Accident patterns in trauma surgery patients with and without self-reported ADHD
Attention deficit/hyperactivity disorder (ADHD) has been associated with a higher risk for accidents and injuries, leading to increased mortality. The objective of this study was to identify the types and mechanisms of accidents in a group of adult trauma victims with self-reported ADHD compared to a control group, based on Adult ADHD Self-Report Scale Version 1.1 (ASRSv1.1). A semi-open/qualitative accident questionnaire was conducted with 116 recruited patients from three trauma surgery units. The adult ADHD (aADHD) group differed significantly from the control group in self-reported psychiatric co-morbidities (p = 0.012), regular psychotropic medication use (p = 0.005), other accidents in the past year (p = 0.002), substance use before the accident (p = 0.007), and overconfidence in relation to the accident (p = 0.033). Most interestingly, we found significantly greater subjective ratings for stress (p = 0.002) and stressful/pressurising events before the accident (p = 0.026) in the adult ADHD group, as well as for self-reported stress at the time when conducting the interview (p = 0.016). The data demonstrate that special attention should be paid to interventions in stress reduction and sufficient treatment of ADHD in terms of preventing accidents and injuries in aADHD. Therefore, we suggest, in addition to pharmaceutical therapy, the integration of stress-management and coping strategies into aADHD management.
KeywordsAdult attention deficit/hyperactivity disorder (aADHD) Accidents Psychosocial stress Cross-sectional study
The authors would like to thank all the staff members of the Occupational Accident Clinic [Berufsgenossenschaftliche Unfallklinik (BGU)] Frankfurt, the Department of Trauma, Hand and Reconstructive Surgery and Department of Oral, Dental and Cosmetic Facial surgery, University Hospital of Frankfurt as well as all patients for participation.
This study, as part of the Prevalence of Adult Attention Deficit/-Hyperactivity Disorder in Accident Victims (PrADA) study of the Department of Psychiatry, Psychosomatic Medicine and Psychotherapy at Goethe University in Frankfurt/Main, Germany, was funded by Medice Arzneimittel Pütter GmbH & Co KG. The Sponsor receives the data from the study only as cumulative, anonymized results in the form of a publication, and had no influence on study design and interpretation.
Compliance with ethical standards
Conflict of interest
AR has received speaker’s honoraria from Medice, Shire, Servier, Janssen and Neuraxpharm as well as grant support from Medice. SKS has received author’s and speaker’s honoraria as well as travel costs from Medice Arzneimittel and travel costs from Shire. All other co-authors have no conflict of interest to declare.
All procedures performed in studies involving human participants were in accordance with ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendment or comparable ethical standards.
- Bachmann CJ, Philipsen A, Hoffmann F (2017) ADHD in Germany: trends in diagnosis and pharmacotherapy. Dtsch Ärzteblatt Int 114(9):141–148Google Scholar
- Buchli-Kammermann J, Corbisiero S, Stieglitz R-D (2011) Screening der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Erwachsenenalter: Validierung der deutschen Version der ASRS-v1.1 [Screening for adult attention deficit/hyperactivity disorder (ADHD): validation of the German version of the ASRS-v1.1]. Klinische Diagnostik und Evaluation 4:219–235Google Scholar
- El Farouki K, Lagarde E, Orriols L, Bouvard M-P, Contrand B, Galera C (2014) The increased risk of road crashes in attention deficit hyperactivity disorder (ADHD) adult drivers. Driven by distraction? Results from a responsibility case–control study. PLoS One 9(12):e115002CrossRefPubMedPubMedCentralGoogle Scholar
- Faraone SV, Sergeant J, Gillberg C, Biederman J (2003) The worldwide prevalence of ADHD. Is it an American condition? World Psychiatry Off J World Psychiatr Assoc 2(2):104–113Google Scholar
- Fayyad J, Sampson NA, Hwang I, Adamowski T, Aguilar-Gaxiola S, Al-Hamzawi A, Andrade LHSG, Borges G, de Girolamo G, Florescu S, Gureje O, Haro JM, Hu C, Karam EG, Lee S, Navarro-Mateu F, O’Neill S, Pennell B-E, Piazza M, Posada-Villa J, ten Have M, Torres Y, Xavier M, Zaslavsky AM, Kessler RC (2017) The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys. Atten Deficit Hyperact Disord 9(1):47–65CrossRefGoogle Scholar
- Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, Howes MJ, Jin R, Secnik K, Spencer T, Ustun TB, Walters EE (2005) The World Health Organization Adult ADHD Self-Report Scale (ASRS). A short screening scale for use in the general population. Psychol Med 35(2):245–256CrossRefPubMedGoogle Scholar
- Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K, Spencer T, Ustun TB, Walters EE, Zaslavsky AM (2006) The prevalence and correlates of adult ADHD in the United States. Results from the National Comorbidity Survey Replication. Am J Psychiatry 163(4):716–723CrossRefPubMedPubMedCentralGoogle Scholar
- Kittel-Schneider S, Spiegel S, Renner T, Romanos M, Reif A, Reichert S, Heupel J, Schnetzler L, Stopper H, Jacob C (2016) Cytogenetic effects of chronic methylphenidate treatment and chronic social stress in adults with attention-deficit/hyperactivity disorder. Pharmacopsychiatry 49(4):146–154CrossRefPubMedGoogle Scholar
- Kooij SJJ, Bejerot S, Blackwell A, Caci H, Casas-Brugué M, Carpentier PJ, Edvinsson D, Fayyad J, Foeken K, Fitzgerald M, Gaillac V, Ginsberg Y, Henry C, Krause J, Lensing MB, Manor I, Niederhofer H, Nunes-Filipe C, Ohlmeier MD, Oswald P, Pallanti S, Pehlivanidis A, Ramos-Quiroga JA, Rastam M, Ryffel-Rawak D, Stes S, Asherson P (2010) European consensus statement on diagnosis and treatment of adult ADHD. The European Network Adult ADHD. BMC Psychiatry 10:67CrossRefPubMedPubMedCentralGoogle Scholar
- Nogueira M, Bosch R, Valero S, Gomez-Barros N, Palomar G, Richarte V, Corrales M, Nasillo V, Vidal R, Casas M, Ramos-Quiroga JA (2014) Early-age clinical and developmental features associated to substance use disorders in attention-deficit/hyperactivity disorder in adults. Compr Psychiatry 55(3):639–649CrossRefPubMedGoogle Scholar
- Quinlan EB, Cattrell A, Jia T, Artiges E, Banaschewski T, Barker G, Bokde ALW, Bromberg U, Büchel C, Brühl R, Conrod PJ, Desrivieres S, Flor H, Frouin V, Gallinat J, Garavan H, Gowland P, Heinz A, Martinot J-L, Paillère Martinot M-L, Nees F, Papadopoulos-Orfanos D, Paus T, Poustka L, Smolka MN, Vetter NC, Walter H, Whelan R, Glennon JC, Buitelaar JK, Happé F, Loth E, Barker ED, Schumann G (2017) Psychosocial stress and brain function in adolescent psychopathology. Am J Psychiatry 174(8):785–794CrossRefPubMedGoogle Scholar
- Sargant NN, Finley F (2013) Le TDAH au volant: conseils aux adolescents. TDAH en pratique 5(4):13–15Google Scholar
- Schlander M, Trott G-E, Schwarz O (2010a) Gesundheitsökonomie der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung in Deutschland Teil 1. Versorgungsepidemiologie und Krankheitskosten (The health economics of attention deficit hyperactivity disorder in Germany. Part 1: Health care utilization and cost of illness). Der Nervenarzt 81(3):289–300CrossRefPubMedGoogle Scholar
- Schlander M, Trott G-E, Schwarz O (2010b) Gesundheitsökonomie der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung in Deutschland. Teil 2. Therapeutische Optionen und ihre Kosteneffektivität (The health economics of attention deficit hyperactivity disorder in Germany. Part 2: Therapeutic options and their cost-effectiveness). Der Nervenarzt 81(3):301–314CrossRefPubMedGoogle Scholar
- Sobanski E, Sabljic D, Alm B, Skopp G, Kettler N, Mattern R, Strohbeck-Kuhner P (2008) Driving-related risks and impact of methylphenidate treatment on driving in adults with attention-deficit/hyperactivity disorder (ADHD). J Neural Transm (Vienna, Austria: 1996) 115(2):347–356CrossRefGoogle Scholar
- Swensen A, Birnbaum HG, Ben Hamadi R, Greenberg P, Cremieux P-Y, Secnik K (2004) Incidence and costs of accidents among attention-deficit/hyperactivity disorder patients. J Adolesc Health Off Publ Soc Adolesc Med 35(2):346.e1–346.e9Google Scholar
- Vingilis E, Mann RE, Erickson P, Toplak M, Kolla NJ, Seeley J, Jain U (2014) Attention deficit hyperactivity disorder, other mental health problems, substance use, and driving. Examination of a population-based, representative Canadian sample. Traffic Inj Prev 15(sup1):S1–S9CrossRefPubMedGoogle Scholar