Sex differences in the comorbidity between attention deficit-hyperactivity disorder and posttraumatic stress disorder: A systematic literature review and meta-analysis

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; Comorbidity; PTSD; Posttraumatic stress disorder; Sex differences.