and the factors that predict it (role changes) and influence its severity (gender and rurality).

Methods: A longitudinal quantitative study measured adjustment disorder with the 8-item Adjustment Disorder New Module, and role change with a visual analogue scale. At T₁, 182 participants with (or surviving) cancer completed questionnaires and agreed to follow-up, 72 responded 12 months later at T₂.

Results: Those reporting clinical levels of adjustment disorder at baseline were six times more likely to report the same at T₂; this risk was significantly higher for rural participants. Levels of adjustment disorder remained stable across 12-months. Only rural males reported an increase in role change. The degree of role change reported at baseline predicted adjustment disorder at T₂ for rural participants.

Conclusions: This study underscores the heightened risk of persistent adjustment disorder symptomology over time, for those with (or surviving) cancer who have experienced significant adjustment difficulties earlier in the journey. Role change emerged as a predictive factor in adjustment disorder for those from rural communities. These findings highlight the need for screening for adjustment disorder at multiple time points and offer insights into the psychological challenges faced by cancer patients, particularly those in rural areas.