180. Principle Component Analysis of A National Sample of Undergraduate Post-Secondary Students With Adhd Reveals Significant Well-Being And Quality of Life Concerns Unaddressed By Current Treatment

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Attention Deficit Hyperactivity Disorder (ADHD) is estimated to impact approximately ∼5% of college students and can profoundly affect this population due to increasing independence and self-responsibility. Historically, studies of this population have been limited in both sample size and scope, with research primarily focusing on the cognitive dimensions and drug use comorbidities of the disorder. Here, we use responses from a national dataset of college students in order to integrate multiple epidemiological and health behavior psychological factors to create a more comprehensive understanding of the health and well-being dimensions of the disorder. This study, the first to examine ADHD in a national sample of college students, is also unique in that it addresses the statistical problem of multicollinearity. The results of this study will allow clinicians to pinpoint modifiable risk factors like sleep hygiene and emotional regulation that can be employed to improve treatment outcomes in college students with ADHD. Analyses were conducted on data from the 2017 Spring American College Health Association’s National College Health Assessment-II, which included 47,281 undergraduate students from 92 United States institutions. First, chi-squared and independent samples t-tests were conducted on multiple dimensions of health and wellness factors to determine if students with ADHD had lowered well-being. Next, a principal component analysis (PCA) was used within a subset ADHD population (2,673 individuals, 65% female, 23% students of color, 3% international) on 59 health-related variables. This PCA reduced collinearity by creating clusters from highly correlated input variables. An ordinal logistic regression was used to estimate the strength and significance of different factors on general health. All analyses were conducted using SPSS Version 25 and Program R for Mac Version 3.5.0. Overall, individuals with ADHD were significantly more likely to show lower levels of well-being for multiple measures of general health, including stress, sleep quality, sadness, anxiety, loneliness, alcohol use, other drug use, exercise, and suicidal thoughts (p<0.001 for all). Within the ADHD population, only 57% reported receiving treatment within the last 12 months, and of those, 80% received medication only. Treatment was not associated with improved GPA or overall wellbeing. The PCA analyses within the ADHD subset demonstrated high collinearity among the 59 predictor variables and yielded four significant clusters, which were broadly conceptualized as “psychological well-being”; “abusive relationships and substance abuse”; “physical activity”, and “co-morbid diagnoses”. When run in an ordinal logistic regression, each of these four components significantly predicted overall health (p<0.001 for all). These findings confirm that college students diagnosed with ADHD have significantly lower levels of overall well-being. Treatment guidelines by the American Academy of Pediatrics establish that whereas pharmacological treatment can improve some of the cognitive aspects of ADHD, it does not necessarily address important behavioral and psychological dimensions of the disorder. This research supports incorporating inclusion of modifiable risk factors including sleep hygiene, relationship skills, emotional regulation, and substance use harm reduction into treatment strategies.