Academic journal article East Asian Archives of Psychiatry

A Cross-Sectional Cohort Study of Prevalence, Co-Morbidities, and Correlates of Attention-Deficit Hyperactivity Disorder among Adult Patients Admitted to the Li Ka Shing Psychiatric Outpatient Clinic, Hong Kong

Academic journal article East Asian Archives of Psychiatry

A Cross-Sectional Cohort Study of Prevalence, Co-Morbidities, and Correlates of Attention-Deficit Hyperactivity Disorder among Adult Patients Admitted to the Li Ka Shing Psychiatric Outpatient Clinic, Hong Kong

Article excerpt

Introduction

Attention-deficit hyperactivity disorder (ADHD) is a persisting pattern of inattention and / or hyperactivityimpulsivity that interferes with functioning or development. The worldwide prevalence of ADHD in the adult population has been reported to be 4.4%, a level only slightly less than the 5.3% estimated worldwide prevalence in children.1 The meta-analysis study from Faraone et al2 indicated that around two thirds of children with ADHD continue to have impairing levels of ADHD symptoms as an adult. Furthermore, ADHD has been associated with a number of co-morbid psychiatric disorders, such as mood, anxiety, and substance use disorders, and higher rates of suicidal attempts and criminality.3-5 Nonetheless a US-based study showed that about 50% of patients with ADHD had obtained treatment for other co-morbid mental and substance-related disorders and only about 10% had received treatment for ADHD.6 Prevalences of ADHD among adult psychiatric outpatient samples, applying DSM-IV-TR criteria, have been estimated to be 15.9%, 16.8% and 22% in Turkey, Mexico and North East England, respectively.7-9 A multinational cross-sectional study in Europe, based on Diagnostic Interview for ADHD in Adults (DIVA) and applying DSM-5 criteria, revealed that 17.4% of outpatients were diagnosed with ADHD.10

To the best of our knowledge, there has been no local study of the prevalence of ADHD among adult psychiatric outpatients. Nonetheless there is growing awareness that undiagnosed and untreated ADHD can result in several negative impacts on the individual's life as well as society.11 Knowledge of the prevalence of ADHD in the adult outpatient psychiatric clinic can enable clinicians to treat the ADHD as well as co-morbid conditions, and also to consider ADHD a possible differential diagnosis. The present study aimed to examine the prevalence of ADHD in adult psychiatric outpatients and to compare the socio-demographic characteristics, DSM-5 Axis I-II comorbidities, correlates, and functional impairments in those with and without ADHD.

Methods

This was a cross-sectional cohort study of adult patients aged between 18 and 64 years seen at the Li Ka Shing psychiatric outpatient clinic (LKSPC) of Prince of Wales Hospital, Hong Kong between 12 March 2015 and 17 June 2015. This study was approved by the Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee. Informed and written consent was obtained from all participants. Patients were excluded if they refused to give informed consent, had major neurological disease, or could not understand and complete the questionnaires. During the recruitment period, patients were identified at the registration counter when they recorded their first attendance at the LKSPC. Subsequently, their electronic medical notes were scrutinised with the help of a case report form with regard to socio-demographic data, correlates, and the DSM-5 Axis I-II disorder diagnoses, according to the usual standards of clinical practice at LKSPC, i.e. all new outpatients' history and mental state examination were entered electronically into a standardised admission summary template of the psychiatric clinical information system, and all admission summaries were later reviewed by the corresponding supervising consultant psychiatrist.

The participants were evaluated for a diagnosis of ADHD in 2 phases. In the screening phase, on their first visit to LKSPC, participants were asked to complete the following 3 self-report questionnaires before seeing their clinician: (1) Adult ADHD Self-Report Scale-v1.1 (ASRS-v1.1) Screener and Symptom Checklist (traditional Chinese version)12; (2) childhood symptoms and family history enquiries: 2 dichotomous yes-or-no questions on the experience of any one of the symptoms covered by the ASRS-v1.1 Symptom Checklist before the age of 12 years, and the family history of ADHD; and (3) Sheehan Disability Scale (SDS) in Cantonese Chinese version. …

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