Nair Siddhi, Deshpande Neha, Hill Catherine, Cortese Samuele, Van Someren Eus J W, Chellappa Sarah Laxhmi
Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UK.
BMJ Ment Health. 2025 Jul 14;28(1):e301625. doi: 10.1136/bmjment-2025-301625.
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.
We investigated whether disruption of self-reported sleep and circadian factors mediate the associations of ADHD traits with depression symptom severity and QoL.
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.
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)).
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.
Our results may help current clinical guidelines that do not typically link sleep/circadian complaints to QoL in ADHD assessment.
注意力缺陷多动障碍（ADHD）患者患抑郁症的风险更高，生活质量（QoL）更低；然而，尚不清楚睡眠和昼夜节律紊乱是否介导了这种风险的增加。
我们调查了自我报告的睡眠和昼夜节律因素的紊乱是否介导了ADHD特征与抑郁症状严重程度和生活质量之间的关联。
来自一项大规模横断面在线调查（荷兰睡眠登记处）的1364名参与者（平均年龄：51.86（标准差=0.37）岁，75%为女性）完成了一份社会人口学问卷、成人ADHD评定量表、医院焦虑抑郁量表、生活满意度量表（SLS）和坎特里尔阶梯量表（CL）（生活质量测量工具）、失眠严重程度指数、匹兹堡睡眠质量指数和慕尼黑昼夜类型问卷。
较高的ADHD特征与抑郁症状严重程度显著相关（p=0.03）、生活质量较低（p<0.001）、失眠严重程度较高（p<0.001）、睡眠质量较低（p<0.001）和较晚的昼夜类型（p=0.01）。没有睡眠或昼夜节律因素显著介导ADHD症状严重程度与抑郁之间的关联（所有p>0.1）。相反，只有失眠严重程度显著介导了ADHD特征与生活质量之间的关联（SLS：标准化β=-0.10，95%置信区间（-0.12至-0.04）；CL：标准化β=0.103，95%置信区间（0.04至0.16））。
ADHD特征与较低的生活质量相关，且部分由失眠严重程度介导。针对该人群失眠主诉的未来研究可能有助于减轻他们的抑郁主诉并改善他们的生活质量。
我们的结果可能有助于当前在ADHD评估中通常不将睡眠/昼夜节律主诉与生活质量联系起来的临床指南。
