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Cross–national prevalence and correlates of adult attention–deficit hyperactivity disorder

Institute of Development, Research, Advocacy and Applied Care (IDRAAC), Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Centre, Balamand University, Beirut, Lebanon

R. De Graaf, PhD

Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands

R. Kessler, PhD

Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA

J. Alonso, MD, PhD

Health Services Research Unit, Institut Municipal d'Investigació Mèdica, Barcelona, Spain

M. Angermeyer, MD

Department of Psychiatry, University of Leipzig, Germany

K. Demyttenaere, MD, PhD

Department of Neurosciences and Psychiatry, University Hospitals Gasthuisberg, Belgium

G. De Girolamo, MD

Department of Mental Health, AUSL di Bologna, Bologna, Italy

J. M. Haro, MD, PhD

Sant Joan de Déu-SSM, Fundacio San Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain

E. G. Karam, MD, IDRAAC

Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Centre, Balamand University, Beirut, Lebanon

C. Lara, MD, PhD

Instituto Nacional de Psiquiatria, Universidada Autonoma Metropolitana, Mexico City, Mexico

J.-P. Lépine, MD

Hospital Fernand Widal, Paris, France

J. Ormel, PhD

Department of Psychiatry and Department of Epidemiology and Bioinformatics, University Medical Centre, Groningen, The Netherlands

J. Posada-Villa, MD

Colegio Mayor de Cundinamarca University, Saldarriaga Concha Foundation, Bogota, Colombia

A. M. Zaslavsky, PhD and R. Jin, MA

Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts, USA

Correspondence: Dr John Fayyad, Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Centre, PO Box 166378, Beirut-Achrafieh 1100-2807, Lebanon. Tel: +961 (1)58 3583; fax: +961 (1)58 7190; email: jfayyad{at}idraac.org

Declaration of interest None.

Funding detailed in Acknowledgements.

Background Little is known about the epidemiology of adult attention-deficit hyperactivity disorder (ADHD).

Aims To estimate the prevalence and correlates of DSM–IV adult ADHD in the World Health Organization World Mental Health Survey Initiative.

Method An ADHD screen was administered to respondents aged 18-44 years in ten countries in the Americas, Europe and the Middle East (n=11422). Masked clinical reappraisal interviews were administered to 154 US respondents to calibrate the screen. Multiple imputation was used to estimate prevalence and correlates based on the assumption of cross-national calibration comparability.

Results Estimates of ADHD prevalence averaged 3.4% (range 1.2–7.3%), with lower prevalence in lower-income countries (1.9%) compared with higher-income countries (4.2%). Adult ADHD often co-occurs with other DSM–IV disorders and is associated with considerable role disability. Few cases are treated for ADHD, but in many cases treatment is given for comorbid disorders.

Conclusions Adult ADHD should be considered more seriously in future epidemiological and clinical studies than is currently the case.

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