Adult ADHD Symptoms in a Large Metropolitan Area From Brazil: Prevalence and Associations with Psychiatric Comorbidity,Bullying,Sexual Abuse,and Quality of Life
Restricted accessResearch articleFirst published online May, 2024
Adult ADHD Symptoms in a Large Metropolitan Area From Brazil: Prevalence and Associations with Psychiatric Comorbidity,Bullying,Sexual Abuse,and Quality of Life
There is scant data about the prevalence and correlates of ADHD in middle-income countries.
Objective:
The aim of this study was to investigate the prevalence and psychiatric correlates of symptomatic ADHD in a large metropolitan area of a middle-income country.
Methods:
An in-person household survey with randomly selected 2,297 adults aged 19 to 60 from Rio de Janeiro, Brazil, assessed by trained lay interviewers. The Adult Self-Rating Scale Screener (ASRS-6) was used. Chi-square and logistic regression were conducted.
Results:
ADHD prevalence was 4.59 (95% CI [3.56, 5.44]). Those with ADHD were younger and more often unemployed; they displayed more psychiatric symptoms (depression, anxiety, and alcohol abuse) and a history of bullying and sexual abuse. They also had worse physical health indicators. Findings remained significant when controlling for socioeconomic variables.
Conclusion:
Adults with symptomatic ADHD from a large metropolitan area in Brazil show a pattern of findings consistent with what has been observed in higher-income countries
AdlerL. A.ShawD. M.SpencerT. J.NewcornJ. H.HammernessP.SittD. J.MinerlyC.DavidowJ. V.FaraoneS. V. (2012). Preliminary examination of the reliability and concurrent validity of the attention-deficit/hyperactivity disorder self-report scale v1. 1 symptom checklist to rate symptoms of attention-deficit/hyperactivity disorder in adolescents. Journal of Child and Adolescent Psychopharmacology, 22(3), 238–244.
2.
AppolinarioJ. C.SichieriR.LopesC. S.MoraesC. E.da VeigaG. V.FreitasS.NunesM. A. A.WangY. P.HayP. (2022). Correlates and impact of DSM-5 binge eating disorder, bulimia nervosa and recurrent binge eating: A representative population survey in a middle-income country. Social Psychiatry and Psychiatric Epidemiology, 57(7), 1491–1503.
3.
BakerL.PrevattF.ProctorB. (2012). Drug and alcohol use in college students with and without ADHD. Journal of Attention Disorders, 16(3), 255–263.
4.
BarkleyR. A.FischerM.SmallishL.FletcherK. (2002). The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. Journal of Abnormal Psychology, 111, 279–289.
5.
BiedermanJ.PettyC. R.WoodworthK. Y.LomedicoA.HyderL. L.FaraoneS. V. (2012). Adult outcome of attention-deficit/hyperactivity disorder: A controlled 16-year follow-up study. The Journal of Clinical Psychiatry, 73(7), 577.
6.
BongS. H.KimK. M.SeolK. H.KimJ. W. (2021). Bullying perpetration and victimization in elementary school students diagnosed with attention-deficit/hyperactivity disorder. Asian Journal of Psychiatry, 62, 102729.
7.
BreslinF. C.PoleJ. D. (2009). Work injury risk among young people with learning disabilities and attention-deficit/hyperactivity disorder in Canada. American Journal of Public Health, 99(8), 1423–1430.
8.
ChouW. J.LiuT. L.YangP.YenC. F.HuH. F. (2018). Bullying victimization and perpetration and their correlates in adolescents clinically diagnosed with ADHD. Journal of Attention Disorders, 22(1), 25–34.
9.
CookC. R.WilliamsK. R.GuerraN. G.KimT. E.SadekS. (2010). Predictors of bullying and victimization in childhood and adolescence: A meta-analytic investigation. School Psychology Quarterly, 25(2), 65.
10.
CorbisieroS.Hartmann-SchorroR. M.Riecher-RösslerA.StieglitzR. D. (2017). Screening for adult attention-deficit/hyperactivity disorder in a psychiatric outpatient population with specific focus on sex differences. Frontiers in Psychiatry, 8, 115.
11.
DaleyD.JacobsenR. H.LangeA. M.SørensenA.WalldorfJ. (2019). The economic burden of adult attention deficit hyperactivity disorder: A sibling comparison cost analysis. European Psychiatry, 61, 41–48.
12.
DasD.CherbuinN.ButterworthP.AnsteyK. J.EastealS. (2012). A population-based study of attention deficit/hyperactivity disorder symptoms and associated impairment in middle-aged adults. PLoS One, 7(2), e31500.
13.
de ZwaanM.GrußB.MüllerA.GraapH.MartinA.GlaesmerH.HilbertA.PhilipsenA. (2012). The estimated prevalence and correlates of adult ADHD in a German community sample. European Archives of Psychiatry and Clinical Neuroscience, 262, 79–86.
14.
DoshiJ. A.HodgkinsP.KahleJ.SikiricaV.CangelosiM. J.SetyawanJ.ErderM. H.NeumannP. J. (2012). Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. Journal of the American Academy of Child & Adolescent Psychiatry, 51(10), 990–1002.
15.
EakinL.MindeK.HechtmanL.OchsE.KraneE.BouffardR.GreenfieldB.LooperK. (2004). The marital and family functioning of adults with ADHD and their spouses. Journal of Attention Disorders, 8(1), 1–10.
FaraoneS. V.BanaschewskiT.CoghillD.ZhengY.BiedermanJ.BellgroveM. A.NewcornJ. H.GignacM.Al SaudN. M.ManorI.RohdeL. A.YangL.CorteseS.AlmagorD.SteinM. A.AlbattiT. H.AljoudiH. F.AlqahtaniM. M. J.AshersonP.. . . WangY. (2021). The world federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. Neuroscience & Biobehavioral Reviews, 128, 789–818.
18.
FaraoneS. V.BiedermanJ.MickE. (2006). The age-dependent decline of attention deficit hyperactivity disorder: A meta-analysis of follow-up studies. Psychological Medicine, 36(2), 159–165.
19.
FayyadJ.SampsonN. A.HwangI.AdamowskiT.Aguilar-GaxiolaS.Al-HamzawiA.AndradeL. H.BorgesG.de GirolamoG.FlorescuS.GurejeO.HaroJ. M.HuC.KaramE. G.LeeS.Navarro-MateuF.O’NeillS.PennellB. E.PiazzaM.. . . KesslerR. C. (2017). The descriptive epidemiology of DSM-IV adult ADHD in the world health organization world mental health surveys. ADHD Attention Deficit and Hyperactivity Disorders, 9, 47–65.
20.
FoglerJ. M.WeaverA. L.KatusicS.VoigtR. G.BarbaresiW. J. (2022). Recalled experiences of bullying and victimization in a longitudinal, population-based birth cohort: The influence of ADHD and co-occurring psychiatric disorder. Journal of Attention Disorders, 26(1), 15–24.
21.
FraguasR.Jr.HenriquesS. G.Jr.De LuciaM. S.IosifescuD. V.SchwartzF. H.MenezesP. R.MenezesP. R.GattazW. F.MartinsM. A. (2006). The detection of depression in medical setting: A study with PRIME-MD. Journal of Affective Disorders, 91(1), 11–17.
22.
FriedrichsB.IglW.LarssonH.LarssonJ. O. (2012). Coexisting psychiatric problems and stressful life events in adults with symptoms of ADHD—a large Swedish population-based study of twins. Journal of Attention Disorders, 16(1), 13–22.
23.
GjervanB.HjemdalO.NordahlH. M. (2016). Functional impairment mediates the relationship between adult ADHD inattentiveness and occupational outcome. Journal of Attention Disorders, 20(6), 510–518.
24.
GroenmanA. P.JanssenT. W.OosterlaanJ. (2017). Childhood psychiatric disorders as risk factor for subsequent substance abuse: A meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 56(7), 556–569.
25.
HesseM. (2013). The ASRS-6 has two latent factors: Attention deficit and hyperactivity. Journal of Attention Disorders, 17(3), 203–207.
26.
HessonJ.FowlerK. (2018). Prevalence and correlates of self-reported ADD/ADHD in a large national sample of Canadian adults. Journal of Attention Disorders, 22(2), 191–200.
27.
HuntleyZ.YoungS. (2014). Alcohol and substance use history among ADHD adults: The relationship with persistent and remitting symptoms, personality, employment, and history of service use. Journal of Attention Disorders, 18(1), 82–90.
28.
KesslerR. C.AdlerL.AmesM.DemlerO.FaraoneS.HiripiE. V. A.HowesM. J.JinR.SecnikK.SpencerT.UstunT. B.WaltersE. E. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256.
29.
KesslerR. C.AdlerL.BarkleyR.BiedermanJ.ConnersC. K.DemlerO.FaraoneS. V.GreenhillL. L.HowesM. J.SecnikK.SpencerT.UstunT. B.WaltersE. E.ZaslavskyA. M. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. American Journal of Psychiatry, 163(4), 716–723.
30.
KesslerR. C.AdlerL. A.GruberM. J.SarawateC. A.SpencerT.Van BruntD. L. (2007). Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. International Journal of Methods in Psychiatric Research, 16(2), 52–65.
31.
KesslerR. C.UstunT. B. (2008). The WHO World Mental Health Surveys: Global perspectives on the epidemiology of mental disorders. Cambridge University Press.
32.
KooijJ. S.BuitelaarJ. K.FurerJ. W.RijndersC. A. T.HodiamontP. P. (2005). Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychological Medicine, 35(6), 817–827.
33.
KroenkeK.SpitzerR. L.WilliamsJ. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.
34.
LangevinR.MarshallC.WallaceA.GagnéM. E.KingslandE.TemcheffC. (2023). Disentangling the associations between attention deficit hyperactivity disorder and child sexual abuse: A systematic review. Trauma, Violence, & Abuse, 24(2), 369–389.
35.
LeeS. S.HumphreysK. L.FloryK.LiuR.GlassK. (2011). Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: A meta-analytic review. Clinical Psychology Review, 31(3), 328–341.
36.
LibutzkiB.LudwigS.MayM.JacobsenR. H.ReifA.HartmanC. A. (2019). Direct medical costs of ADHD and its comorbid conditions on basis of a claims data analysis. European Psychiatry, 58, 38–44.
37.
LimaC. T.FreireA. C. C.SilvaA. P. B.TeixeiraR. M.FarrellM.PrinceM. (2005). Concurrent and construct validity of the AUDIT in an urban Brazilian sample. Alcohol and Alcoholism, 40(6), 584–589.
38.
MarshalM. P.MolinaB. S. G.PelhamW. E.Jr. (2003). Childhood ADHD and adolescent substance use: An examination of deviant peer group affiliation as a risk factor. Psychology of Addictive Behaviors, 17(4), 293–302.
39.
MattosP.SegenreichD.SaboyaE.LouzãM.DiasG.RomanoM. (2006). Adaptação transcultural para o português da escala Adult Self-Report Scale para avaliação do transtorno de déficit de atenção/hiperatividade (TDAH) em adultos. Archives of Clinical Psychiatry, 33(4), 188–194.
40.
McDonaldA. J.CookS.TurnerN. E.IalomiteanuA. R.MannR. E.BondyS. J.RoereckeM.McCreadyJ.MillstoneD.HamiltonH. A.Elton-MarshallT.RehmJ.KurdyakP.IlieG.VingilisE. R.WickensC. M.van der MaasM.CusimanoM. D. (2021). Adult attention-deficit hyperactivity disorder symptoms and psychological distress, hazardous drinking, and problem gambling: A population-based study. Psychiatry Research, 301, 113985.
41.
MorenoA. L.SousaD. A. D.SouzaA. M. F. L. P. D.ManfroG. G.Salum JuniorG. A.KollerS. H.de Lima OsórioF.CrippaJ. A. D. S. (2016). Factor structure, reliability, and item parameters of the Brazilian-Portuguese version of the GAD-7 questionnaire. Temas em psicologia. São Paulo, 24(1), 367–376.
42.
MoulinF.CholletA.Ramos-QuirogaJ. A.BouvardM.MelchiorM.GaléraC. (2018). Prevalence and psychosocial correlates of ADHD symptoms in young adulthood: A French population-based study. Journal of Attention Disorders, 22(2), 167–181.
43.
ØstergaardS. D.LarsenJ. T.DalsgaardS.WilensT. E.MortensenP. B.AgerboE.MorsO.PetersenL. (2016). Predicting ADHD by assessment of Rutter’s indicators of adversity in infancy. PLoS One, 11(6), e0157352.
44.
Piñeiro-DieguezB.Balanzá-MartínezV.García-GarcíaP.Soler-LópezB., & CAT Study Group. (2016). Psychiatric comorbidity at the time of diagnosis in adults with ADHD: The CAT study. Journal of Attention Disorders, 20(12), 1066–1075.
45.
PolanczykG.LaranjeiraR.ZaleskiM.PinskyI.CaetanoR.RohdeL. A. (2010). ADHD in a representative sample of the Brazilian population: Estimated prevalence and comparative adequacy of criteria between adolescents and adults according to the item response theory. International Journal of Methods in Psychiatric Research, 19(3), 177–184.
46.
RamtekkarU. P.ReiersenA. M.TodorovA. A.ToddR. D. (2010). Sex and age differences in attention-deficit/hyperactivity disorder symptoms and diagnoses: Implications for DSM-V and ICD-11. Journal of the American Academy of Child & Adolescent Psychiatry, 49(3), 217–228.
47.
RobinsL.HelzerJ. (1985). Diagnostic Interview Schedule (DIS Version III-A). Washington University, Department of Psychiatry.
48.
RucklidgeJ. J.BrownD. L.CrawfordS.KaplanB. J. (2006). Retrospective reports of childhood trauma in adults with ADHD. Journal of Attention Disorders, 9(4), 631–641.
49.
RucklidgeJ. J.Downs-WoolleyM.TaylorM.BrownJ. A.HarrowS. E. (2016). Psychiatric comorbidities in a New Zealand sample of adults with ADHD. Journal of Attention Disorders, 20(12), 1030–1038.
50.
RussellA. E.FordT.WilliamsR.RussellG. (2016). The association between socioeconomic disadvantage and attention deficit/hyperactivity disorder (ADHD): A systematic review. Child Psychiatry & Human Development, 47, 440–458.
51.
SibleyM. H.MitchellJ. T.BeckerS. P. (2016). Method of adult diagnosis influences estimated persistence of childhood ADHD: A systematic review of longitudinal studies. Lancet Psychiatry, 3, 1157–1165.
52.
SibleyM. H.PelhamW. E.MolinaB. S.GnagyE. M.WaxmonskyJ. G.WaschbuschD. A.DerefinkoK. J.WymbsB. T.GarefinoA. C.BabinskiD. E.KuriyanA. B. (2012). When diagnosing ADHD in young adults emphasize informant reports, DSM items, and impairment. Journal of Consulting and Clinical Psychology, 80, 1052–1061.
53.
SilveiraM. F.AlmeidaJ. C.FreireR. S.HaikalD. S.MartinsA. E. (2013). Psychometric properties of the quality of life assessment instrument: 12-item health survey (SF-12). Cien Saude Colet, 18(7), 1923–1931.
54.
SimonV.CzoborP.BálintS.MészárosA.BitterI. (2009). Prevalence and correlates of adult attention-deficit hyperactivity disorder: Meta-analysis. The British Journal of Psychiatry, 194(3), 204–211.
55.
SinghamT.VidingE.SchoelerT.ArseneaultL.RonaldA.CecilC. M.McCroryE.RijsdijkF.PingaultJ. B. (2017). Concurrent and longitudinal contribution of exposure to bullying in childhood to mental health: The role of vulnerability and resilience. JAMA Psychiatry, 74(11), 1112–1119.
56.
SongP.ZhaM.YangQ.ZhangY.LiX.RudanI. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of Global Health, 11, 04009.
57.
Statistics (IBGE) Brazilian Institute of Geography and Brazilian Demographic Census. (2020). Brazilian Institute of Geography and Statistics. https://ftp.ibge.gov.br/
58.
StensengF.BelskyJ.SkalickaV.WichstrømL. (2016). Peer rejection and attention deficit hyperactivity disorder symptoms: Reciprocal relations through ages 4, 6, and 8. Child Development, 87(2), 365–373.
59.
UstunB.AdlerL. A.RudinC.FaraoneS. V.SpencerT. J.BerglundP.GruberM. J.KesslerR. C. (2017). The World Health Organization adult attention-deficit/hyperactivity disorder self-report screening scale for DSM-5. JAMA Psychiatry, 74(5), 520–526.
60.
VasconcellosM. T. L. D.SilvaP. L. D. N.SzwarcwaldC. L. (2005). Sampling design for the world health survey in Brazil. Cadernos de Saúde Pública, 21, S89–S99.
61.
WillcuttE. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics, 9(3), 490–499.
62.
WymbsB. T.DawsonA. E.EganT. E.SacchettiG. M. (2019). Rates of intimate partner violence perpetration and victimization among adults with ADHD. Journal of Attention Disorders, 23(9), 949–958.
63.
WymbsB. T.DawsonA. E.SuhrJ. A.BunfordN.GidyczC. A. (2017). ADHD symptoms as risk factors for intimate partner violence perpetration and victimization. Journal of Interpersonal Violence, 32(5), 659–681.
64.
YoshimasuK.BarbaresiW. J.ColliganR. C.VoigtR. G.KillianJ. M.WeaverA. L.KatusicS. K. (2018). Adults with persistent ADHD: Gender and psychiatric comorbidities—A population-based longitudinal study. Journal of Attention Disorders, 22(6), 535–546.
65.
ZhangK. A.MarkonK. E. (2021). Age and gender measurement noninvariance of the adult ADHD self-report scale screener. Journal of Attention Disorders, 25(3), 403–413.
66.
ZwickerA.MacKenzieL. E.DrobininV.BagherA. M.Howes VallisE.PropperL.BagnellA.AbidiS.PavlovaB.AldaM.Denovan-WrightE. M.UherR. (2020). Neurodevelopmental and genetic determinants of exposure to adversity among youth at risk for mental illness. Journal of Child Psychology and Psychiatry, 61(5), 536–544.
