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[Preprint]. 2025 Jan 10:2025.01.10.25320323.
doi: 10.1101/2025.01.10.25320323.

Sex Differences in the Comorbidity between Attention Deficit-Hyperactivity Disorder and Posttraumatic Stress Disorder: A Systematic Literature Review and Meta-Analysis

Julia Wilson  1 , Doruntina Fida  1 , Rie Maurer  2 , Aleta Wiley  1 , Therese Rajasekera  1   3 , Primavera Spagnolo  1   3
Affiliations

Sex Differences in the Comorbidity between Attention Deficit-Hyperactivity Disorder and Posttraumatic Stress Disorder: A Systematic Literature Review and Meta-Analysis

Julia Wilson et al. medRxiv. .

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Abstract

Objective: Attention Deficit-Hyperactivity Disorder (ADHD) and Posttraumatic Stress Disorder (PTSD) are often comorbid and share a common core of symptoms. However, sex and gender-related factors significantly influence their prevalence, clinical presentation, and diagnosis. Here, we conducted a systematic literature review and meta-analysis to examine sex differences in ADHD/PTSD comorbidity during childhood and adulthood.

Methods: A scoping review of PsycINFO and PubMed yielded 13 eligible studies with complete outcome data. We conducted fixed-effects meta-analyses of the sex-stratified prevalence of ADHD/PTSD using pooled odds ratios (OR) with a 95% confidence interval (CI). Fixed-effects subgroup analyses were performed using age as a subgroup. Effect size heterogeneity was assessed using the I2 index and Cochran's Q test.

Results: In the whole sample (N= 13,585; F= 7005, M= 6580), the diagnosis of ADHD/PTSD was significantly higher in females than in males (OR = 1.32, p = 0.02). Between-study heterogeneity was low-to-moderate and not significant (I2 = 41%; p = 0.06), validating the fixed-effects model. Age-stratified subgroup analyses revealed higher ADHD/PTSD odds in females compared to males only in adult populations (OR=1.41; p = 0.01). Additionally, females were more likely to be diagnosed with both disorders in studies where ADHD was the primary diagnosis (OR = 1.60; p = 0.002), and in studies employing structured clinical interviews as diagnostic tools (OR = 1.46; p = 0.009).

Conclusions: Our study is the first to show that the association between ADHD and PTSD is stronger in females, suggesting that ADHD may increase risk for PTSD in a sex-specific manner.

Keywords: ADHD; Attention Deficit-Hyperactivity Disorder; PTSD; Posttraumatic Stress Disorder; gender; meta-analysis; sex.

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Conflict of interest statement

Declaration of competing interest: The authors declare no competing interests.

Figures

Figure 1.
Figure 1.
PRISMA Flow Diagram
Figure 2.
Figure 2.
Odds Ratio of Comorbid PTSD/ADHD in Females Compared to Males
Figure 3.
Figure 3.
Funnel Plot of Between-Study Heterogeneity of Female: Male ADHD/PTSD Odds Ratio
See this image and copyright information in PMC

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