Adult ADHD Often Disabling: Study

Work performance, quality of life suffer compared with general population

  • by
    Contributing Writer, MedPage Today

WASHINGTON -- Adults with symptoms of ADHD but no formal diagnosis have impaired quality of life, productivity, and functioning compared with those who don't have such symptoms, researchers reported here.

In a case-control study matched from a national survey, those with ADHD symptoms had significantly worse quality of life than those without symptoms as measured by the EQ-5D-5L index in adjusted analyses (P=0.002), although there were no differences in EQ-VAS scores of health-related quality of life, according to Regina Grebla, PhD, of Shire plc's Lexington, Mass. office, and colleagues.

These patients also had significantly worse outcomes in terms of productivity (P<0.001) and activity impairment (P<0.0001), and in functioning as measured by the Sheehan Disability Scale (P<0.0001), they reported at the American Professional Society of ADHD and Related Disorders (APSARD) meeting here.

"The major relevance of this study is to highlight the importance of screening for ADHD symptoms, because even if you don't have a diagnosis, you should be aware that there's a possibility that you're symptomatic," Grebla told MedPage Today. "Just the presence of these self-reported symptoms is associated with these impacts on quality of life."

Grebla and colleagues took a sample of the more than 22,000 adults who had responded to the 2013 National Health & Wellness Survey, re-contacted them online, and asked them to respond to a custom survey regarding sociodemographics, recent health conditions, ADHD symptoms as measured by the Adult ADHD Self-Report Scale (ASRS-v1.1), diagnosis of ADHD by a physician and treatment, health insurance and healthcare utilization, comorbid physical and mental health conditions, and lifestyle characteristics.

The 1,493 adults with self-reported ADHD symptoms were matched with 5,054 controls. The mean age of the population was 45.3, 57% were female, and 75% were white.

Researchers used the following scales to measure outcomes: the EuroQol EQ-5D-5L to measure quality of life; the Work Productivity and Activity Impairment Index (WPAI) to measure productivity loss and activity impairment; and the Sheehan Disability Scale (SDS) and Rosenberg Self-Esteem Scale (RSES) to measure functioning and psycho-social impacts of ADHD.

Compared with adults who didn't have self-reported ADHD symptoms, those with such symptoms had lower household incomes, a higher unemployment rate, more frequent recreational drug use, and more comorbidities, including anorexia/binge eating disorder/bulimia, anxiety, chronic constipation, depression, food addiction, insomnia, obsessive compulsive disorder, panic disorder, and post-traumatic stress disorder (P<0.05).

In unadjusted analyses, adults with self-reported ADHD symptoms had impaired quality of life, productivity, and functioning and psychosocial impacts compared with those without self-reported symptoms.

They had significantly lower unadjusted mean EQ-5D-5L index value scores (0.74 versus 0.82, P<0.001) and EQ-VAS scores (67.86 versus 75.71, P<0.001).

A greater proportion of adults with self-reported ADHD symptoms had problems with the EQ domains of mobility, self-care, usual activities, pain/discomfort, and anxiety/depression compared to those without self-reported ADHD symptoms (all P<0.001), the researchers added.

They also had significantly greater productivity impairment in all measures as evidenced by higher unadjusted mean WPAI work productivity loss (38.96 versus 15.96, P<0.001), absenteeism (13.08 versus 3.83, P<0.001), presenteeism (33.74 versus 13.60, P<0.001), and activity impairment (46.19 versus 25.73, P<0.001).

In addition, these adults had significantly higher unadjusted mean SDS total and subscale scores (P<0.001) and significantly lower unadjusted mean RSES scores (16.58 versus 20.93, P<0.001).

In adjusted comparisons between the groups, researchers observed a slight statistically significant difference in EQ-ED-5L scores in adults with and without ADHD symptoms (P=0.002) but no significant difference in EQ-VAS scores.

They also found a statistically significant mean difference in WPAI productivity loss (P<0.001) and activity impairment (P<0.0001).

Those with self-reported symptoms also experienced greater functional impairment as measured by SDS scores (P<0.0001), but in these adjusted analyses the researchers didn't see a significant difference in RSES scores between groups.

The study was limited by its reliance on self-report, opening up the potential for confounding by recall bias. In addition, temporal relationships between the onset of ADHD symptoms and all reported diagnoses could not be established.

Still, Grebla said the results highlight the need for increased recognition of the condition and follow up. She and her colleagues noticed through the project that many adults encounter a physician assistant or nurse practitioner: "That's where it could be useful to have an ASRS self-report screener, a six-item questionnaire, just to see if there's a chance you have ADHD," Grebla said.

She added that her team is now doing some subgroup analyses to look at areas like resource utilization in this population, to see if they are in the hospital more often or have other unknown healthcare needs.

The study was funded by Shire. Grebla is a Shire employee.

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