Abstract
Attention-deficit/hyperactivity disorder (ADHD) has been often found to be comorbid with other disorders, including anxiety, depression, and unhealthy behaviors such as drinking alcohol and smoking. These factors were often discussed separately, and the mediating effects of mental health on substance use are unknown. To study the mediating effects of anxiety and depression on the relationship between ADHD and drinking/smoking behaviors, we conducted a cross-sectional study of 1870 college students from Shanghai, China. The Adult ADHD Self-Report Scale (ASRS-v1.1) and Wender Utah Rating Scale (WURS) were used to identify the current and past ADHD. Structural Equation Modeling was carried out to clarify the mediating effect of anxiety and depression on the relationship between core ADHD symptoms and smoking/drinking behaviors. We found that inattention as one of the core symptoms of ADHD was associated with an increased risk of depression as a direct effect, as well as slightly increased risk of smoking/drinking behaviors by an indirect effect of depression. Hyperactivity-impulsivity, as another core symptom of ADHD had a robust impact on smoking and drinking behaviors, while being mediated by anxiety and depression. In conclusion, anxiety and depression was associated with further increased risk behaviors of smoking/drinking alcohol among those students with ADHD.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder among children and adults, worldwide[1]
Our first hypothesis is that ADHD symptoms increase the risk of smoking/drinking alcohol, and the relationship may be intensified by anxiety and depression in college students
There were 180 participants (9.62%) with a Wender Utah Rating Scale (WURS) score of 46 or above. These participants were placed into either ADHD symptomatic or non-symptomatic groups according to the criteria above, 7.75% of the sample were symptomatic, scoring above the cut-off point for ADHD
Summary
Attention-deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder among children and adults, worldwide[1]. Whether substance use is causally associated with depression and anxiety, or opposite causality, consistent and robust genetic polymorphisms had been found by an approach of Mendelian randomization It suggested that this relationship is more consistent with a self-medication hypothesis than with tobacco use being a risk factor for depression and anxiety[16]. A recent study suggested that ADHD symptoms predicted smoking and drinking alcohol when controlling for anxiety and depression in adolescents[23]. The mediating effect is unclear of mental health such as anxiety and depression on the relationship between ADHD and smoking/drinking alcohol is unclear. Our first hypothesis is that ADHD symptoms increase the risk of smoking/drinking alcohol, and the relationship may be intensified by anxiety and depression in college students
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