Prevalence of Adjustment Disorder and Its Associated Factors among First Year Medical Students of the Faculty of Medicine, University of Ruhuna, Sri Lanka

Introduction:
Adjustment disorder is a stress-related condition that develops following identifiable stressors and is characterized by emotional and behavioural symptoms that impair functioning. First-year medical undergraduates experience multiple academic, social, and personal life changes that may predispose them to psychological distress. This study aimed to determine the prevalence of adjustment disorder and identify its associated factors among first-year medical students at the Faculty of Medicine, University of Ruhuna.

Methods:
A cross-sectional analytical study was conducted among 256 first-year medical undergraduates. Data were collected using a pre-tested self-administered questionnaire within the first three months of university entrance. Adjustment Disorder New Module-20 (ADNM-20) was used to assess the presence of adjustment disorder. ADNM-20 scores were categorized as low risk (<47.5) or high risk (≥47.5). Chi-square test and multiple logistic regression were used to identify independent predictors of adjustment disorder at a 0.05 significance level.

Results:
The mean age of the participants was 20.3 years, and 66.4% were females. A high prevalence of adjustment disorder was observed (62.1%). Avoidance (mean = 2.70) and depressed mood (mean = 2.69) were the most prominent symptoms. Several factors showed significant associations with the presence of adjustment disorder in bivariate analysis, including female gender, non-users of alcohol, Sinhala/Tamil medium education, and important changes in health status, relationships, and personal life. Multivariate analysis identified two independent predictors: female gender (OR = 3.09, 95% CI: 1.71–5.59, p<0.001) and experiencing personal life changes (OR = 2.11, 95% CI: 1.16–3.85, p=0.015).

Conclusion:
Adjustment disorder is highly prevalent among first-year medical undergraduates, indicating substantial psychological vulnerability during the transition to medical school. Female students and those experiencing significant personal life changes are at a higher risk. Findings highlight the need for early screening, strengthened student mental health services, structured orientation programs, and targeted psycho-educational interventions to support student well-being.