ORIGINAL ARTICLES

The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative

R de Graaf¹, R C Kessler², J Fayyad³, M ten Have¹, J Alonso⁴, M Angermeyer⁵, G Borges⁶, K Demyttenaere⁷, I Gasquet⁸, G de Girolamo⁹, J M Haro¹⁰, R Jin², E G Karam³, J Ormel¹¹, J Posada-Villa¹²

¹ Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
² Harvard Medical School, Department of Health Care Policy, Boston, MA, USA
³ Institute for Development, Research, Advocacy and Applied Care (IDRAAC), Department of Psychiatry and Clinical Psychology, St. George Hospital University Medical Center and Faculty of Medicine, Balamand University, Beirut, Lebanon
⁴ Health Services Research Unit, Institut Municipal d’Investigació Mèdica (IMIM), Barcelona, CIBER en Epidemiologia y Salud Publica (CIBERESP), Spain
⁵ Department of Psychiatry, University of Leipzig, Germany
⁶ Instituto Nacional de Psiquiatria and Universidad Autónoma Metropolitana-Xochimilco, Calzada, Mexico City, Mexico
⁷ Department of Neurosciences and Psychiatry, University Hospitals Gasthuisberg, University of Leuven, Leuven, Belgium
⁸ Hôpitaux de Paris, Paris, France
⁹ Health Care Research Agency, Emilia-Romanga Region, Bologna, Italy
¹⁰ Sant Joan de Déu-SSM, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
¹¹ Department of Psychiatry and Department of Epidemiology and Bioinformatics, University Medical Center Groningen, Graduate School of Behavioural and Cognitive Neurosciences and Graduate School for Experimental Psychopathology, University of Groningen, The Netherlands
¹² Medico Psiquiatra, U. Javerina, Centro Medico de la Sabana, Bogota, Colombia

Dr Ron de Graaf, Netherlands Institute of Mental Health and Addiction, Da Costakade 45, 3521 VS Utrecht, The Netherlands; rgraaf{at}trimbos.nl

Objectives: To estimate the prevalence and workplace consequences of adult attention-deficit/hyperactivity disorder (ADHD).

Methods: An ADHD screen was administered to 18–44-year-old respondents in 10 national surveys in the WHO World Mental Health (WMH) Survey Initiative (n = 7075 in paid or self-employment; response rate 45.9–87.7% across countries). Blinded clinical reappraisal interviews were administered in the USA to calibrate the screen. Days out of role were measured using the WHO Disability Assessment Schedule (WHO-DAS). Questions were also asked about ADHD treatment.

Results: An average of 3.5% of workers in the 10 countries were estimated to meet DSM-IV criteria for adult ADHD (inter-quartile range: 1.3–4.9%). ADHD was more common among males than females and less common among professionals than other workers. ADHD was associated with a statistically significant 22.1 annual days of excess lost role performance compared to otherwise similar respondents without ADHD. No difference in the magnitude of this effect was found by occupation, education, age, gender or partner status. This effect was most pronounced in Colombia, Italy, Lebanon and the USA. Although only a small minority of workers with ADHD ever received treatment for this condition, higher proportions were treated for comorbid mental/substance disorders.

Conclusions: ADHD is a relatively common condition among working people in the countries studied and is associated with high work impairment in these countries. This impairment, in conjunction with the low treatment rate and the availability of cost-effective therapies, suggests that ADHD would be a good candidate for targeted workplace screening and treatment programs.

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