Attention Deficit Hyperactivity Disorder and Risk of Posttraumatic Stress and Related Disorders: A Prospective Longitudinal Evaluation in U.S. Army Soldiers.

Cross-sectional associations between attention deficit hyperactivity disorder (ADHD) and posttraumatic stress disorder (PTSD) have been observed, but longitudinal studies assessing this association are lacking. This prospective study evaluated the association between predeployment ADHD and postdeployment PTSD among U.S. Army soldiers. Soldiers who deployed to Afghanistan were surveyed before deployment (T0) and approximately 1 month (T1), 3 months (T2), and 9 months (T3) after their return. Logistic regression was performed to estimate the association between predeployment ADHD and postdeployment (T2 or T3) PTSD among 4,612 soldiers with data at all waves and no record of stimulant medication treatment during the study. To evaluate specificity of the ADHD-PTSD association, we examined associations among predeployment ADHD, postdeployment major depressive episode (MDE), generalized anxiety disorder (GAD), and suicidal ideation. Weighted prevalence of ADHD predeployment was 6.1% (SE = 0.4%). Adjusting for other risk factors, predeployment ADHD was associated with risk of postdeployment PTSD, adjusted odds ratio (AOR) = 2.13, 95% CI [1.51, 3.00], p < .001, including incidence among soldiers with no predeployment history of PTSD, AOR = 2.50, 95% CI [1.69, 3.69], p < .001. ADHD was associated with postdeployment MDE, AOR = 2.80, 95% CI [2.01, 3.91], p < .001, and GAD, AOR = 3.04, 95% CI [2.10, 4.42], p < .001, but not suicidal ideation. Recognition of associations between predeployment ADHD and postdeployment PTSD, MDE, and GAD may inform targeted prevention efforts. Future research should examine whether treatment of ADHD is protective against PTSD and related disorders in trauma-exposed individuals.

[1]  Kelly L Zuromski,et al.  Pre-deployment predictors of suicide attempt during and after combat deployment: Results from the Army Study to Assess Risk and Resilience in Servicemembers. , 2019, Journal of psychiatric research.

[2]  R. Kessler,et al.  Childhood Maltreatment and Lifetime Suicidal Behaviors Among New Soldiers in the US Army: Results From the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). , 2017, The Journal of clinical psychiatry.

[3]  Raj K. Kalapatapu,et al.  Use of Stimulants and Performance Enhancers During and After Trauma Exposure in a Combat Veteran: A Possible Risk Factor for Posttraumatic Stress Symptoms. , 2017, The American journal of psychiatry.

[4]  A. Danese,et al.  Evaluation of the Persistence, Remission, and Emergence of Attention-Deficit/Hyperactivity Disorder in Young Adulthood. , 2016, JAMA psychiatry.

[5]  J. Swanson,et al.  Attention-Deficit/Hyperactivity Disorder Trajectories From Childhood to Young Adulthood: Evidence From a Birth Cohort Supporting a Late-Onset Syndrome. , 2016, JAMA psychiatry.

[6]  M. Paulus,et al.  Randomized Placebo-Controlled Trial of Methylphenidate or Galantamine for Persistent Emotional and Cognitive Symptoms Associated with PTSD and/or Traumatic Brain Injury , 2016, Neuropsychopharmacology.

[7]  S. Faraone,et al.  Examining the association between posttraumatic stress disorder and attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. , 2016, The Journal of clinical psychiatry.

[8]  N. Crum‐Cianflone,et al.  Prescription Stimulants and PTSD Among U.S. Military Service Members. , 2015, Journal of traumatic stress.

[9]  Sonia Jain,et al.  Prospective longitudinal evaluation of the effect of deployment-acquired traumatic brain injury on posttraumatic stress and related disorders: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). , 2015, The American journal of psychiatry.

[10]  D. Belsky,et al.  Is Adult ADHD a Childhood-Onset Neurodevelopmental Disorder? Evidence From a Four-Decade Longitudinal Cohort Study. , 2015, The American journal of psychiatry.

[11]  R. Kessler,et al.  How well can post‐traumatic stress disorder be predicted from pre‐trauma risk factors? An exploratory study in the WHO World Mental Health Surveys , 2014, World psychiatry : official journal of the World Psychiatric Association.

[12]  S. Aga-Mizrachi,et al.  Methylphenidate and desipramine combined treatment improves PTSD symptomatology in a rat model , 2014, Translational Psychiatry.

[13]  M. Stein,et al.  The Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) , 2014, Psychiatry.

[14]  R. Kessler,et al.  Thirty-day prevalence of DSM-IV mental disorders among nondeployed soldiers in the US Army: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). , 2014, JAMA psychiatry.

[15]  S. Faraone,et al.  Is ADHD a risk for posttraumatic stress disorder (PTSD)? Results from a large longitudinal study of referred children with and without ADHD , 2014, The world journal of biological psychiatry : the official journal of the World Federation of Societies of Biological Psychiatry.

[16]  R. Kessler,et al.  Clinical reappraisal of the Composite International Diagnostic Interview Screening Scales (CIDI‐SC) in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) , 2013, International journal of methods in psychiatric research.

[17]  Nancy Gebler,et al.  Design of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) , 2013, International journal of methods in psychiatric research.

[18]  Darin D. Dougherty,et al.  Functional Genomics of Attention-Deficit/Hyperactivity Disorder (ADHD) Risk Alleles on Dopamine Transporter Binding in ADHD and Healthy Control Subjects , 2013, Biological Psychiatry.

[19]  Zoë H. Brett,et al.  The association of a novel haplotype in the dopamine transporter with preschool age posttraumatic stress disorder. , 2013, Journal of child and adolescent psychopharmacology.

[20]  S. Faraone,et al.  Posttraumatic stress disorder in adult attention-deficit/hyperactivity disorder: clinical features and familial transmission. , 2013, The Journal of clinical psychiatry.

[21]  R. Heun,et al.  Completed suicide, ideation and attempt in attention deficit hyperactivity disorder , 2012, Acta psychiatrica Scandinavica.

[22]  K. Lattal,et al.  Methylphenidate enhances extinction of contextual fear. , 2012, Learning & memory.

[23]  Barbara Stanley,et al.  The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. , 2011, The American journal of psychiatry.

[24]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[25]  Kendall C. Wilkins,et al.  Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions , 2011, Depression and anxiety.

[26]  R. Kessler,et al.  Structure and diagnosis of adult attention-deficit/hyperactivity disorder: analysis of expanded symptom criteria from the Adult ADHD Clinical Diagnostic Scale. , 2010, Archives of general psychiatry.

[27]  Patricia A. Berglund,et al.  Applied Survey Data Analysis , 2010 .

[28]  Terry L. Schell,et al.  Disparate prevalence estimates of PTSD among service members who served in Iraq and Afghanistan: possible explanations. , 2010, Journal of traumatic stress.

[29]  N. Greenberg.  Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences and Services to Assist Recovery , 2009 .

[30]  N. Breslau.  The Epidemiology of Trauma, PTSD, and Other Posttrauma Disorders , 2009, Trauma, violence & abuse.

[31]  Atia Daud,et al.  Comorbidity/Overlapping Between ADHD and PTSD in Relation to IQ Among Children of Traumatized/Non-Traumatized Parents , 2009, Journal of Attention Disorders.

[32]  A. Arnsten,et al.  Catecholamine and second messenger influences on prefrontal cortical networks of "representational knowledge": a rational bridge between genetics and the symptoms of mental illness. , 2007, Cerebral cortex.

[33]  Ronald C Kessler,et al.  Validity of the World Health Organization Adult ADHD Self‐Report Scale (ASRS) Screener in a representative sample of health plan members , 2007, International journal of methods in psychiatric research.

[34]  B. Kaplan,et al.  Retrospective Reports of Childhood Trauma in Adults With ADHD , 2006, Journal of attention disorders.

[35]  R. Kessler,et al.  The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. , 2006, The American journal of psychiatry.

[36]  A. James,et al.  Attention deficit hyperactivity disorder and suicide: a review of possible associations , 2004, Acta psychiatrica Scandinavica.

[37]  C. Hoge,et al.  THE NEW ENGLAND JOURNAL OF MEDICINE , 1977, The Lancet.

[38]  T. B. Üstün,et al.  The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) , 2004, International journal of methods in psychiatric research.

[39]  C. Nemeroff,et al.  The role of childhood trauma in the neurobiology of mood and anxiety disorders: preclinical and clinical studies , 2001, Biological Psychiatry.

[40]  C. Brewin,et al.  Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. , 2000, Journal of consulting and clinical psychology.

[41]  Jonathon R. Howlett,et al.  Prevention of Trauma and Stressor-Related Disorders: A Review , 2016, Neuropsychopharmacology.

[42]  G. Arbanas.  Diagnostic and Statistical Manual of Mental Disorders (DSM-5) , 2015 .

[43]  R Core Team,et al.  R: A language and environment for statistical computing. , 2014 .

[44]  E. Onaivi.  Cannabinoid receptors in brain: pharmacogenetics, neuropharmacology, neurotoxicology, and potential therapeutic applications. , 2009, International review of neurobiology.

[45]  S. Faraone,et al.  Antecedents and complications of trauma in boys with ADHD: findings from a longitudinal study. , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.