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The effects of temporally secondary co-morbid mental disorders on the associations of DSM-IV ADHD with adverse outcomes in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

Published online by Cambridge University Press:  08 October 2013

R. C. Kessler ,
L. A. Adler ,
P. Berglund ,
J. G. Green ,
K. A. McLaughlin ,
J. Fayyad ,
L. J. Russo ,
N. A. Sampson ,
V. Shahly  and
A. M. Zaslavsky
R. C. Kessler*
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
L. A. Adler
Affiliation:
Departments of Psychiatry and Child and Adolescent Psychiatry, NYU School of Medicine and Psychiatry, NY VA Harbor Healthcare Service, New York, NY, USA
P. Berglund
Affiliation:
University of Michigan, Institute for Social Research, Ann Arbor, MI, USA
J. G. Green
Affiliation:
School of Education, Boston University, Boston, MA, USA
K. A. McLaughlin
Affiliation:
Division of General Pediatrics, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA
J. Fayyad
Affiliation:
Institute for Development Research, Advocacy, and Applied Care (IDRAAC), St George Hospital University Medical Center, Beirut, Lebanon
L. J. Russo
Affiliation:
Shire Development Inc., Wayne, PA, USA
N. A. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
V. Shahly
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
A. M. Zaslavsky
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MA, USA
*
*Address for correspondence: R. C. Kessler, Ph.D., Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115, USA. (Email: kessler@hcp.med.harvard.edu)
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Abstract

Background

Although DSM-IV attention deficit hyperactivity disorder (ADHD) is known to be associated with numerous adverse outcomes, uncertainties exist about how much these associations are mediated temporally by secondary co-morbid disorders.

Method

The US National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a national survey of adolescents aged 13–17 years (n = 6483 adolescent–parent pairs), assessed DSM-IV disorders with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Statistical decomposition was used to compare direct effects of ADHD with indirect effects of ADHD through temporally secondary mental disorders (anxiety, mood, disruptive behavior, substance disorders) in predicting poor educational performance (suspension, repeating a grade, below-average grades), suicidality (ideation, plans, attempts) and parent perceptions of adolescent functioning (physical and mental health, interference with role functioning and distress due to emotional problems).

Results

ADHD had significant gross associations with all outcomes. Direct effects of ADHD explained most (51.9–67.6%) of these associations with repeating a grade in school, perceived physical and mental health (only girls), interference with role functioning and distress, and significant components (34.5–44.6%) of the associations with school suspension and perceived mental health (only boys). Indirect effects of ADHD on educational outcomes were predominantly through disruptive behavior disorders (26.9–52.5%) whereas indirect effects on suicidality were predominantly through mood disorders (42.8–59.1%). Indirect effects on most other outcomes were through both mood (19.8–31.2%) and disruptive behavior (20.1–24.5%) disorders, with anxiety and substance disorders less consistently important. Most associations were comparable for girls and boys.

Conclusions

Interventions aimed at reducing the adverse effects of ADHD might profitably target prevention or treatment of temporally secondary co-morbid disorders.

Keywords

Adolescenceattention deficit hyperactivity disorder (ADHD)co-morbidityDSM-IVepidemiologyNational Comorbidity Survey Replication Adolescent Supplement (NCS-A)prevalence
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 8 , June 2014 , pp. 1779 - 1792
Copyright
Copyright © Cambridge University Press 2013 

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