Anxiety, mood, and substance use disorders in adult men and women with and without attention-deficit/hyperactivity disorder: A substantive and methodological overview
Catharina Annette Hartman, Henrik Larsson, Melissa Vos, Alessio Bellato, Berit Libutzki, Berit Skretting Solberg et al. · 2023 · 99 citationsRead the paper
Knowledge on psychiatric comorbidity in adult ADHD is essential for prevention, detection, and treatment of these conditions. This review (1) focuses on large studies (n > 10,000; surveys, claims data, population registries) to identify (a) overall, (b) sex- and (c) age-specific patterns of comorbidity of anxiety disorders (ADs), major depressive disorder (MDD), bipolar disorder (BD) and substance use disorders (SUDs) in adults with ADHD relative to adults without ADHD; and (2) describes methodological challenges relating to establishing comorbidity in ADHD in adults as well as priorities for future research. Meta-analyses (ADHD: n = 550,748; no ADHD n = 14,546,814) yielded pooled odds ratios of 5.0(CI:3.29-7.46) for ADs, 4.5(CI:2.44-8.34) for MDD, 8.7(CI:5.47-13.89) for BD and 4.6(CI:2.72-7.80) for SUDs, indicating strong differences in adults with compared to adults without ADHD. Moderation by sex was not found: high comorbidity held for both men and women with sex-specific patterns as in the general population: higher prevalences of ADs, MDD and BD in women and a higher prevalence of SUDs in men. Insufficient data on different phases of the adult lifespan prevented conclusions on developmental changes in comorbidity. We discuss methodological challenges, knowledge gaps, and future research priorities.
What the full text shows
Tested in real conditions- Adults with ADHD have a significantly higher risk of Bipolar Disorder (BD) compared to adults without ADHD. — 8.7 odds ratio (CI: 5.47-13.89) (Pooled meta-analysis of large studies)
- Adults with ADHD have a significantly higher risk of Anxiety Disorders (ADs) compared to adults without ADHD. — 5.0 odds ratio (CI: 3.29-7.46) (Pooled meta-analysis of large studies)
- Adults with ADHD have a significantly higher risk of Substance Use Disorders (SUDs) compared to adults without ADHD. — 4.6 odds ratio (CI: 2.72-7.80) (Pooled meta-analysis of large studies)
- Adults with ADHD have a significantly higher risk of Major Depressive Disorder (MDD) compared to adults without ADHD. — 4.5 odds ratio (CI: 2.44-8.34) (Pooled meta-analysis of large studies)
- Sex does not modify the overall high comorbidity risk, though sex-specific patterns persist (women higher for ADs, MDD, BD; men higher for SUDs). — No statistically significant moderation by sex (Adults with and without ADHD)
- Setup
- ADHD group (n = 550,748) and non-ADHD group (n = 14,546,814) across high-income European countries and the USA.
- How
- Meta-analysis and review of nine large-scale studies (n > 10,000) using surveys, insurance claims, and population registries. The authors used pooled odds ratios to compare psychiatric comorbidity in adults with ADHD versus those without.
- Limitations
- Data primarily from high-income Western countries (USA and Europe). · Insufficient data to draw conclusions on developmental changes across the adult lifespan. · Limited statistical power to fully address heterogeneity in pooled estimates. · Excluded other comorbidities like autism spectrum disorder or personality disorders.
Summarized by Gemma 4 from the open-access full text · 13 Oct 2026. Read it