ADHD and depressive symptoms in adolescents: the role of community violence exposure

Abstract

Purpose

Comorbid depression is common in adolescents with attention-deficit/hyperactivity disorder (ADHD). As yet, however, little is known about the factors associated with co-occurring depression in this population. To address this research gap, the current study examined the role of community violence exposure in the association between ADHD symptoms and depression.

Methods

Data came from 505 Russian adolescents [mean age 14.37 (SD = 0.96)] who had teacher-reported information on ADHD symptoms that was collected in conjunction with the Social and Health Assessment (SAHA). Adolescent self-reports of witnessing and being a victim of community violence were also obtained while depressive symptoms were self-assessed with an adapted version of the Center for Epidemiologic Studies-Depression Scale (CES-D). Logistic regression analyses were performed to examine associations.

Results

In univariable analyses, both witnessing and being a victim of violence were associated with significantly increased odds for depressive symptoms in adolescents with ADHD symptoms compared to non-ADHD adolescents who had not experienced community violence. However, in the multivariable analysis only being a victim of violence continued to be associated with significantly increased odds for depression [odds ratio (OR) 4.67, 95% confidence interval (CI) 1.33–16.35].

Conclusion

Exposure to community violence may be associated with depression in adolescents with ADHD symptoms. Clinicians should enquire about exposure to community violence in adolescents with ADHD/ADHD symptoms. Early therapeutic interventions to address the effects of violence exposure in adolescents with ADHD may be beneficial for preventing depression in this group.

This is a preview of subscription content, log in to check access.

References

  1. 1.

    Thomas R, Sanders S, Doust J, Beller E, Glasziou P (2015) Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics 135(4):e994–e1001

    PubMed  Article  Google Scholar 

  2. 2.

    Daley D, Birchwood J (2010) ADHD and academic performance: why does ADHD impact on academic performance and what can be done to support ADHD children in the classroom? Child Care Health Dev 36(4):455–464

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Bagwell CL, Molina BS, Pelham WE Jr, Hoza B (2001) Attention-deficit hyperactivity disorder and problems in peer relations: predictions from childhood to adolescence. J Am Acad Child Adolesc Psychiatry 40(11):1285–1292

    CAS  PubMed  Article  Google Scholar 

  4. 4.

    Scahill L, Schwab-Stone M, Merikangas KR, Leckman JF, Zhang H, Kasl S (1999) Psychosocial and clinical correlates of ADHD in a community sample of school-age children. J Am Acad Child Adolesc Psychiatry 38(8):976–984

    CAS  PubMed  Article  Google Scholar 

  5. 5.

    Johnston C, Mash EJ (2001) Families of children with attention-deficit/hyperactivity disorder: review and recommendations for future research. Clin Child Fam Psychol Rev 4(3):183–207

    CAS  PubMed  Article  Google Scholar 

  6. 6.

    Isaksson J, Stickley A, Koposov R, Ruchkin V (2018) The danger of being inattentive—ADHD symptoms and risky sexual behaviour in Russian adolescents. Eur Psychiatry 47:42–48

    CAS  PubMed  Article  Google Scholar 

  7. 7.

    Holmberg K, Hjern A (2006) Health complaints in children with attention-deficit/hyperactivity disorder. Acta Paediatr 95(6):664–670

    PubMed  Article  Google Scholar 

  8. 8.

    Ruchkin V, Koposov RA, Koyanagi A, Stickley A (2017) Suicidal behavior in juvenile delinquents: the role of ADHD and other comorbid psychiatric disorders. Child Psychiatry Hum Dev 48(5):691–698

    PubMed  Article  Google Scholar 

  9. 9.

    Danckaerts M, Sonuga-Barke EJ, Banaschewski T, Buitelaar J, Dopfner M, Hollis C, Santosh P, Rothenberger A, Sergeant J, Steinhausen HC, Taylor E, Zuddas A, Coghill D (2010) The quality of life of children with attention deficit/hyperactivity disorder: a systematic review. Eur Child Adolesc Psychiatry 19(2):83–105

    PubMed  Article  Google Scholar 

  10. 10.

    Taurines R, Schmitt J, Renner T, Conner AC, Warnke A, Romanos M (2010) Developmental comorbidity in attention-deficit/hyperactivity disorder. Atten Defic Hyperact Disord 2(4):267–289

    PubMed  Article  Google Scholar 

  11. 11.

    Larson K, Russ SA, Kahn RS, Halfon N (2011) Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics 127(3):462–470

    PubMed  PubMed Central  Article  Google Scholar 

  12. 12.

    Biederman J, Newcorn J, Sprich S (1991) Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. Am J Psychiatry 148(5):564–577

    CAS  PubMed  Article  Google Scholar 

  13. 13.

    Busch B, Biederman J, Cohen LG, Sayer JM, Monuteaux MC, Mick E, Zallen B, Faraone SV (2002) Correlates of ADHD among children in pediatric and psychiatric clinics. Psychiatr Serv 53(9):1103–1111

    PubMed  Article  Google Scholar 

  14. 14.

    Becker SP, Fite PJ, Vitulano ML, Rubens SL, Evans SC, Cooley JL (2014) Examining anxiety and depression as moderators of the association between ADHD symptoms and academic and social problems in Hispanic adolescents. J Psychopathol Behav Assess 36(2):265–275

    Article  Google Scholar 

  15. 15.

    Booster GD, Dupaul GJ, Eiraldi R, Power TJ (2012) Functional impairments in children with ADHD: unique effects of age and comorbid status. J Atten Disord 16(3):179–189

    PubMed  Article  Google Scholar 

  16. 16.

    Biederman J, Faraone S, Mick E, Moore P, Lelon E (1996) Child Behavior Checklist findings further support comorbidity between ADHD and major depression in a referred sample. J Am Acad Child Adolesc Psychiatry 35(6):734–742

    CAS  PubMed  Article  Google Scholar 

  17. 17.

    Angold A, Costello EJ, Erkanli A (1999) Comorbidity. J Child Psychol Psychiatry 40(1):57–87

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Daviss WB (2008) A review of co-morbid depression in pediatric ADHD: etiologies, phenomenology, and treatment. J Child Adolesc Psychopharmacol 18(6):565–571

    PubMed  PubMed Central  Article  Google Scholar 

  19. 19.

    Biederman J, Ball SW, Monuteaux MC, Mick E, Spencer TJ, McCreary M, Cote M, Faraone SV (2008) New insights into the comorbidity between ADHD and major depression in adolescent and young adult females. J Am Acad Child Adolesc Psychiatry 47(4):426–434

    PubMed  Article  Google Scholar 

  20. 20.

    Humphreys KL, Katz SJ, Lee SS, Hammen C, Brennan PA, Najman JM (2013) The association of ADHD and depression: mediation by peer problems and parent-child difficulties in two complementary samples. J Abnorm Psychol 122(3):854–867

    PubMed  PubMed Central  Article  Google Scholar 

  21. 21.

    Jerrell JM, McIntyre RS, Park YM (2015) Risk factors for incident major depressive disorder in children and adolescents with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 24(1):65–73

    PubMed  Article  Google Scholar 

  22. 22.

    Ostrander R, Herman KC (2006) Potential cognitive, parenting, and developmental mediators of the relationship between ADHD and depression. J Consult Clin Psychol 74(1):89–98

    PubMed  Article  Google Scholar 

  23. 23.

    Brown NM, Brown SN, Briggs RD, German M, Belamarich PF, Oyeku SO (2017) Associations between adverse childhood experiences and ADHD diagnosis and severity. Acad Pediatr 17(4):349–355

    PubMed  Article  Google Scholar 

  24. 24.

    Lewis T, Schwebel DC, Elliott MN, Visser SN, Toomey SL, McLaughlin KA, Cuccaro P, Tortolero Emery S, Banspach SW, Schuster MA (2015) The association between youth violence exposure and attention-deficit/hyperactivity disorder (ADHD) symptoms in a sample of fifth-graders. Am J Orthopsychiatry 85(5):504–513

    PubMed  PubMed Central  Article  Google Scholar 

  25. 25.

    Daviss WB, Diler RS, Birmaher B (2009) Associations of lifetime depression with trauma exposure, other environmental adversities, and impairment in adolescents with ADHD. J Abnorm Child Psychol 37(6):857–871

    PubMed  Article  Google Scholar 

  26. 26.

    Foster JD, Kuperminc GP, Price AW (2004) Gender differences in posttraumatic stress and related symptoms among inner-city minority youth exposed to community violence. J Youth Adolesc 33(1):59–69

    Article  Google Scholar 

  27. 27.

    Gorman-Smith D, Tolan P (1998) The role of exposure to community violence and developmental problems among inner-city youth. Dev Psychopathol 10(1):101–116

    CAS  PubMed  Article  Google Scholar 

  28. 28.

    Lambert SF, Boyd RC, Cammack NL, Ialongo NS (2012) Relationship proximity to victims of witnessed community violence: associations with adolescent internalizing and externalizing behaviors. Am J Orthopsychiatry 82(1):1–9

    PubMed  PubMed Central  Article  Google Scholar 

  29. 29.

    Ruchkin V, Lorberg B, Koposov R, Schwab-Stone M, Sukhodolsky DG (2008) ADHD symptoms and associated psychopathology in a community sample of adolescents from the European north of Russia. J Atten Disord 12(1):54–63

    PubMed  Article  Google Scholar 

  30. 30.

    Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1(3):385–401

    Article  Google Scholar 

  31. 31.

    Stickley A, Koyanagi A, Koposov R, Schwab-Stone M, Ruchkin V (2014) Loneliness and health risk behaviours among Russian and U.S. adolescents: a cross-sectional study. BMC Public Health 14:366

    PubMed  PubMed Central  Article  Google Scholar 

  32. 32.

    DuPaul GJ, Power TJ, Anastopoulos AD, Reid R (1998) ADHD Rating Scale-IV: checklists, norms, and clinical interpretation. Guilford, New York

    Google Scholar 

  33. 33.

    Power TJ, Costigan TE, Leff SS, Eiraldi RB, Landau S (2001) Assessing ADHD across settings: contributions of behavioral assessment to categorical decision making. J Clin Child Psychol 30(3):399–412

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Pineda D, Ardila A, Rosselli M, Arias BE, Henao GC, Gomez LF, Mejia SE, Miranda ML (1999) Prevalence of attention-deficit/hyperactivity disorder symptoms in 4- to 17-year-old children in the general population. J Abnorm Child Psychol 27(6):455–462

    CAS  PubMed  Article  Google Scholar 

  35. 35.

    Richters JE, Martinez P (1993) The NIMH community violence project: I. Children as victims of and witnesses to violence. Psychiatry 56(1):7–21

    CAS  PubMed  Article  Google Scholar 

  36. 36.

    Pynoos RS, Frederick C, Nader K, Arroyo W, Steinberg A, Eth S, Nunez F, Fairbanks L (1987) Life threat and posttraumatic stress in school-age children. Arch Gen Psychiatry 44(12):1057–1063

    CAS  PubMed  Article  Google Scholar 

  37. 37.

    Wozniak J, Crawford MH, Biederman J, Faraone SV, Spencer TJ, Taylor A, Blier HK (1999) Antecedents and complications of trauma in boys with ADHD: findings from a longitudinal study. J Am Acad Child Adolesc Psychiatry 38(1):48–55

    CAS  PubMed  Article  Google Scholar 

  38. 38.

    Aguado-Gracia J, Mundo-Cid P, Lopez-Seco F, Acosta-Garcia S, Cortes-Ruiz MJ, Vilella E, Masana-Marín A (2018) Lifetime victimization in children and adolescents With ADHD. J Interpers Violence. https://doi.org/10.1177/0886260518771680

    PubMed  Article  Google Scholar 

  39. 39.

    Razani N, Hilton JF, Halpern-Felsher BL, Okumura MJ, Morrell HE, Yen IH (2015) Neighborhood characteristics and ADHD: results of a national study. J Atten Disord 19(9):731–740

    PubMed  Article  Google Scholar 

  40. 40.

    King S, Waschbusch DA (2010) Aggression in children with attention-deficit/hyperactivity disorder. Expert Rev Neurother 10(10):1581–1594

    PubMed  Article  Google Scholar 

  41. 41.

    Gudjonsson GH, Sigurdsson JF, Sigfusdottir ID, Young S (2014) A national epidemiological study of offending and its relationship with ADHD symptoms and associated risk factors. J Atten Disord 18(1):3–13

    PubMed  Article  Google Scholar 

  42. 42.

    Fowler PJ, Tompsett CJ, Braciszewski JM, Jacques-Tiura AJ, Baltes BB (2009) Community violence: a meta-analysis on the effect of exposure and mental health outcomes of children and adolescents. Dev Psychopathol 21(1):227–259

    PubMed  Article  Google Scholar 

  43. 43.

    Lynch M, Cicchetti D (1998) An ecological-transactional analysis of children and contexts: the longitudinal interplay among child maltreatment, community violence, and children’s symptomatology. Dev Psychopathol 10(2):235–257

    CAS  PubMed  Article  Google Scholar 

  44. 44.

    Fitzpatrick KM (1993) Exposure to violence and presence of depression among low-income, African–American youth. J Consult Clin Psychol 61(3):528–531

    CAS  PubMed  Article  Google Scholar 

  45. 45.

    Martinez P, Richters JE (1993) The NIMH community violence project: II. Children’s distress symptoms associated with violence exposure. Psychiatry 56(1):22–35

    CAS  PubMed  Article  Google Scholar 

  46. 46.

    Mazza JJ, Reynolds WM (1999) Exposure to violence in young inner-city adolescents: relationships with suicidal ideation, depression, and PTSD symptomatology. J Abnorm Child Psychol 27(3):203–213

    CAS  PubMed  Article  Google Scholar 

  47. 47.

    Ruchkin V, Henrich CC, Jones SM, Vermeiren R, Schwab-Stone M (2007) Violence exposure and psychopathology in urban youth: the mediating role of posttraumatic stress. J Abnorm Child Psychol 35(4):578–593

    PubMed  Article  Google Scholar 

  48. 48.

    Schwab-Stone M, Koposov R, Vermeiren R, Ruchkin V (2013) Cross-cultural findings on community violence exposure and internalizing psychopathology: comparing adolescents in the United States, Russia, and Belgium. Child Psychiatry Hum Dev 44(4):516–524

    PubMed  Article  Google Scholar 

  49. 49.

    Overstreet S, Braun S (2000) Exposure to community violence and post-traumatic stress symptoms: mediating factors. Am J Orthopsychiatry 70(2):263–271

    CAS  PubMed  Article  Google Scholar 

  50. 50.

    Schwab-Stone ME, Ayers TS, Kasprow W, Voyce C, Barone C, Shriver T, Weissberg RP (1995) No safe haven: a study of violence exposure in an urban community. J Am Acad Child Adolesc Psychiatry 34(10):1343–1352

    CAS  PubMed  Article  Google Scholar 

  51. 51.

    McLaughlin KA, Lambert HK (2017) Child trauma exposure and psychopathology: mechanisms of risk and resilience. Curr Opin Psychol 14:29–34

    PubMed  PubMed Central  Article  Google Scholar 

  52. 52.

    Cooley-Quille M, Lorion M (1999) Adolescents’ exposure to community violence: sleep and psychophysiological functioning. J Community Psychol 27(4):367–375

    Article  Google Scholar 

  53. 53.

    Wang CC, Wu YY, Yang YH, Hu HF, Yen CF (2018) Relationships of subjective insomnia and sleep duration with depression, anxiety, and pain problems in children and adolescents with attention-deficit/hyperactivity disorder. Neuropsychiatry 8(1):138–145

    Article  Google Scholar 

  54. 54.

    Nolen-Hoeksema S (2001) Gender differences in depression. Curr Dir Psychol Sci 10(5):173–176

    Article  Google Scholar 

  55. 55.

    Rosario M, Salzinger S, Feldman RS, Ng-Mak DS (2008) Intervening processes between youths’ exposure to community violence and internalizing symptoms over time: the roles of social support and coping. Am J Community Psychol 41(1–2):43–62

    PubMed  Article  Google Scholar 

  56. 56.

    Osofsky JD, Wewers S, Hann DM, Fick AC (1993) Chronic community violence: what is happening to our children? Psychiatry 56(1):36–45

    CAS  PubMed  Article  Google Scholar 

  57. 57.

    Stein BD, Jaycox LH, Kataoka S, Rhodes HJ, Vestal KD (2003) Prevalence of child and adolescent exposure to community violence. Clin Child Fam Psychol Rev 6(4):247–264

    PubMed  Article  Google Scholar 

  58. 58.

    Schwab-Stone M, Chen C, Greenberger E, Silver D, Lichtman J, Voyce C (1999) No safe haven. II: the effects of violence exposure on urban youth. J Am Acad Child Adolesc Psychiatry 38(4):359–367

    CAS  PubMed  Article  Google Scholar 

Download references

Acknowledgements

AK’s work was supported by the Miguel Servet contract financed by the CP13/00150 and PI15/00862 projects, integrated into the National R + D + I and funded by the ISCIII—General Branch Evaluation and Promotion of Health Research—and the European Regional Development Fund (ERDF-FEDER).

Author information

Affiliations

Authors

Corresponding author

Correspondence to Andrew Stickley.

Ethics declarations

Conflict of interest

The authors declare they have no conflict of interest.

Ethical standards

Prior to being included in the study informed consent was obtained from all participants. The study was approved by the institutional review committee at the Northern State Medical University, Arkhangelsk, Russia. The study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Stickley, A., Koposov, R., Koyanagi, A. et al. ADHD and depressive symptoms in adolescents: the role of community violence exposure. Soc Psychiatry Psychiatr Epidemiol 54, 683–691 (2019). https://doi.org/10.1007/s00127-019-01662-5

Download citation

Keywords

  • Attention-deficit/hyperactivity disorder
  • Depressive symptoms
  • Witness violence
  • Violent victimization
  • Adolescent