ADHD and Generalized Anxiety Disorder: Hand in Hand?

According to a new nationally representative study, 1 in 4 adults aged 20 to 39 with attention deficit hyperactivity disorder (ADHD) have generalized anxiety disorder (GAD), and individuals with ADHD are 4 times more likely to have GAD at some point in their life, when compared to those without ADHD.

Other relevant factors, such as sociodemographics, adverse childhood experiences, and a lifetime history of substance use disorders and major depressive disorders were controlled; individuals with ADHD were still more than twice as likely to have GAD.

“These findings underline how vulnerable adults with ADHD are to generalized anxiety disorders. There are many studies linking adult ADHD to depression and suicidality, but less attention has been paid to generalized activity disorders and other adverse outcomes across the life course,” lead author Esme Fuller-Thomson said. Fuller-Thomson is a professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work and Director of the Institute for Life Course & Aging.

Investigators examined a nationally representative sample of 6898 respondents from the Canadian Community Health Survey-Mental Health aged 20 to 39. Of those surveyed, 272 had ADHD and 682 had GAD. They found female respondents with ADHD had nearly 5 times higher odds of GAD, even after controlling for other covariates.

“ADHD has been severely underdiagnosed and undertreated in girls and women,” said coauthor Andie MacNeil, a Master of Social Work graduate from the University of Toronto. “These findings suggest that women with ADHD may also be more susceptible to experiencing anxiety, emphasizing the need for greater support for women with ADHD.”

Additionally, adults who had experienced adverse childhood experiences such as childhood sexual or physical abuse or chronic parental domestic violence were 3 times more likely to have GAD, and 60% of those with ADHD who had anxiety disorders had experienced at least 1 of these adverse childhood experiences.

Having an income below $40,000, having fewer close relationships, and having a lifetime history of major depressive disorder were amongst the other factors associated with GAD among adults with ADHD. The odds of GAD for individuals with ADHD were 6-fold if they had a lifetime history of major depressive disorder.

“These results highlight the importance of screening for mental illness and addressing depressive symptoms when providing support to those with ADHD,” said Lauren Carrique, a recent graduate of University of Toronto's MSW program who is a social worker at Toronto General Hospital. “Individuals experiencing ADHD, GAD, and depression are a particularly vulnerable subgroup that may need targeted outreach by health professionals.”

References

1. Fuller-Thomson E, Carrique L, MacNeil A. Generalized anxiety disorder among adults with attention deficit hyperactivity disorder. J Affect Disord. 2021;S0165-0327(21)01096-X.

2. University of Toronto. Adults with ADHD four times more likely to have generalized anxiety disorder. News release. November 18, 2021. Accessed December 13, 2021. https://www.eurekalert.org/news-releases/935302