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

By Chan, L. F. | East Asian Archives of Psychiatry, June 2017 | Go to article overview

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


Chan, L. F., East Asian Archives of Psychiatry


Abstract

Objectives: To examine the prevalence, co-morbidities, and correlates of attention-deficit hyperactivity disorder (ADHD) among adult patients who attended the Li Ka Shing psychiatric outpatient clinic (LKSPC), Hong Kong.

Methods: This study was a cross-sectional cohort study of patients consecutively referred to LKSPC over a 3-month period for evaluation of adult ADHD in 2 phases. In the screening phase, the Adult ADHD Self-Report Scale--v1.1 (ASRS-v1.1) Screener and Symptom Checklist and Sheehan Disability Scale (SDS) were used in the evaluation. In the interview phase, ADHD diagnosis was ascertained using the Diagnostic Interview for ADHD in Adults, version 2.0 (DIVA 2.0), with the DSM-5 criteria, in patients who exceeded the cut-off point of either the ASRS-v1.1 Screener or Symptom Checklist.

Results: The study included 254 patients of whom 49 were diagnosed with ADHD. Patients with ADHD were aged 18 to 60 (mean, 40.1) years, and 63.3% were women. The estimated prevalence of ADHD in adult psychiatric patients, by sensitivity analysis, was 13% to 19.3% with a higher prevalence in men than women (24.7% vs. 17.1%). Adult ADHD was highly co-morbid with substance / alcohol use disorders and forensic record, and associated with functional impairment. In the ADHD combined presentation group, there was additional co-morbidities of bipolar disorder, active substance use and chronic alcohol use, and a higher associated risk of suicidal attempt.

Conclusions: Efforts are needed to increase the detection and treatment of adult ADHD that affects a relevant proportion of our adult psychiatric outpatient population, and was associated with adverse social outcomes and functional impairment.

Key words: Attention deficit disorder with hyperactivity; Comorbidity; Hong Kong; Prevalence

Introduction

Attention-deficit hyperactivity disorder (ADHD) is a persisting pattern of inattention and / or hyperactivity-impulsivity 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 al (2) 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. …

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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
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