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Observational Study
. 2018 Jul 13;18(1):223.
doi: 10.1186/s12888-018-1803-y.

Health-related quality of life and burden of illness in adults with newly diagnosed attention-deficit/hyperactivity disorder in Sweden

E Ahnemark  1 , M Di Schiena  2 , A-C Fredman  2   3 , E Medin  4   5 , J K Söderling  6 , Y Ginsberg  7   8
Affiliations
Observational Study

Health-related quality of life and burden of illness in adults with newly diagnosed attention-deficit/hyperactivity disorder in Sweden

E Ahnemark et al. BMC Psychiatry. .

Abstract

Background: This observational, cross-sectional, retrospective chart review aimed to identify factors determining health-related quality of life (HRQoL) in adults with newly diagnosed attention-deficit/hyperactivity disorder (ADHD) in Sweden.

Methods: Adult participants with a new clinical diagnosis of ADHD were enrolled from two specialist outpatient clinics in Stockholm, Sweden, from 2013 to 2015. Data extracted from patient records included demographics, clinical characteristics and comorbid psychiatric diagnoses identified using the Mini International Neuropsychiatric Interview (MINI). Depression severity was assessed using the Montgomery-Åsberg Depression Rating Scale - Self-reported (MADRS-S). The self-rated five-dimension EuroQol questionnaire (EQ-5D) was used to measure HRQoL. Predictors of EQ-5D index score were identified using multivariate linear regression adjusting for age, sex, education level, and main income source.

Results: The mean age of the 189 enrolled patients was 35.2 years (standard deviation [SD], 12.3), and 107 (57%) were female. Psychiatric comorbidities were present in 92 patients (49%), with anxiety and depression being the most common diagnoses. The mean EQ-5D index score was 0.63 (SD, 0.28). Low EQ-5D index scores were significantly associated with high MADRS-S scores, multiple comorbid psychiatric disorders, low educational achievement, female sex, and not having a main income derived from employment or self-employment.

Conclusions: These findings suggest that adults with newly diagnosed ADHD experience low HRQoL, which may often be exacerbated by psychiatric comorbidities such as anxiety and depression. Patients presenting with ADHD and psychiatric comorbidities in adulthood may require particular care and resources in the management of their ADHD.

Keywords: ADHD; HRQoL; Psychiatric comorbidities.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Regional Ethical Review Board in Stockholm and the need for consent was waived due to the retrospective nature of the study. The study was conducted in accordance with the ethical standards of the World Medical Association Declaration of Helsinki. The data-gathering form was based on the recommendations for neuropsychiatric investigations of patients with suspected ADHD described in recent guidelines (www.psykiatristid.se) and validated by a clinical expert.

Consent for publication

Not applicable.

Competing interests

Dr. Ewa Ahnemark is an employee of Shire and owns stock or stock options. The following authors have received compensation for serving as consultants or speakers for, or they or the institutions they work for have received research support or royalties from, the companies or organizations indicated: Dr. Marianne Di Schiena (Prima Child and Adult Psychiatry AB); Dr. Anne-Christine Fredman (Evolan, Lilly, Novartis, Servier, and Shire); Dr. Emma Medin (PAREXEL International); Dr. Jonas. K. Söderling (COMBINE Sweden, Novo Nordisk, and PAREXEL International); Dr. Ylva Ginsberg (Eli Lilly, HB Pharma, Janssen-Cilag, Lundbeck, and Novartis).

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
EQ-5D index score subgroup analysis. Error bars show 95% confidence intervals. aMADRS-S derived from PHQ-9 score for patients enrolled at Liljeholmen (1.206 × PHQ-9) + 4.062. ADHD: attention-deficit/hyperactivity disorder; ASRS-v1.1: Adult ADHD Self-Report Scale version 1.1; DIVA 2.0: Diagnostic Interview for ADHD in Adults, second edition (A1: Attention deficit; A2: hyperactivity/impulsivity); EQ-5D: 5-dimension EuroQol questionnaire; MADRS-S: Montgomery–Åsberg Depression Rating Scale – Self-reported; MINI: Mini International Neuropsychiatric Interview; PHQ-9: Patient Health Questionnaire 9; VAS: visual analog scale
Fig. 2
Fig. 2
EQ-5D index score linear regression model. *P < 0.05, **P < 0.01, ***P < 0.001. Error bars show 95% confidence intervals. aAny MINI diagnosis other than anxiety and depression. bReference populations for binary variables (other patient characteristics): education, secondary or university vs. no secondary; main income from full- or part-time employment vs. other sources; male sex vs. female sex; autism, confirmed diagnosis vs. no diagnosis. “Reference” indicates subgroup used for statistical comparisons with other subgroups. p values rounded to nearest 0.01 decimal places. ADHD: attention-deficit/hyperactivity disorder; ASRS: Adult ADHD Self-Report Scale version 1.1; CI: confidence interval; DIVA 2.0: Diagnostic Interview for ADHD in Adults, second edition (A1: Attention Deficit; A2: hyperactivity/impulsivity); EQ-5D: 5-dimension EuroQol questionnaire; MADRS-S: Montgomery–Åsberg Depression Rating Scale – Self-reported; MINI: Mini International Neuropsychiatric Interview; WAIS-IV: Wechsler Adult Intelligence Scale IV
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