Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Medicine
Published in: BMC Medicine 1/2023

Open Access 01-12-2023 | Type 2 Diabetes | Research article

Psychiatric comorbidities in women with cardiometabolic conditions with and without ADHD: a population-based study

Authors: Unnur Jakobsdottir Smari, Unnur Anna Valdimarsdottir, Thor Aspelund, Arna Hauksdottir, Edda Bjork Thordardottir, Catharina A. Hartman, Pontus Andell, Henrik Larsson, Helga Zoega

Published in: BMC Medicine | Issue 1/2023

Login to get access

Abstract

Background

Leveraging a large nationwide study of Icelandic women, we aimed to narrow the evidence gap around female attention-deficit/hyperactivity disorder (ADHD) and cardiometabolic comorbidities by determining the prevalence of obesity, hypertension, type 2 diabetes, and cardiovascular diseases among women with ADHD and examine the association between cardiometabolic conditions and co-occurring ADHD with anxiety and mood disorders, alcoholism/substance use disorder (SUD), self-harm, and suicide attempts.

Methods

We conducted a cross-sectional analysis of the nationwide, all-female, population-based SAGA Cohort Study (n = 26,668). To ascertain diagnoses and symptoms, we used self-reported history of ADHD diagnoses, selected cardiometabolic conditions and psychiatric disorders, and measured current depressive, anxiety, and PTSD symptoms through appropriate questionnaires (PHQ-9, GAD-7, and PCL-5). We calculated age-adjusted prevalences of cardiometabolic conditions by women’s ADHD status and estimated adjusted prevalence ratios (PR) and 95% confidence intervals (CI), using modified Poisson regression models. Similarly, we assessed the association of cardiometabolic conditions and co-occurring ADHD with current psychiatric symptoms and psychiatric disorders, using adjusted PRs and 95% CIs.

Results

We identified 2299 (8.6%) women with a history of ADHD diagnosis. The age-adjusted prevalence of having at least one cardiometabolic condition was higher among women with ADHD (49.5%) than those without (41.7%), (PR = 1.19, 95% CI 1.14–1.25), with higher prevalence of all measured cardiometabolic conditions (myocardial infarctions (PR = 2.53, 95% CI 1.83-–3.49), type 2 diabetes (PR = 2.08, 95% CI 1.66–2.61), hypertension (PR = 1.23, 95% CI 1.12–1.34), and obesity (PR = 1.18, 95% CI 1.11–1.25)). Women with cardiometabolic conditions and co-occurring ADHD had, compared with those without ADHD, substantially increased prevalence of (a) all measured mood and anxiety disorders, e.g., depression (PR = 2.38, 95% CI 2.19–2.58), bipolar disorder (PR = 4.81, 95% CI 3.65–6.35), posttraumatic stress disorder (PR = 2.78, 95% CI 2.52–3.07), social phobia (PR = 2.96, 95% CI 2.64–3.32); (b) moderate/severe depressive, anxiety, and PTSD symptoms with PR = 1.76 (95% CI 1.67–1.85), PR = 1.97 (95% CI 1.82–2.12), and PR = 2.01 (95% CI 1.88–2.15), respectively; (c) alcoholism/SUD, PR = 4.79 (95% CI 3.90–5.89); and (d) self-harm, PR = 1.47 (95% CI 1.29–1.67) and suicide attempts, PR = 2.37 (95% CI 2.05–2.73).

Conclusions

ADHD is overrepresented among women with cardiometabolic conditions and contributes substantially to other psychiatric comorbidities among women with cardiometabolic conditions.
Appendix
Available only for authorised users
Literature
1.
Fayyad J, Sampson NA, Hwang I, Adamowski T, Aguilar-Gaxiola S, Al-Hamzawi A, et al. The descriptive epidemiology of DSM-IV adult ADHD in the world health organization world mental health surveys. Adhd-Attend Deficit. 2017;9(1):47–65.CrossRef
2.
London AS, Landes SD. Cohort change in the prevalence of ADHD among US adults: evidence of a gender-specific historical period effect. J Atten Disord. 2021;25(6):771–82.PubMedCrossRef
3.
Cherkasova MV, Roy A, Molina BSG, Scott G, Weiss G, Barkley RA, et al. Review: adult outcome as seen through controlled prospective follow-up studies of children with attention-deficit/hyperactivity disorder followed into adulthood. J Am Acad Child Psy. 2022;61(3):378–91.CrossRef
4.
Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med. 2006;36(2):159–65.PubMedCrossRef
5.
Dalsgaard S, Ostergaard SD, Leckman JF, Mortensen PB, Pedersen MG. Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. Lancet. 2015;385(9983):2190–6.PubMedCrossRef
6.
Sun SH, Kuja-Halkola R, Faraone SV, D’Onofrio BM, Dalsgaard S, Chang Z, et al. Association of psychiatric comorbidity with the risk of premature death among children and adults with attention-deficit/hyperactivity disorder. Jama Psychiat. 2019;76(11):1141–9.CrossRef
7.
Hinshaw SP, Nguyen PT, O’Grady SM, Rosenthal EA. Annual research review: attention-deficit/hyperactivity disorder in girls and women: underrepresentation, longitudinal processes, and key directions. J Child Psychol Psyc. 2022;63(4):484–96.CrossRef
8.
Young S, Adamo N, Asgeirsdottir BB, Branney P, Beckett M, Colley W, et al. Females with ADHD: an expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry. 2020;20(1):404.PubMedPubMedCentralCrossRef
9.
Solberg BS, Halmoy A, Engeland A, Igland J, Haavik J, Klungsoyr K. Gender differences in psychiatric comorbidity: a population-based study of 40 000 adults with attention deficit hyperactivity disorder. Acta Psychiatr Scand. 2018;137(3):176–86.PubMedCrossRef
10.
Chen Q, Hartman CA, Haavik J, Harro J, Klungsoyr K, Hegvik TA, et al. Common psychiatric and metabolic comorbidity of adult attention-deficit/hyperactivity disorder: a population-based cross-sectional study. PLoS ONE. 2018;13(9):e0204516.PubMedPubMedCentralCrossRef
11.
Balazs J, Gyori D, Horvath LO, Meszaros G, Szentivanyi D. Attention-deficit hyperactivity disorder and nonsuicidal self-injury in a clinical sample of adolescents: the role of comorbidities and gender. BMC Psychiatry. 2018;18:34.PubMedPubMedCentralCrossRef
12.
Swanson EN, Owens EB, Hinshaw SP. Pathways to self-harmful behaviors in young women with and without ADHD: a longitudinal examination of mediating factors. J Child Psychol Psychiatry. 2014;55(5):505–15.PubMedCrossRef
13.
Nock MK, Joiner TE, Gordon KH, Lloyd-Richardson E, Prinstein MJ. Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts. Psychiat Res. 2006;144(1):65–72.CrossRef
14.
Fuller-Thomson E, Riviere RN, Carrique L, Agbeyaka S. The dark side of ADHD: factors associated with suicide attempts among those with ADHD in a national representative Canadian sample. Arch Suicide Res. 2022;26(3):1122–40.PubMedCrossRef
15.
Meza JI, Owens EB, Hinshaw SP. Childhood predictors and moderators of lifetime risk of self-harm in girls with and without attention-deficit/hyperactivity disorder. Dev Psychopathol. 2021;33(4):1351–67.PubMedCrossRef
16.
Cortese S, Moreira-Maia CR, St Fleur D, Morcillo-Penalver C, Rohde LA, Faraone SV. Association between ADHD and obesity: a systematic review and meta-analysis. Am J Psychiat. 2016;173(1):34–43.PubMedCrossRef
17.
Du Rietz E, Brikell I, Butwicka A, Leone M, Chang Z, Cortese S, D’Onofrio BM, Hartman CA, Lichtenstein P, Faraone SV, Kuja-Halkola R, Larsson H. Mapping phenotypic and aetiological associations between ADHD and physical conditions in adulthood in Sweden: a genetically informed register study. Lancet Psychiat. 2021;8:774–83.CrossRef
18.
Garcia-Argibay M, du Rietz E, Lu Y, Martin J, Haan E, Lehto K, et al. The role of ADHD genetic risk in mid-to-late life somatic health conditions (vol 12, 166, 2022). Transl Psychiat. 2022;12(1);;152.CrossRef
19.
Garcia-Argibay M, Du Rietz E, Hartman CA, Lichtenstein P, Chang Z, Fava C, et al. Cardiovascular risk factors in attention-deficit/hyperactivity disorder: a family design study of Swedish conscripts. Int J Meth Psych Res. 2022;31. https://​doi.​org/​10.​1002/​mpr.​1930.
20.
Cortese S, Tessari L. Attention-deficit/hyperactivity disorder (ADHD) and obesity: update 2016. Curr Psychiat Rep. 2017;19(1):4.CrossRef
21.
Li L, Yao H, Zhang L, Garcia-Argibay M, Du Rietz E, Brikell I, Solmi M, Cortese S, Ramos-Quiroga JA, Ribasés M, Chang Z, Larsson H. Attention-deficit/hyperactivity disorder is associated with increased risk of cardiovascular diseases: a systematic review and meta-analysis. JCPP Adv. 2023;3:e12158.PubMedPubMedCentralCrossRef
22.
Guo F, Moellering DR, Garvey WT. The progression of cardiometabolic disease: validation of a new cardiometabolic disease staging system applicable to obesity. Obesity (Silver Spring). 2014;22(1):110–8.PubMedCrossRef
23.
Deaton C, Froelicher ES, Wu LH, Ho C, Shishani K, Jaarsma T. The global burden of cardiovascular disease. J Cardiovasc Nurs. 2011;26(4):S5–14.PubMedCrossRef
24.
de Wit L, Luppino F, van Straten A, Penninx B, Zitman F, Cuijpers P. Depression and obesity: a meta-analysis of community-based studies. Psychiatry Res. 2010;178(2):230–5.PubMedCrossRef
25.
Ali S, Stone MA, Peters JL, Davies MJ, Khunti K. The prevalence of co-morbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. Diabetic Med. 2006;23(11):1165–73.PubMedCrossRef
26.
Song H, Fang F, Arnberg FK, Mataix-Cols D, Fernandez de la Cruz L, Almqvist C, et al. Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study. BMJ. 2019;365:l1255.PubMedPubMedCentralCrossRef
27.
Shen Q, Song H, Aspelund T, Yu JR, Lu DH, Jakobsdottir J, et al. Cardiovascular disease and subsequent risk of psychiatric disorders: a nationwide sibling-controlled study. Elife. 2022;11:e80143.PubMedPubMedCentralCrossRef
28.
Myers AK, Grannemann BD, Lingvay I, Trivedi MH. Brief report: Depression and history of suicide attempts in adults with new-onset Type 2 Diabetes. Psychoneuroendocrino. 2013;38(11):2810–4.CrossRef
29.
Webb RT, Kontopantelis E, Doran T, Qin P, Creed F, Kapur N. Suicide risk in primary care patients with major physical diseases. Arch Gen Psychiat. 2012;69(3):256–64.PubMedCrossRef
30.
Cook BG, Li DM, Heinrich KM. Obesity, physical activity, and sedentary behavior of youth with learning disabilities and ADHD. J Learn Disabil-Us. 2015;48(6):563–76.CrossRef
31.
Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, et al. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. Eur Neuropsychopharm. 2018;28(10):1059–88.CrossRef
32.
Khalife N, Kantomaa M, Glover V, Tammelin T, Laitinen J, Ebeling H, et al. Childhood attention-deficit/hyperactivity disorder symptoms are risk factors for obesity and physical inactivity in adolescence. J Am Acad Child Psy. 2014;53(4):425–36.CrossRef
33.
Leppert B, Riglin L, Wootton RE, Dardani C, Thapar A, Staley JR, et al. The effect of attention deficit/hyperactivity disorder on physical health outcomes: a 2-sample Mendelian randomization study. Am J Epidemiol. 2021;190(6):1047–55.PubMedCrossRef
34.
Kim EJ, Kwon HJ, Ha M, Lim MH, Oh SY, Kim JH, et al. Relationship among attention-deficit hyperactivity disorder, dietary behaviours and obesity. Child Care Hlth Dev. 2014;40(5):698–705.CrossRef
35.
36.
Danielsdottir HB, Aspelund T, Thordardottir EB, Fall K, Fang F, Tomasson G, et al. Adverse childhood experiences and resilience among adult women: a population-based study. Elife. 2022;11:e71770.PubMedPubMedCentralCrossRef
37.
38.
Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder - the GAD-7. Arch Intern Med. 2006;166(10):1092–7.PubMedCrossRef
39.
Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress. 2015;28(6):489–98.PubMedCrossRef
40.
Kessler RC, Ustun TB. The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Meth Psych Res. 2004;13(2):93–121.CrossRef
41.
Gudjonsson GH, Sigurdsson JF, Sigfusdottir ID, Young S. An epidemiological study of ADHD symptoms among young persons and the relationship with cigarette smoking, alcohol consumption and illicit drug use. J Child Psychol Psyc. 2012;53(3):304–12.CrossRef
42.
Li L, Chang Z, Sun JW, Garcia-Argibay M, Du Rietz E, Dobrosavljevic M, et al. Attention-deficit/hyperactivity disorder as a risk factor for cardiovascular diseases: a nationwide population-based cohort study. World Psychiatry. 2022;21(3):452–9.PubMedPubMedCentralCrossRef
43.
Chang Z, Ghirardi L, Quinn PD, Asherson P, D’Onofrio BM, Larsson H. Risks and benefits of attention-deficit/hyperactivity disorder medication on behavioral and neuropsychiatric outcomes: a qualitative review of pharmacoepidemiology studies using linked prescription databases. Biol Psychiat. 2019;86(5):335–43.PubMedCrossRef
44.
Zhang L, Yao HH, Li L, Du Rietz E, Andell P, Garcia-Argibay M, et al. Risk of cardiovascular diseases associated with medications used in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. JAMA Netw Open. 2022;5(11):e2243597.PubMedPubMedCentralCrossRef
45.
Chang Z, D’Onofrio BM, Quinn PD, Lichtenstein P, Larsson H. Medication for attention-deficit/hyperactivity disorder and risk for depression: a nationwide longitudinal cohort study. Biol Psychiat. 2016;80(12):916–22.PubMedCrossRef
46.
Chen MH, Wei HT, Chen LC, Su TP, Bai YM, Hsu JW, et al. Autistic spectrum disorder, attention deficit hyperactivity disorder, and psychiatric comorbidities: a nationwide study. Res Autism Spect Dis. 2015;10:1–6.CrossRef
47.
Sattar N, Rawshani A, Franzen S, Rawshani A, Svensson AM, Rosengren A, et al. Age at diagnosis of type 2 diabetes mellitus and associations with cardiovascular and mortality risks findings from the Swedish National Diabetes Registry. Circulation. 2019;139(19):2228–37.PubMedCrossRef
Metadata
Title
Psychiatric comorbidities in women with cardiometabolic conditions with and without ADHD: a population-based study
Authors
Unnur Jakobsdottir Smari
Unnur Anna Valdimarsdottir
Thor Aspelund
Arna Hauksdottir
Edda Bjork Thordardottir
Catharina A. Hartman
Pontus Andell
Henrik Larsson
Helga Zoega
Publication date
01-12-2023

Other articles of this Issue 1/2023

BMC Medicine 1/2023 Go to the issue

Research article

Metabolic systems approaches update molecular insights of clinical phenotypes and cardiovascular risk in patients with homozygous familial hypercholesterolemia

Research article

Prospective and Mendelian randomization analyses on the association of circulating fatty acid binding protein 4 (FABP-4) and risk of colorectal cancer

Research article

Real-world data emulating randomized controlled trials of non-vitamin K antagonist oral anticoagulants in patients with venous thromboembolism

Research article

Genome-wide association analyses identified novel susceptibility loci for pulmonary embolism among Han Chinese population

Research article

A novel approach to risk exposure and epigenetics—the use of multidimensional context to gain insights into the early origins of cardiometabolic and neurocognitive health

Research article

Financial hardship associated with catastrophic out-of-pocket spending tied to primary care services in low- and lower-middle-income countries: findings from a modeling study