31 March 2022

Farchakh Y et al. Prim Care Companion CNS Disord 2022; 24: 21m03025

The increasingly widespread use and availability of social media may have an impact on people with ADHD, who have been reported to be at risk of developing problematic social media use (Hussain and Griffiths, 2018). Additionally, problematic social media use has been shown to be associated with higher levels of symptoms of depression and anxiety (Malaeb et al, 2021), which often co-occur with ADHD (Knouse et al, 2013; Overgaard et al, 2016). Hence, this study aimed to understand the relationship between problematic social media use and ADHD, and determine whether depression or anxiety could have roles in mediating this association.

This cross-sectional study enrolled Lebanese adults (aged >18 years) randomly selected from Lebanon’s governorates between January and May 2019. Participants responded to a questionnaire to collect sociodemographic information, as well as rating scales to measure anxiety (the Hamilton Anxiety Rating Scale*), depression (the Hamilton Depression Rating Scale) and problematic social media use (Social Media Disorder Scale). Participants also responded to the Adult ADHD Self-Report Scale (ASRS§) to enable identification of individuals with ADHD.

In total, 466 participants were recruited; 285 participants were female, and the mean (standard deviation [SD]) age was 27.29 (11.46) years. A total of 42 participants returned ASRS results compatible with an ADHD diagnosis. The mean (SD) Social Media Disorder Scale score for the entire cohort was 8.15 (5.17).

A bivariate analysis using presence vs absence of ADHD as the dependent variable showed that adults with ADHD showed higher levels of anxiety (mean [SD] score 20.88 [11.86] vs 14.43 [10.45]; p<0.001) and problematic social media use (mean [SD] score 10.05 [6.60] vs 7.96 [5.59]; p=0.027) than adults without ADHD, whereas mean (SD) scores for depression were not statistically significantly different between the two groups.

A multivariable analysis using presence vs absence of ADHD as the dependent variable and monthly income and problematic social media use as independent variables showed that higher problematic social media use was significantly associated with higher odds of ADHD (adjusted odds ratio [aOR] 1.065; 95% confidence interval [CI] 1.010‒1.122; p=0.019), whereas there was no significant correlation between monthly income and ADHD. When anxiety was added as an independent variable, the analysis showed that higher anxiety was significantly associated with higher odds of ADHD (aOR 1.043; 95% CI 1.013‒1.075; p=0.005). Moreover, anxiety was found to mediate the association between problematic social media use and ADHD by 24.49%, whereas depression was not a mediator.

The authors described some limitations to this study. Firstly, its retrospective nature may have introduced recall bias, and selection bias may have also been present due to participation refusal. The cross-sectional design of the study made it impossible to evaluate causality behind the interactions between ADHD, anxiety and problematic social media use. Furthermore, ADHD cases were identified through the self-reported ASRS questionnaire and were not validated by a clinician; subclinical symptoms of ADHD may have gone undetected, since the subclinical symptom score was not used. Data collection may have also been affected by bias due to limitations inherent to self-reported questionnaires, such as participants having difficulty understanding the questions, or under- or over-estimating their symptoms. Additionally, genetic or environmental components, such as parents diagnosed with ADHD or substance-use problems, may have equally contributed towards the development of ADHD symptoms and problematic social media use, but were not assessed in this study. Finally, the generalisability of the findings is limited due to the relatively low mean age of the sample.

The authors concluded that, in this study, problematic social media use was clearly correlated with ADHD symptoms, which was explained by the finding that the constant stimulation provided by social network sites results in decreased levels of attention. In addition, higher anxiety was correlated with the presence of ADHD symptoms, and anxiety partially mediated the association between problematic social media use and ADHD.

Read more about problematic social media use in adults with ADHD here

 

*The Hamilton Anxiety Rating Scale is a 14-item scale used to evaluate anxiety symptomatology. Each item is rated on a 4-point Likert scale (0 = no symptoms; 4 = very severe symptoms), with higher total scores indicating higher levels of anxiety
The Hamilton Depression Rating Scale is a 17-item scale used to evaluate the severity of symptoms of depression, with higher total scores indicating higher levels of depression
The Social Media Disorder Scale is a 27-item scale used to assess the degree of problematic social media use. The 27 items are grouped according to the nine criteria of preoccupation, tolerance, withdrawal, displacement, escape, problems, deception, displacement and conflict (Van den Eijnden et al, 2016). Higher total scores reflect a greater degree of problematic social media use
§The ASRS is an 18-item screening tool that measures the frequency of symptoms of adult ADHD according to Diagnostic and Statistical Manual of Mental Disorders – 4th Edition criteria, and provides a scoring system to aid with diagnosis (Kessler et al, 2005). Answers are rated according to a 5-point Likert scale (0 = “never” to 4 = “very often”), with higher scores indicating symptoms highly compatible with ADHD

Disclaimer: The views expressed here are the views of the author(s) and not those of Takeda.

Farchakh Y, Dagher M, Barbar S, et al. Association between problematic social media use and attention-deficit/hyperactivity disorder in a sample of Lebanese adults. Prim Care Companion CNS Disord 2022; 24: 21m03025.

Hussain Z, Griffiths MD. Problematic social networking site use and comorbid psychiatric disorders: a systematic review of recent large-scale studies. Front Psychiatry 2018; 9: 686.

Kessler RC, Adler L, Ames M, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in general population. Psychol Med 2005; 35: 245-256.

Knouse LE, Zvorsky I, Safren SA. Depression in adults with attention-deficit/hyperactivity disorder (ADHD): the mediating role of cognitive-behavioral factors. Cognit Ther Res 2013; 37: 1220-1232.

Malaeb D, Salameh P, Barbar S, et al. Problematic social media use and mental health (depression, anxiety, and insomnia) among Lebanese adults: any mediating effect of stress? Perspect Psychiatr Care 2021; 57: 539-549.

Overgaard KR, Aase H, Torgersen S, et al. Co-occurrence of ADHD and anxiety in preschool children. J Atten Disord 2016; 20: 573-580.

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