Co-morbid psychiatric disorders among incarcerated ADHD populations: a meta-analysis.

S Young,P Hodgkins,O Sedgwick,G Gudjonsson,M Lantigua,M Fridman,R A González

doi:10.1017/s0033291715000598

Abstract

Rates of psychiatric disorders are highly prevalent among prison inmates, and recent evidence confirms over-representation of youths and adults with attention deficit hyperactivity disorder (ADHD). The risk for psychiatric co-morbidity may be greater among offenders with ADHD. We undertook a systematic review and meta-analysis of reported rates of co-existing psychiatric morbidity with ADHD in prison samples. Studies published from 1980 to 2015 were identified using five bibliographic indexes, review articles and reference lists. Included studies had a defined ADHD group and provided additional prevalence on at least one of the following: conduct disorder, substance use disorder, mood disorder, anxiety disorder, or personality disorder. We performed meta-analytical estimates of the prevalence of each co-morbid disorder within ADHD, and estimated the risk for co-existing disorders among prisoners with ADHD by pooling odds ratios (OR) with 95% confidence intervals. Eighteen studies with data for 1615 with ADHD and 3128 without ADHD were included. The risk (OR) of all psychiatric morbidity is increased among adult inmates with ADHD. Associations in youths with ADHD were restricted to mood disorder (OR 1.89, 95% confidence interval 1.09-3.28). This study quantifies the extent of co-morbidity presented by offenders with ADHD, especially adults. The differences between risk estimates for youths and adults indicate an incremental effect in both frequency and severity for the development of further co-morbid pathology through adulthood. The findings have implications for clinical intervention and for criminal justice policy.

Highlights

Attention deficit hyperactivity disorder (ADHD) is one of the most diagnosed mental health problems in children; meta-analyses estimate a world pooled prevalence of 5.3% in children and 2.5% in adults (Polanczyk et al 2007; Simon et al 2009)
We explored the risk for co-morbidity overall and by age group separately for each of the following psychiatric disorders: conduct disorder (CD), substance use disorders (SUD), mood disorders (MD), anxiety disorders (AD) and personality disorders (PD)
Once further duplicates had been identified manually, 325 publications remained for which the full text was retrieved. 281 publications were further excluded as they did not report on incarcerated ADHD samples and/or did not provide associated co-morbid disorders data

Summary

Introduction

Attention deficit hyperactivity disorder (ADHD) is one of the most diagnosed mental health problems in children; meta-analyses estimate a world pooled prevalence of 5.3% in children and 2.5% in adults (Polanczyk et al 2007; Simon et al 2009). Co-morbid psychiatric problems are common presentations in both children and adults with ADHD (Pliszka, 1998) and a US nationally representative household survey found that adults with ADHD were five times more likely to develop a mood disorder, four times more likely to develop an anxiety disorder, and three times more likely to develop substance use disorder (Kessler et al 2006). Individuals with these co-morbid disorders are likely to experience greater occupational impairment, compared to people with ADHD alone. We undertook a systematic review and meta-analysis of reported rates of co-existing psychiatric morbidity with ADHD in prison samples

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Discussion

Conclusion