Associations of ADHD traits, sleep/circadian factors, depression and quality of life
Associations of ADHD traits, sleep/circadian factors, depression and quality of life
BACKGROUND: Individuals with attention deficit hyperactivity disorder (ADHD) are at a higher risk of depression and lower quality of life (QoL); however, it is unclear whether disrupted sleep and circadian rhythms mediate this increased risk.
OBJECTIVES: We investigated whether disruption of self-reported sleep and circadian factors mediate the associations of ADHD traits with depression symptom severity and QoL.
METHODS: 1364 participants (mean: 51.86 (SD=0.37) years, 75% women) from a large-scale cross-sectional online survey (Netherlands Sleep Registry) completed a sociodemographic questionnaire, the Adult ADHD Rating Scale, Hospital Anxiety and Depression Scale, Satisfaction With Life Scale (SLS) and Cantril Ladder (CL) (QoL measures), Insomnia Severity Index, Pittsburgh Sleep Quality Index and Munich Chronotype Questionnaire.
FINDINGS: Higher ADHD traits were significantly associated with depression symptom severity (p=0.03), lower QoL (p<0.001), insomnia severity (p<0.001), lower sleep quality (p<0.001) and later chronotype (p=0.01). No sleep or circadian factor significantly mediated the association of the severity of symptoms of ADHD and depression (all p>0.1). Conversely, only insomnia severity significantly mediated the association of ADHD traits and QoL (SLS: standardised β=-0.10, 95% CI (-0.12 to -0.04); CL: standardised β=0.103, 95% CI (0.04 to 0.16)).
CONCLUSION: ADHD traits were associated with lower QoL and it was partially mediated by insomnia severity. Future studies targeting insomnia complaints in this population may help mitigate their depression complaints and improve their QoL.
CLINICAL IMPLICATIONS: Our results may help current clinical guidelines that do not typically link sleep/circadian complaints to QoL in ADHD assessment.
Adult, Attention Deficit Disorder with Hyperactivity/epidemiology, Circadian Rhythm/physiology, Cross-Sectional Studies, Depression/epidemiology, Female, Humans, Male, Middle Aged, Quality of Life/psychology, Severity of Illness Index, Sleep Initiation and Maintenance Disorders/epidemiology, Sleep Quality, Sleep, Adult psychiatry, Depression & mood disorders
Nair, Siddhi
67692960-e0bc-4db3-83a1-617daa9845b2
Deshpande, Neha
6dbb05cf-0c8d-41ce-8fe9-52c037c5f6b1
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Someren, Eus Van
035b57d3-e470-410f-aa45-11df69c2e073
Chellappa, Sarah
516582b5-3cba-4644-86c9-14c91a4510f2
14 July 2025
Nair, Siddhi
67692960-e0bc-4db3-83a1-617daa9845b2
Deshpande, Neha
6dbb05cf-0c8d-41ce-8fe9-52c037c5f6b1
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Someren, Eus Van
035b57d3-e470-410f-aa45-11df69c2e073
Chellappa, Sarah
516582b5-3cba-4644-86c9-14c91a4510f2
Nair, Siddhi, Deshpande, Neha, Cortese, Samuele, Someren, Eus Van and Chellappa, Sarah
(2025)
Associations of ADHD traits, sleep/circadian factors, depression and quality of life.
BMJ Mental Health, 28 (1), [e301625].
(doi:10.1136/bmjment-2025-301625).
Abstract
BACKGROUND: Individuals with attention deficit hyperactivity disorder (ADHD) are at a higher risk of depression and lower quality of life (QoL); however, it is unclear whether disrupted sleep and circadian rhythms mediate this increased risk.
OBJECTIVES: We investigated whether disruption of self-reported sleep and circadian factors mediate the associations of ADHD traits with depression symptom severity and QoL.
METHODS: 1364 participants (mean: 51.86 (SD=0.37) years, 75% women) from a large-scale cross-sectional online survey (Netherlands Sleep Registry) completed a sociodemographic questionnaire, the Adult ADHD Rating Scale, Hospital Anxiety and Depression Scale, Satisfaction With Life Scale (SLS) and Cantril Ladder (CL) (QoL measures), Insomnia Severity Index, Pittsburgh Sleep Quality Index and Munich Chronotype Questionnaire.
FINDINGS: Higher ADHD traits were significantly associated with depression symptom severity (p=0.03), lower QoL (p<0.001), insomnia severity (p<0.001), lower sleep quality (p<0.001) and later chronotype (p=0.01). No sleep or circadian factor significantly mediated the association of the severity of symptoms of ADHD and depression (all p>0.1). Conversely, only insomnia severity significantly mediated the association of ADHD traits and QoL (SLS: standardised β=-0.10, 95% CI (-0.12 to -0.04); CL: standardised β=0.103, 95% CI (0.04 to 0.16)).
CONCLUSION: ADHD traits were associated with lower QoL and it was partially mediated by insomnia severity. Future studies targeting insomnia complaints in this population may help mitigate their depression complaints and improve their QoL.
CLINICAL IMPLICATIONS: Our results may help current clinical guidelines that do not typically link sleep/circadian complaints to QoL in ADHD assessment.
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e301625.full
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More information
Accepted/In Press date: 15 June 2025
Published date: 14 July 2025
Additional Information:
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.
Keywords:
Adult, Attention Deficit Disorder with Hyperactivity/epidemiology, Circadian Rhythm/physiology, Cross-Sectional Studies, Depression/epidemiology, Female, Humans, Male, Middle Aged, Quality of Life/psychology, Severity of Illness Index, Sleep Initiation and Maintenance Disorders/epidemiology, Sleep Quality, Sleep, Adult psychiatry, Depression & mood disorders
Identifiers
Local EPrints ID: 504200
URI: http://eprints.soton.ac.uk/id/eprint/504200
ISSN: 2755-9734
PURE UUID: ff9c46d7-0014-48e5-9e53-cd3c02881858
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Date deposited: 29 Aug 2025 16:32
Last modified: 30 Aug 2025 02:14
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Contributors
Author:
Siddhi Nair
Author:
Neha Deshpande
Author:
Eus Van Someren
Author:
Sarah Chellappa
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