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-repor...

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Main Authors: Catherine Hill, Samuele Cortese, Eus J W Van Someren, Sarah Laxhmi Chellappa, Siddhi Nair, Neha Deshpande
Format: Article
Language:English
Published: BMJ Publishing Group 2025-07-01
Series:BMJ Mental Health
Online Access:https://mentalhealth.bmj.com/content/28/1/e301625.full
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author Catherine Hill
Samuele Cortese
Eus J W Van Someren
Sarah Laxhmi Chellappa
Siddhi Nair
Neha Deshpande
author_facet Catherine Hill
Samuele Cortese
Eus J W Van Someren
Sarah Laxhmi Chellappa
Siddhi Nair
Neha Deshpande
author_sort Catherine Hill
collection DOAJ
description 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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spelling doaj-art-2da6eb8843b34223b658097d7aed2e0d2025-08-20T02:37:20ZengBMJ Publishing GroupBMJ Mental Health2755-97342025-07-0128110.1136/bmjment-2025-301625Associations of ADHD traits, sleep/circadian factors, depression and quality of lifeCatherine Hill0Samuele Cortese1Eus J W Van Someren2Sarah Laxhmi Chellappa3Siddhi Nair4Neha Deshpande5Clinical and Experimental Sciences, University of Southampton Faculty of Medicine, Southampton, UKCentre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UKNetherlands Institute for Neuroscience, Amsterdam, The NetherlandsCentre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UKCentre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UKCentre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UKBackground 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.https://mentalhealth.bmj.com/content/28/1/e301625.full
spellingShingle Catherine Hill
Samuele Cortese
Eus J W Van Someren
Sarah Laxhmi Chellappa
Siddhi Nair
Neha Deshpande
Associations of ADHD traits, sleep/circadian factors, depression and quality of life
BMJ Mental Health
title Associations of ADHD traits, sleep/circadian factors, depression and quality of life
title_full Associations of ADHD traits, sleep/circadian factors, depression and quality of life
title_fullStr Associations of ADHD traits, sleep/circadian factors, depression and quality of life
title_full_unstemmed Associations of ADHD traits, sleep/circadian factors, depression and quality of life
title_short Associations of ADHD traits, sleep/circadian factors, depression and quality of life
title_sort associations of adhd traits sleep circadian factors depression and quality of life
url https://mentalhealth.bmj.com/content/28/1/e301625.full
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