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31 May 2018

Stickley A et al. Psychiatry Res 2018; 265: 317-323

It has been reported that emotional dysregulation is highly prevalent in both children and adults with ADHD, with most studies focusing on negative emotions; however, little is known about the role of positive emotions in ADHD. This study firstly aimed to examine the association between ADHD symptoms and happiness in adults in the general population. Additionally, it sought to investigate the roles that demographics, physical and mental health (such as emotional instability, anxiety and depression), stressors and social support play in the association between happiness and adult ADHD.

This study utilised data from the 2007 Adult Psychiatric Morbidity Survey (AMPS), where one individual who agreed to participate in the survey was recruited from one household. ADHD symptoms were determined using the Adult ADHD Self-Report Scale (ASRS) v1.1 Screener,* assessing Diagnostic and Statistical Manual of Mental Disorders – 4th Edition (DSM-IV) ADHD symptoms in adults, while happiness was reported using a 3-point scale. Additional data on demographics, stressful life events, depressive episode, anxiety disorder, mood instability, physical health conditions and social support were also collected through self-reporting and questionnaires, such as the Clinical Interview Schedule Revised (CIS-R) for assessing mental health. By dividing individuals by symptom level, both univariable and multivariable ordinal logistic regression analyses were performed to determine the association between ADHD symptoms and happiness, while subsequent mediation analysis allowed determination of the effect of the other measured variables.

The study recruited 7274 individuals from England aged ≥18 years (mean age 47.5 years, standard deviation 18.2; 51.6% female). Of these, 39.2% reported they were ‘very happy’, 52.5% reported being ‘fairly happy’ and 8.3% were ‘not too happy’. Based on ASRS score, 77.0% fell into the lowest symptom category (scoring 0–9), 17.6% scored 10–13, 4.3% scored 14–17, and 1.2% fell into the highest symptom category with a score of 18–24. Ordinal logistic regression modelling showed an increase in the odds ratio (OR) for lower happiness as the number of ADHD symptoms increased, with a univariable OR of 10.06 (95% confidence interval [CI] 6.12–16.54) and multivariable OR of 10.57 (95% CI 6.43–17.37) in individuals with an ASRS score of 18–24. The results of the mediation analysis showed that the most important mediator was mood instability (mediated % = 37.1%), followed by anxiety disorder (35.6%), depressive episode (29.9%), stressful life events (13.8%), physical health conditions (10.9%), social support (7.8%), income (5.6%), marital status (4.6%) and education (1.2%).

This study had some limitations which need to be considered when interpreting these results. Firstly, the use of the ASRS as a means of distinguishing ADHD from other psychiatric disorders may lead to false positives due to the overlap of symptoms. Of particular note is the potential overlap with major depressive disorder, a condition marked by low levels of positive effect. In addition, use of the CIS-R to assess anxiety and depression has been found to be only ‘moderately valid’ in assessing common mental disorders. Moreover, using a single-item question for measuring happiness is potentially less reliable compared with multiple-item scales.

This study suggests that an increased ADHD symptom severity in adults in the general population is linked to an increased odds of feeling less happy, and multiple factors can affect this association. The authors indicated that this highlights the need to both recognise and treat undiagnosed ADHD in adults, particularly as treatment can be beneficial in reducing problems which can occur alongside ADHD as well as emotional dysregulation. Moreover, screening for, and treating, psychiatric comorbidities may be beneficial for improving emotional well-being in adults with ADHD.

Read more about adult ADHD and happiness here

 

*This constitutes a 6-item scale for inattention (4 items) and hyperactivity (2 items) symptoms experienced in the past 6 months, comprising part of a longer 18-item scale used to assess DSM-IV ADHD symptoms in adults. This self-administered test was judged to be the strongest predictor of ADHD after a diagnostic assessment process. The study used a 5-point scale (0 ‘never’ to 4 ‘very often’) giving a final score between 0 and 24. A score of ≥14 was considered to be indicative of possible ADHD. Symptom level was also defined using 4 strata based on these scores: 0–9; 10–13; 14–17; 18–24. Individuals within the first strata (0–9) represented those with the lowest level of symptoms and were used as the reference category. Level of symptoms increased with increasing strata, with stratum 4 (18–24) representing those with the highest level of symptoms
When asked ‘taking all things together, how would you say you were these days?’, respondents were required to give one of the following options: very happy; fairly happy; not too happy
The multivariable model adjusted for sex, age and ethnicity

Stickley A, Koyanagi A, Takahashi H, et al. Attention-defecit/hyperactivity disorder symptoms and happiness among adults in the general population. Psychiatry Res 2018; 256: 317-323.

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