Clinical correlates of comorbid attention deficit hyperactivity disorder in adults suffering from bipolar disorder: A meta-analysis

Abstract

Objective: Attention deficit hyperactivity disorder is a frequent comorbid condition in adults with bipolar disorder. We performed a meta-analysis aimed at assessing sociodemographic and clinical correlates of attention deficit hyperactivity disorder in bipolar disorder. Method: We searched main electronic databases up to June 2021. Random-effects meta-analyses, with relevant meta-regression and quality-based sensitivity analyses, were carried out to estimate the association between attention deficit hyperactivity disorder and putative correlates, grading the quality of evidence. Results: We included 43 studies, based on 38 independent samples. Attention deficit hyperactivity disorder participants were more likely to be males (odds ratio = 1.46; p < 0.001) and unemployed (odds ratio = 1.45; p = 0.045), and less likely to be married (odds ratio = 0.62; p = 0.014). They had an earlier onset of bipolar disorder (standardized mean difference = −0.36; p < 0.001); more mood episodes (standardized mean difference = 0.35; p = 0.007), particularly depressive (standardized mean difference = 0.30; p = 0.011) and mixed (standardized mean difference = 0.30; p = 0.031) ones; higher odds of using antidepressants (odds ratio = 1.80; p = 0.024) and attempted suicides (odds ratio = 1.83; p < 0.001) and lower odds of psychotic features (odds ratio = 0.63; p = 0.010). Moreover, they were more likely to have generalized anxiety disorder (odds ratio = 1.50; p = 0.019), panic disorder (odds ratio = 1.89; p < 0.001), social phobia (odds ratio = 1.61; p = 0.017), eating disorders (odds ratio = 1.91; p = 0.007), antisocial personality disorder (odds ratio = 3.59; p = 0.004) and substance (odds ratio = 2.29; p < 0.001) or alcohol (odds ratio = 2.28; p < 0.001) use disorders. Quality of the evidence was generally low or very low for the majority of correlates, except for bipolar disorder onset and alcohol/substance use disorders (high), and suicide attempts (moderate). Conclusion: Comorbid bipolar disorder/attention deficit hyperactivity disorder may have some distinctive clinical features including an earlier onset of bipolar disorder and higher comorbid alcohol/substance use disorder rates. Further research is needed to identify additional clinical characteristics of this comorbidity.

Association of sociodemographic, proximal, and distal clinical factors with current suicidal ideation: Findings from a nonclinical sample of young adults

“…However, there is accumulating evidence that other neurodevelopmental vulnerabilities, for example, attention-deficit/hyperactivity disorder (ADHD) symptoms and specific learning disabilities may also serve as prerequisites of trajectories leading to suicide. Indeed, recent meta-analyses found that a diagnosis of ADHD is associated with increased risk of suicidal ideation, plans and attempts as well as completed suicide [ 38 , 39 ]. Also, it has been found that specific learning disorders, including reading disabilities (RDs), are associated with higher risk of suicidal attempts after adjustment for known risk factors, for example, CT, a history of mental disorders and substance abuse [ 40 ].…”

Inattention, Impulsivity, and Hyperactivity among Individuals with Self-Reported Impaired Wound Healing

“…It can be hypothesized that other psychological and/or medical conditions for which patients report AD or HI may also make these patients more vulnerable for having accidents and injury. Several psychological and medical conditions have ADHD as comorbidity, including mood disorders (e.g., anxiety, depression), substance use disorders, personality disorders, autism, and insomnia [ 17 ]. In addition, neurological and digestive diseases have been associated with ADHD symptomatology as well [ 18 , 19 , 20 ].…”

Prevalence and correlates of manic/hypomanic and depressive predominant polarity in bipolar disorder: systematic review and meta-analysis

“…Following a similar approach used in recent meta-analyses, 27 , 28 we used GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) items, 29 adapted for non-interventional observational studies, to classify the quality of evidence as high, moderate, low or very low for each variable showing a statistically significant estimate ( P < 0.05).…”