Clinical Correlations of ADHD Symptoms with Anxiety, Depression, and Self-Esteem in Medical Students: A Cross-Sectional Study

Yıl 2024, Cilt: 46 Sayı: 5, 700 - 710, 12.09.2024

Murat Eyüboğlu , Büşra Durmuş , Ali Ercan Altınöz , Damla Eyüboğlu

https://doi.org/10.20515/otd.1461068

Öz

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. This study explores the relationship between ADHD symptoms and the prevalence of anxiety, depression, and self-esteem issues among medical students. A cross-sectional study was conducted with 210 medical students. The Adult ADHD Self-Report Scale (ASRS), Hospital Anxiety and Depression Scale (HADS), and Rosenberg Self-Esteem Scale (RSES) were employed. ADHD risk was assessed using the dichotomized scoring of the ASRS. Logistic regression models evaluating the impact of ADHD symptoms on anxiety, depression, and self-esteem. The study found that 24% of participants were at high risk for ADHD. There was no significant difference in academic success, smoking habits, or perceived socioeconomic status between high and low-ADHD-risk groups. However, high-risk ADHD participants showed significantly worse scores in anxiety, depression, and self-esteem. Gender differences in ADHD prevalence were not observed. A strong relationship was identified between ADHD symptoms and increased anxiety and depression. Notably, 47% of students scored above the threshold for depression and 41% for anxiety. Logistic regression analysis revealed that high ADHD risk increased the scores for anxiety and depression but had no significant effect on self-esteem. The high prevalence of ADHD symptoms among medical students is a significant concern, particularly given their association with increased anxiety and depression. Early identification and treatment of ADHD in youth could potentially mitigate the development of mood symptoms and prevent the decline in self-esteem

Anahtar Kelimeler

medical students, ADHD, depression, anxiety, self-esteem

Tıp Öğrencilerinde DEHB Belirtilerinin Anksiyete, Depresyon ve Benlik Saygısı ile İlişkisi: Kesitsel Bir Çalışma

Öz

Dikkat Eksikliği Hiperaktivite Bozukluğu (DEHB), dikkatsizlik, hiperaktivite ve dürtüsellik belirtileri ile karakterize nörogelişimsel bir bozukluktur. Bu çalışma, tıp öğrencileri arasında DEHB belirtileri ile anksiyete, depresyon ve benlik saygısı sorunları arasındaki ilişkiyi araştırmaktadır. Çalışma 210 tıp öğrencisi ile kesitsel olarak yapılmıştır. Erişkin DEHB Öz-Bildirim Ölçeği (ASRS), Hastane Anksiyete ve Depresyon Ölçeği ve Rosenberg Benlik Saygısı Ölçeği kullanılmıştır. DEHB riski, ASRS'nin ikiye ayrılmış puanlaması kullanılarak değerlendirilmiştir. Lojistik regresyon modelleri DEHB belirtilerinin anksiyete, depresyon ve benlik saygısı üzerindeki etkisini değerlendirmiştir. Çalışmada katılımcıların %24'ünün DEHB için yüksek risk altında olduğu bulunmuştur. Yüksek ve düşük DEHB riski olan gruplar arasında akademik başarı, sigara kullanım alışkanlıkları veya algılanan sosyoekonomik durum açısından anlamlı bir fark bulunmamıştır. Ancak, yüksek riskli DEHB katılımcılarında anksiyete, depresyon ve benlik saygısı puanları anlamlı derecede daha kötüydü. DEHB yaygınlığında cinsiyet farklılıkları gözlemlenmemiştir. Anksiyete ve depresyon ile DEHB belirtileri arasında güçlü bir ilişki tespit edilmiştir. Dikkat çekici olarak, öğrencilerin %47'si depresyon ve %41'i anksiyete için eşik değerinin üzerinde puan almıştır. Lojistik regresyon analizi, yüksek DEHB riskinin anksiyete ve depresyon puanlarını artırdığını ancak benlik saygısı üzerinde anlamlı bir etkisi olmadığını ortaya koymuştur. Tıp öğrencileri arasında DEHB belirtilerinin yüksek yaygınlığı, özellikle artan anksiyete ve depresyon ile olan ilişkisi göz önüne alındığında önemli bir endişe kaynağıdır. Gençlerde DEHB'nin erken tanı ve tedavisi, ruhsal semptomlarının gelişimini hafifletebilir ve benlik saygısındaki düşüşü engelleyebilir.

Anahtar Kelimeler

DEHB, tıp öğrencileri, anksiyete, depresyon, benlik saygısı

Kaynakça

• 1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC, 2013.
• 2. Faraone SV, Asherson P, Banaschewski T, Biederman J, Buitelaar JK, Ramos-Quiroga JA, et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers. 2015;1:15020.
• 3. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007;164(6):942-8.
• 4. Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics. 2012;9(3):490-9.
• 5. Shen Y, Chan BSM, Liu J, Meng F, Yang T, He Y, et al. Estimated prevalence and associated risk factors of attention deficit hyperactivity disorder (ADHD) among medical college students in a Chinese population. J Affect Disord. 2018;241:291-6.
• 6. Zhong S, Lu L, Wilson A, Wang Y, Duan S, Ou J, et al. Attention-deficit/ hyperactivity disorder symptoms and suicidal ideation among college students: A structural equation modeling approach. J Affect Disord. 2021;279:572-7.
• 7. DuPaul GJ, Weyandt LL. Introduction to special series on college students with ADHD. J Atten Disord. 2009;13(3):232-3.
• 8. Asherson P, Buitelaar J, Faraone SV, Rohde LA. Adult attention-deficit hyperactivity disorder: key conceptual issues. Lancet Psychiat. 2016;3(6):568-78.
• 9. Barkley RA, Murphy, K. R., & Fischer, M. ADHD in adults: What the science says. New York, NY: Guilford Press; 2008.
• 10. Anastopoulos AD, DuPaul GJ, Weyandt LL, Morrissey-Kane E, Sommer JL, Rhoads LH, et al. Rates and Patterns of Comorbidity Among First-Year College Students With ADHD. J Clin Child Adolesc Psychol. 2018;47(2):236-47.
• 11. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716-23.
• 12. Biederman J, Petty CR, Evans M, Small J, Faraone SV. How persistent is ADHD? A controlled 10-year follow-up study of boys with ADHD. Psychiatry Res. 2010;177(3):299-304.
• 13. Garcia CR, Bau CH, Silva KL, Callegari-Jacques SM, Salgado CA, Fischer AG, et al. The burdened life of adults with ADHD: impairment beyond comorbidity. Eur Psychiatry. 2012;27(5):309-13.
• 14. Willcutt EG, Nigg JT, Pennington BF, Solanto MV, Rohde LA, Tannock R, et al. Validity of DSM-IV attention deficit/hyperactivity disorder symptom dimensions and subtypes. J Abnorm Psychol. 2012;121(4):991-1010.
• 15. van Amsterdam, J, van der Velde, B, Schulte, M, van den Brink, W. Causal Factors of Increased Smoking in ADHD: A Systematic Review. Substance Use & Misuse. 2017; 53(3), 432–445.
• 16. Harrison AG, Alexander SJ, Armstrong IT. Higher Reported Levels of Depression, Stress, and Anxiety Are Associated With Increased Endorsement of ADHD Symptoms by Postsecondary Students. Can J Sch Psychol. 2013;28(3):243-60.
• 17. Karawekpanyawong N, Wongpakaran T, Wongpakaran N, Boonnag C, Siritikul S, Chalanunt S, et al. Impact of Perceived Social Support on the Relationship between ADHD and Depressive Symptoms among First Year Medical Students: A Structural Equation Model Approach. Children (Basel). 2021;8(5).
• 18. Tyssen R, Vaglum P. Mental health problems among young doctors: an updated review of prospective studies. Harv Rev Psychiatry. 2002;10(3):154-65.
• 19. Kita Y, Inoue Y. The Direct/Indirect Association of ADHD/ODD Symptoms with Self-esteem, Self-perception, and Depression in Early Adolescents. Front Psychiatry. 2017;8:137.
• 20. Babinski DE, Pelham WE, Molina BSG, Waschbusch DA, Gnagy EM, Yu JH, et al. Women with Childhood ADHD: Comparisons by Diagnostic Group and Gender. J Psychopathol Behav. 2011;33(4):420-9.
• 21. Newark PE, Elsasser M, Stieglitz RD. Self-Esteem, Self-Efficacy, and Resources in Adults With ADHD. J Atten Disord. 2016;20(3):279-90.
• 22. Chew BL, Jensen SA, Rosen LA. College students' attitudes toward their ADHD peers. J Atten Disord. 2009;13(3):271-6.
• 23. Gray S, Woltering S, Mawjee K, Tannock R. The Adult ADHD Self-Report Scale (ASRS): utility in college students with attention-deficit/hyperactivity disorder. Peerj. 2014;2.
• 24. Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005;35(2):245-56.
• 25. Adler LA, Spencer T, Faraone SV, Kessler RC, Howes MJ, Biederman J, et al. Validity of pilot Adult ADHD Self- Report Scale (ASRS) to Rate Adult ADHD symptoms. Ann Clin Psychiatry. 2006;18(3):145-8.
• 26. Kessler RC, Adler LA, Gruber MJ, Sarawate CA, Spencer T, Van Brunt DL. Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) Screener in a representative sample of health plan members. Int J Methods Psychiatr Res. 2007;16(2):52-65.
• 27. Dogan S, Oncu B, Varol-Saracoglu G, Kucukgoncu S. Validity and reliability of the Turkish version of the Adult ADHD Self-Report Scale (ASRS-v1.1). Anadolu Psikiyatr De. 2009;10(2):77-87.
• 28. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70.
• 29. Aydemir O, Guvenir G, Kuey L, Kultur S. Hastane Anksiyete ve Depresyon Ölçeği Türkçe Formunun Geçerlilik ve Güvenilirlik Çalışması. Turk Psikiyatri Dergisi. 1997;8:280-7.
• 30. Rosenberg M. Society and the adolescent self-image. Princeton NJ: Princeton University Press; 1965.
• 31. Cuhadaroglu F. Self-esteem in adolescents. Unpublished dissertation. Hacettepe University Faculty of Medicine, Ankara 1986.
• 32. Nankoo MMA, Palermo R, Bell JA, Pestell CM. Examining the Rate of Self-Reported ADHD-Related Traits and Endorsement of Depression, Anxiety, Stress, and Autistic-Like Traits in Australian University Students. J Atten Disord. 2019;23(8):869-86.
• 33. Atwoli L, Owiti P, Manguro G, Ndambuki D. Self-reported attention deficit and hyperactivity disorder symptoms among university students in Eldoret, Kenya. East Afr Med J. 2010;87(5):187-91.
• 34. Jarrett MA. Attention-deficit/hyperactivity disorder (ADHD) symptoms, anxiety symptoms, and executive functioning in emerging adults. Psychol Assess. 2016;28(2):245-50.
• 35. Kwak YS, Jung YE, Kim MD. Prevalence and correlates of attention-deficit hyperactivity disorder symptoms in Korean college students. Neuropsychiatr Dis Treat. 2015;11:797-802.
• 36. Adler LA, Faraone SV, Sarocco P, Atkins N, Khachatryan A. Establishing US norms for the Adult ADHD Self-Report Scale (ASRS-v1.1) and characterising symptom burden among adults with self-reported ADHD. Int J Clin Pract. 2019;73(1):e13260.
• 37. Ebejer JL, Medland SE, van der Werf J, Gondro C, Henders AK, Lynskey M, et al. Attention deficit hyperactivity disorder in Australian adults: prevalence, persistence, conduct problems and disadvantage. PLoS One. 2012;7(10):e47404.
• 38. Das D, Cherbuin N, Butterworth P, Anstey KJ, Easteal S. A population-based study of attention deficit/hyperactivity disorder symptoms and associated impairment in middle-aged adults. PLoS One. 2012;7(2):e31500.
• 39. Feifel D. ADHD in adults: the invisible rhinoceros. Psychiatry (Edgmont). 2007;4(12):60-2.
• 40. Retz W, Stieglitz RD, Corbisiero S, Retz-Junginger P, Rosler M. Emotional dysregulation in adult ADHD: What is the empirical evidence? Expert Rev Neurother. 2012;12(10):1241-51.
• 41. Seymour KE, Chronis-Tuscano A, Halldorsdottir T, Stupica B, Owens K, Sacks T. Emotion regulation mediates the relationship between ADHD and depressive symptoms in youth. J Abnorm Child Psychol. 2012;40(4):595-606.
• 42. Eyüboğlu M, Eyüboğlu D, Duran O, Karademir SB, Karaaslan F, Alyu FM. Depression, anxiety, sleep problems and suicidal behavior among medical students: A cross-sectional comparison study between first and sixth year students (tur). J Clin Psy. 2021;24(1):61-8.
• 43. Puthran R, Zhang MW, Tam WW, Ho RC. Prevalence of depression amongst medical students: a meta-analysis. Med Educ. 2016;50(4):456-68.
• 44. Quek TT, Tam WW, Tran BX, Zhang M, Zhang Z, Ho CS, et al. The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis. Int J Environ Res Public Health. 2019;16(15).
• 45. Power TJ, Costigan TE, Eiraldi RB, Leff SS. Variations in anxiety and depression as a function of ADHD subtypes defined by DSM-IV: do subtype differences exist or not? J Abnorm Child Psychol. 2004;32(1):27-37.
• 46. Nelson JM, Gregg N. Depression and anxiety among transitioning adolescents and college students with ADHD, dyslexia, or comorbid ADHD/dyslexia. J Atten Disord. 2012;16(3):244-54.
• 47. Nyer M, Farabaugh A, Fehling K, Soskin D, Holt D, Papakostas GI, et al. Relationship between sleep disturbance and depression, anxiety, and functioning in college students. Depress Anxiety. 2013;30(9):873-80.
• 48. Wolk CB, Carper MM, Kendall PC, Olino TM, Marcus SC, Beidas RS. Pathways to anxiety-depression comorbidity: A longitudinal examination of childhood anxiety disorders. Depress Anxiety. 2016;33(10):978-86.
• 49. Shen Y, Zhang Y, Chan BSM, Meng F, Yang T, Luo X, et al. Association of ADHD symptoms, depression and suicidal behaviors with anxiety in Chinese medical college students. BMC Psychiatry. 2020;20(1):180.
• 50. Levy F. Synaptic gating and ADHD: a biological theory of comorbidity of ADHD and anxiety. Neuropsychopharmacology. 2004;29(9):1589-96.
• 51. Nigg JT, Casey BJ. An integrative theory of attention-deficit/ hyperactivity disorder based on the cognitive and affective neurosciences. Dev Psychopathol. 2005;17(3):785-806.
• 52. Shaw-Zirt B, Popali-Lehane L, Chaplin W, Bergman A. Adjustment, social skills, and self-esteem in college students with symptoms of ADHD. J Atten Disord. 2005;8(3):109-20.
• 53. Kollins SH, McClernon FJ, Fuemmeler BF. Association between smoking and attention-deficit/hyperactivity disorder symptoms in a population-based sample of young adults. Arch Gen Psychiatry. 2005;62(10):1142-7.
• 54. Glass K, Flory K. Are symptoms of ADHD related to substance use among college students? Psychol Addict Behav. 2010;24(3):427-34.