Coexisting Psychiatric Problems and Stressful Life Events in Adults With Symptoms of ADHD—A Large Swedish Population-Based Study of Twins

Abstract

Objective: To explore the associations of subtypes of adult ADHD with other psychiatric problems, stressful life events, and sex differences. Method: Odds ratios were calculated using information from 17,899 participants from a population-based survey of adult twins born in Sweden between 1959 and 1985. Results: Symptoms of attention deficit hyperactivity disorder (ADHD) were associated with an increased risk for symptoms of (odds ratio [95% confidence interval]): generalized anxiety disorder (5.6 [4.3; 6.5]), major depression (2.8 [2.4; 3.2]), bipolar disorder (8.0 [5.1; 12.6]), obsessive-compulsive disorder (3.9 [3.1; 4.9]), and alcohol dependence (2.6 [2.2; 3.1]). Symptoms of ADHD were found to be associated with an increased risk for stressful life events (1.8 [1.3; 2.4]). No significant difference in comorbidity was observed between the two sexes. Conclusion: Both women and men with ADHD are at increased risk for symptoms of other psychiatric disorders. They are also at increased risk for stressful life events.

Keywords

ADHD comorbidities adults population-based study twin study generalized linear mixed effects models

Get full access to this article

View all access options for this article.

References

Able

S. L.

Johnston

J. A.

Adler

L. A.

Swindle

R. W.

(2007). Functional and psychosocial impairment in adults with undiagnosed ADHD. Psychological Medicine, 37, 97-107.

American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders, DSM-IV-TR (4th ed., text rev.). Washington, DC: Author.

Barkley

R. A.

Fischer

Smallish

Fletcher

(2002). The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. Journal of Abnormal Child Psychology, 111, 279-289.

Biederman

Faraone

S. V.

Monuteaux

M. C.

Bober

Cadogen

(2004). Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biological Psychiatry, 55, 692-700.

Biederman

Faraone

S. V.

Spencer

T. J.

Mick

Monuteaux

M. C.

Aleardi

(2006). Functional impairments in adults with self-reports of diagnosed ADHD: A controlled study of 1001 adults in the community. Journal of Clinical Psychiatry, 67, 524-540.

Davidson

M. A.

(2008). ADHD in adults: A review of the literature. Journal of Attention Disorders, 11, 628-641.

De Graaf

Kessler

Fayyad

Ten Have

Alonso

Angermeyer

. . . Posada-Villa

(2008). The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO world mental health survey initiative. Occupational and Environmental Medicine, 65, 835-842.

Elkins

I. J.

McGue

Iacono

W. G.

(2007). Prospective effects of attention-deficit/hyperactive disorder, conduct disorder, and sex on adolescent substance use and abuse. Archives of General Psychiatry, 64, 1145-1152.

Faraone

S. V.

Biederman

(2005). What is the prevalence of adult ADHD? Results of a population screen of 966 adults. Journal of Attention Disorders, 9, 384-391.

10.

Fayyad

De Graaf

Kessler

Alonso

Angermeyer

Demyttenaere

. . . Jin

(2007). Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. British Journal of Psychiatry, 190, 402-409.

11.

Gaub

Carlson

C. L.

(1997). Gender differences in ADHD: A meta-analysis and critical review. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1036-1045.

12.

Gershon

(2002). A meta-analytic review of gender differences in ADHD. Journal of Attention Disorders, 5, 143-154.

13.

Hart

E. L.

Lahey

B. B.

Loeber

Applegate

Frick

P. J.

(1995). Developmental change in attention-deficit hyperactivity disorder in boys: A four-year longitudinal study. Journal of Abnormal Child Psychology, 23, 729-749.

14.

Kessler

R. C.

Adler

Barkley

Biederman

Conners

C. K.

Demler

. . . Zaslavsky

A. M.

(2006). The prevalence and correlates of adult ADHD in the United States: Results from the national comorbidity survey replication. American Journal of Psychiatry, 163, 716-723.

15.

Kollins

S. H.

McClernon

F. J.

Fuemmeler

B. F.

(2005). Association between smoking and attention-deficit/hyperactivity disorder symptoms in a population-based sample of young adults. Archives of General Psychiatry, 62, 1142-1147.

16.

Kooij

S. J.

Boonstra

M. A.

Swinkels

S. H.

Bekker

E. M.

de Noord

Buitelaar

J. K.

(2008). Reliability, validity, and utility of instruments for self-report and informant report concerning symptoms of ADHD in adult patients. Journal of Attention Disorders, 11, 445-458.

17.

Lara

Fayyad

de Graaf

Kessler

Aguilar-Gaxiola

Angermeyer

. . . Sampson

(2009). Childhood predictors of adult attention-deficit/hyperactivity disorder: Results from the world health organization world mental health survey initiative. Biological Psychiatry, 65, 46-54.

18.

Lichtenstein

Sullivan

P. F.

Cnattingius

Gatz

Johansson

Carlström

. . . Pedersen

N. L.

(2006). The Swedish Twin Registry in the third millennium: An update. Twin Research and Human Genetics: The Official Journal of the International Society for Twin Studies, 9, 875-882.

19.

Littell

Milliken

Stroup

Wolfinger

R. D.

Schabenberger

(2006). SAS for mixed models (2nd ed.). Cary, NC: SAS Publishing.

20.

Mannuzza

Klein

R. G.

Bessler

Malloy

LaPadula

(1998). Adult psychiatric status of hyperactive boys grown up. American Journal of Psychiatry, 155, 493-498.

21.

McGough

J. J.

Smalley

S. L.

McCracken

J. T.

Yang

Del’Homme

Lynn

D. E.

Loo

(2005). Psychiatric comorbidity in adult attention deficit hyperactivity disorder: Findings from multiplex families. American Journal of Psychiatry, 162, 1621-1627.

22.

Murphy

K. R.

Barkley

R. A.

Bush

(2002). Young adults with attention deficit hyperactivity disorder: Subtype differences in comorbidity, educational, and clinical history. Journal of Nervous and Mental Disease, 190, 147-157.

23.

Proschan

M. A.

Waclawiw

M. A.

(2000). Practical guidelines for multiplicity adjustment in clinical trials. Controlled Clinical Trials, 21, 527-539.

24.

Rohde

L. A.

Biederman

Zimmermann

Schmitz

Martins

Tramontina

(2000). Exploring ADHD age-of-onset criterion in Brazilian adolescents. European Child and Adolescent Psychiatry, 9, 212-218.

25.

SAS Institute Inc. (2006). Production GLIMMIX procedure. Cary, NC: Author.

26.

Satterfield

J. H.

Hoppe

C. M.

Schell

A. M.

(1982). A prospective study of delinquency in 110 adolescent boys with attention deficit disorder and 88 normal adolescent boys. American Journal of Psychiatry, 139, 795-798.

27.

Sobanski

Brüggemann

Alm

Kern

Deschner

Schubert

. . . Rietschel

(2007). Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD). European Archives of Psychiatry and Clinical Neuroscience, 257, 371-377.

28.

Sobanski

Brüggemann

Alm

Kern

Philipsen

Schmalzried

. . .Rietschel

(2008). Subtype differences in adults with attention-deficit/hyperactivity disorder (ADHD) with regard to ADHD-symptoms, psychiatric comorbidity and psychosocial adjustment. European Psychiatry, 23, 142-149.

29.

Sprafkin

Gadow

K. D.

Weiss

M. D.

Schneider

Nolan

E. E.

(2007). Psychiatric comorbidity in ADHD symptom subtypes in clinic and community adults. Journal of Attention Disorders, 11, 114-124.

30.

Tamam

Karakus

Ozpoyraz

(2008). Comorbidity of adult attention-deficit hyperactivity disorder and bipolar disorder: Prevalence and clinical correlates. European Archives of Psychiatry and Clinical Neuroscience, 258, 385-393.

31.

Todd

R. D.

Huang

Todorov

A. A.

Neuman

R. J.

Reiersen

A. M.

Henderson

C. A.

. . . Reich

W. C.

(2008). Predictors of stability of attention-deficit/hyperactivity disorder subtypes from childhood to young adulthood. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 76-85.

32.

Willcutt

Pennington

Chhabildas

Friedman

Alexander

(1999). Psychiatric comorbidity associated with DSM-IV ADHD in a nonreferred sample of twins. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1355-1362.

33.

Wingo

A. P.

Ghami

S. N.

(2007). A systematic review of rates and diagnostic validity of comorbid adult attention-deficit/hyperactivity disorder and bipolar disorder. Journal of Clinical Psychiatry, 68, 1776-1784.