Adjustment Conditions

The adjustment conditions fall at the milder end of the stress spectrum. For a stress related illness to be compensable under commonwealth legislation, the presence of an identifiable clinical condition must be established. The minimal condition therefore is an adjustment disorder which must be distinguished from distress, a fit of temper or a negative attitude. An adjustment condition is a short-term maladaptive reaction to an identifiable environmental stressor. It is associated with the onset of a range of stress symptoms and a definite but temporary impairment in personal and/or occupational functioning. Typical examples include the individual who goes through a marital breakdown or is subject to severe workload pressures or sudden changes in their job and, consequently, develops a number of stress symptoms such as depressed mood, agitation, reduced concentration, headaches, sleeping difficulties etc. After a period of time, which might be four weeks or three months, or longer, that individual will tend to resume their normal functioning.

Adjustment conditions tend to exhibit either a primary depressive or anxious quality, or can have both anxiety and depressive features. Common diagnostic terms within the adjustment group of conditions include: brief stress reaction, reactive depression, adjustment disorder with mixed emotional features. In current diagnostic systems (eg. the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders6) adjustment conditions are defined as being of a maximum of six months duration. Thus, if an individual receives a diagnosis of an adjustment disorder and is off work for longer than six months, they may have been misdiagnosed, developed other psychological problems or, as sometimes occurs, their clinical condition has resolved and other issues of vocational dissatisfaction or career direction have superseded the original problem.

Some individuals who meet the formal criteria for an adjustment disorder do not lodge compensation claims. We know this from reviewing individuals presenting in employee assistance counselling programmes whose level of dysfunction may be similar to others who do lodge claims. There are many factors that influence the decision to lodge a compensation claim including organisational culture, perceptions of support, personal values, work attitudes etc. The important point here is that many of these milder stress problems can be managed in the workplace.7  Availability of effective conflict resolution procedures, team-building programmes, employee assistance counselling and other human resource interventions can prevent the occurrence of these milder stress problems or minimize their impact.

Clarification of the nature of adjustment type stress conditions and early decision making in claims management can also prevent the over-medicalization of these stress problems. Previously, some individuals with mild stress problems would see their local medical practitioner who would initially give them time off work. They would then return to the GP who may, if the problem persisted, prescribe minor tranquillisers or anti-depressant medication, or send them to a psychiatrist. This passive management process of drug treatment, prolonged time at home, and possible referral to a psychiatrist with further time delays in gaining an appointment, unwittingly served to exacerbate the stress problems of some individuals. These secondary stress problems are now declining with reductions in turnaround time for liability decisions, increased early access to workplace-based interventions and a widening recognition of the importance of active psychosocial treatments in managing stress.

Adjustment conditions respond to a broad range of interventions including workplace initiatives, support counselling, crisis management and stress reduction techniques. Some adjustment disorders resolve with the passage of time or a change in the circumstances associated with onset.