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Network structure of symptomatology of adult attention-deficit hyperactivity disorder in patients with mood disorders

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Abstract

Patients with mood disorders commonly manifest comorbid psychiatric disorders, including attention-deficit/hyperactivity disorder (ADHD). However, few studies have evaluated ADHD symptoms in this population. The current study aimed to explore the network structure of ADHD symptomology and identify central symptoms in patients with mood disorders. The Korean version of the Adult ADHD Self-Report Scale was used to assess the overall ADHD symptoms in 1,086 individuals diagnosed with mood disorders (major depressive disorder [n = 373], bipolar I disorder [n = 314], and bipolar II disorder [n = 399]). We used exploratory graph analysis to detect the number of communities, and the network structure was analyzed using regularized partial correlation models. We identified the central ADHD symptom using centrality indices. Network comparison tests were conducted with different subgroups of patients with mood disorders, including three mood diagnosis groups, between the patients who met the diagnostic criteria for ADHD [ADHD-suspected, n = 259] in their self-report and the others [ADHD-non-suspected, n = 827], and groups with high [n = 503] versus low [n = 252] levels of depressive state. The network analysis detected four communities: disorganization, agitation/restlessness, hyperactivity/impulsivity, and inattention. The centrality indices indicated that “feeling restless” was the core ADHD symptom. The result was replicated in the subgroup analyses within our clinically diverse population of mood disorders, encompassing three presentations: Patients with suspected ADHD, patients without suspected ADHD, and patients with a high depressive state. Our findings reveal that “feeling restless” is the central ADHD symptom. The treatment intervention for “feeling restless” may thus play a pivotal role in tackling ADHD symptoms in adult patients with mood disorders.

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Data availability

Data are available upon request from the correspondence author, [WM]. The data is not publicly available due to privacy or ethical restrictions.

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Acknowledgements

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Funding

This work was supported by a National Research Foundation (NRF) of Korea Grant funded by the Korean government (NRF-2021R1A2C4001779; WM). The funding body had no role in the study design, data collection, data analysis, data interpretation, or writing of this report. The corresponding authors had full access to all the data in this study and had final responsibility for the decision to submit for publication.

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  1. Jakyung Lee and Daseul Lee; these individuals contributed equally to this work as co-first authors.

  2. Jungkyu Park and Woojae Myung; these individuals contributed equally to this work as co-corresponding authors.

Authors and Affiliations

  1. Department of Neuropsychiatry, Seoul National University, Bundang Hospital 29, Gumi-Ro 173 Beon-Gil Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13619, Republic of Korea

    Jakyung Lee, Daseul Lee, HongKyu Ihm, Hyeona Yu, Joohyun Yoon, Yoonjeong Jang, Yuna Kim, Chan Woo Lee, Hyukjun Lee, Tae Hyon Ha & Woojae Myung

  2. Department of Psychiatry, School of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea

    Ji Hyun Baek

  3. Department of Psychology, Kyungpook National University, 80 Daehak-Ro, Buk Gu, Daegu, 41566, Republic of Korea

    Hyo Shin Kang & Jungkyu Park

  4. Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea

    Tae Hyon Ha & Woojae Myung

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Contributions

WM and JP had full access to all of the data in this study and take responsibility for the integrity of the data and the accuracy of the data analysis. JP, HSK, and WM contributed to conceptualization. DL, HKI, HY, YJ, and JY were involved in data curation. WM performed funding acquisition. DL, JL, and HKI did investigation. HSK, JP, and WM did supervision. JL and DL performed statistical analysis. JL, DL, and HKI wrote the original draft. All the authors were involved in writing––review and editing.

Corresponding authors

Correspondence to Jungkyu Park or Woojae Myung.

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Institutional review board statement

This study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the Institutional Review Board of Seoul National Bundang Hospital (protocol code B-2205-756-111, approved May 2, 2022).

Informed consent statement

Patient consent was waived because the data were gathered through a medical chart review. Comparison consent was also waived, as the researchers did not have direct access to participants’ personal information and used anonymized survey data for the analyses.

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Lee, J., Lee, D., Ihm, H. et al. Network structure of symptomatology of adult attention-deficit hyperactivity disorder in patients with mood disorders. Eur Arch Psychiatry Clin Neurosci (2023). https://doi.org/10.1007/s00406-023-01719-2

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