10 Jun 2021

McDonald AJ et al. Psychiatry Res 2021; 301: 113985

The purpose of this study was to examine whether symptoms of adult ADHD are associated with psychological distress, hazardous drinking and problem gambling, after controlling for traumatic brain injury and sociodemographic characteristics.

Data from 2015‒2016 were obtained from an ongoing cross-sectional telephone survey (Centre for Addiction and Mental Health [CAMH] Monitor carried out by CAMH, Ontario, Canada) for adults aged ≥18 years. Assessments included: the ADHD Self-Report Scale-v1.1, the Kessler Psychological Distress Scale, the Alcohol Use Disorder Identification Test and the Problem Gambling Severity Index, which is a subscale of the Canadian Problem Gambling Index. Traumatic brain injury was assessed using a questionnaire.*

Of the 3817 participants who were included in the survey, 263 (44.6% male) had symptoms of ADHD, of which half (50.0%) were aged 18‒29 years. ADHD symptoms were significantly related to age (p<0.001), level of education (p<0.01), psychological distress (p<0.001) and hazardous drinking (p<0.01). However, there were no differences in the presence of problem gambling or traumatic brain injury between adults with and without ADHD symptoms. The unadjusted odds ratios (OR) for ADHD symptoms were significantly associated with psychological distress (OR, 9.26 [95% confidence interval (CI) 6.13‒14.00]; p<0.01) and hazardous drinking (OR, 2.07 [95% CI 1.27‒3.38]; p<0.01) but not problem gambling (OR, 1.50 [95% CI 0.53‒4.25]; p=0.45).  Following a multivariable logistic regression, only psychological distress remained significantly related to ADHD symptoms after adjusting for covariates (OR, 7.14 [95% CI 4.57‒11.15; p<0.01). The adjusted OR for hazardous drinking and problem gambling were (OR, 1.44 [95% CI 0.83‒2.50) and (OR, 0.61 [95% CI 0.15‒2.51), respectively.

This study has several limitations. First, the cross-sectional study prevented the directionality of the relationships to be established. Second, potential confounding effects of medication use and genetic predisposition to ADHD were uncontrolled for. Third, the use of telephone surveys, rather than clinical interviews, to collect self-reported data may have introduced bias. Fourth, measurements of psychological distress were non-specific and could not be equated with diagnosis of anxiety or mood disorders; other psychiatric disorders (e.g. substance-use disorder) were also not examined.

The authors conclude that this study further highlights the importance of clinicians assessing for concomitant ADHD and psychological distress in adults.

Read more about the relationship between adult ADHD symptoms and psychological distress, hazardous drinking and problem gambling here


*Participants were asked the following questions: “We are interested in any head injuries that resulted in you being unconscious (knocked out) for ≥5 minutes, or you had to stay in the hospital for ≥1 night because of it”. Respondents were then asked: “How many times, if ever in your life, have you had this type of head injury”?

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

McDonald AJ, Cook S, Turner NE, et al. Adult attention-deficit hyperactivity disorder symptoms and psychological distress, hazardous drinking, and problem gambling: a population-based study. Psychiatry Res 2021; 301: 113985.

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