skemman.is°1_(… · Web view2019. 8. 30. · It is well established that individuals with...

Depression and anxiety in attention-deficit/hyperactivity disorder: Moderating and mediation effects of self-esteem and social support

Stefanía Björk Jónsdóttir

2016

BSC in Psychology

Author: Stefanía Björk Jónsdóttir

ID number: 0204902099

Supervisor: Heiðdís B. Valdimarsdóttir

Department of Psychology

School of Buiness

Running head: DEPRESSION AND ANXIETY IN ADHD: MODEARTION AND MEDIATION 2

Abstract

It is well established that individuals with attention-deficit hyperactivity disorder

(ADHD) have higher levels of depression and anxiety than individuals without ADHD but less is

known about the mechanisms whereby ADHD is related to depression and anxiety or which

individuals with ADHD are at most risk for depression and anxiety. There is evidence that

individuals with ADHD have lower self-esteem and lower social support than individuals

without ADHD but both of these factors have been associated with depression and anxiety.

Therefore, the aim of this study was to examine if self-esteem and social support buffered to

effects of ADHD on depression and anxiety or if it mediated the relationship between ADHD

and anxiety and depression. A total of 2051 students aged 14-24 participated in this study and

completed measures of ADHD, depression, anxiety, social support and self-esteem. The results

showed that adolescents with ADHD reported higher levels of anxiety and depression and lower

levels of self-esteem and social support. Girls with ADHD reported more anxiety and depression

than boys with ADHD. Neither self-esteem nor social support was found to moderate the effects

of ADHD on depression and anxiety. Self-esteem was found to partially mediate the relationship

between ADHD and depression, however, self-esteem was not found to mediate the relationship

between ADHD and anxiety. Furthermore, social support was not found to mediate the

relationship between ADHD and depression and anxiety. These result suggest that only self-

esteem explained the nature of the relationship between ADHD and depression. Further research

is needed to examine what factors do play a role in the relationship between ADHD and

depression and anxiety and what measure can be taken to alleviate this relationship.

Það hefur verið staðfest að einstaklingar með athyglisbrest og ofvirkni (ADHD) þjást af

meiri þunglyndi og kvíða heldur en einstaklingar án ADHD en minna er vitað um orsakir þar

sem ADHD tengist þunglyndi og kvíða eða hvort einstaklingar með ADHD eru í meiri hættu

fyrir þunglyndi og kvíða. Það eru vísbendingar um það að einstaklingar með ADHD eru með

lægra sjálfstraust og fá minni félagslegan stuðning heldur en einstaklingar án ADHD. Þessir

þættir hafa verið tengdir við þunglyndi og kvíða. Þess vegna er markmið þessarar rannsóknar að

skoða ef sjálfstraust og félagslegur stuðningur dragi úr áhrifum ADHD á þunglyndi og kvíða eða

ef að það miðlar sambandinu á milli ADHD og þunglyndis og kvíða. Þátttakendur voru alls 2051

nemandi á aldrinum 14-24 ára og luku þeir mælingum um ADHD, þunglyndi, kvíða, félagslegan


stuðning og sjálfstraust. Niðurstöðurnar sýndu að þeir unglingar með ADHD tilkynntu meiri

þunglyndi og kvíða og lægri sjálfstraust og minni félagslegan stuðning. Stelpur með ADHD

greindu frá meiri þunglyndi og kvíða heldur en strákar með ADHD. Hvorki sjálfstraust né

félagslegur stuðningur voru fundin hafa samvirkniáhrif af ADHD á þunglyndi og kvíða.

Sjálfstraust miðlaði að hluta til sambandinu á milli ADHD og þunglyndi og kvíða, hins vegar,

var sjálfstraust ekki fundið miðla sambandinu á milli ADHD og kvíða. Að auki, félagslegur

stuðningur var ekki fundin miðla sambandinu á milli ADHD og þunglyndi og kvíða. Þessar

niðurstöður benda til þess að aðeins sjálfstraust útskýrði eðli sambandsins á milli ADHD og

þunglyndis. Frekari rannsókna er þörf til þess að skoða hvaða þættir spila hlutverki í sambandinu

á milli ADHD og þunglyndis og kvíða og hvaða ráðstafanir er hægt að taka til þess að draga úr

þessu sambandi.


Introduction

Attention-deficit hyperactivity disorder (ADHD), which consists of inattention and/or

hyperactivity impulsivity, is a common neuropsychological disorder (Davey, 2008), that has

been found to affect around 3-7% school-aged children worldwide and is diagnosed about three

times more often in boys than in girls. An Icelandic epidemiological study examined the

prevalence of ADHD in teenagers at the ages of 14-16 (N: 10.937). The results showed that 5.4%

met the criteria for ADHD (Gudjonsson et al., 2012). To comparison, a Spanish epidemiological

study examined the prevalence of ADHD in people under the age of 18 (N: 13.026) and

prevalence was estimated at 6.8% (Catalá-López et al., 2012).

Numerous cross-sectional and correlational studies have found that children, adolescents

and adults with ADHD are more likely to have depression and anxiety compared to those people

without ADHD (Wang et al., 2006; Lee et al., 2016; Bowen et al., 2008; Overgaard et al., 2010).

Previous research found that 30% of participants with ADHD had depression and anxiety

whereas less than 10% of the participants without ADHD had depression and anxiety (Zwaan et

al., 2012). Additionally, major depression has been found to be around 25% in adults with

ADHD (Fisher et al., 2007). However, these studies say nothing about causality. It’s not known

if ADHD causes depression or if depression causes ADHD or if they occur simultaneously due

to some unknown third factor.

Regarding differences between genders, it has been suggested that girls with ADHD are

more vulnerable for developing depression and anxiety than boys with ADHD (Rucklidge et al.,

2008; Rucklidge et al., 2001; Skogli et al., 2013). Moreover, girls have been found to be more

likely to have lower self-esteem than boys (Barber et al., 2005). However, Houck and colleagues


(2011) suggested that internalizing problem (depression, anxiety) are negatively related to the

child’s self-concept and found that gender did not predict this relationship.

One risk factor for depression is self-esteem (Schmitz et al., 2003; Sharma et al., 2013; de

Man et al., 2001), with depressed individuals being more likely to report low self-esteem.

Furthermore, low self-esteem has been associated with major depressive disorder and social

anxiety disorder (Van Tuijl et al., 2014).

There is evidence that ADHD is associated with low self-esteem (Kelly et al., 1989;

Barber et al., 2005). A longitudinal study conducted on this matter assessed self-esteem in twins

with ADHD. The twins were first assessed at the age of 8 and then again when they were at the

age of 13. Their parents completed questionnaire about their children’s ADHD symptoms and

the twins completed a questionnaire about self-esteem and youth self-report. The study revealed

that significant relationship existed between high scores of ADHD reported by parents when

their children were at the age of 8 and low score on self-esteem reported by the adolescents at the

age of 13 (Edbom et al., 2006). Therefore, a long term relationship was found to exist between

ADHD symptoms and low self-esteem.

There is also evidence that some children with ADHD have what has been called positive

illusory bias. That is, they overestimate they’re own competency (Owens et al., 2007), with some

studies finding that children with ADHD rate themselves more favorably on self-perception

measurements than other children without ADHD (Hoza et al., 2004; Hoza et al., 2000). Hoza et

al. (2010) conducted a longitudinal study examining positive self-perception bias among 797

children with ADHD and comparison children from the ages of 8-13. The children rated their

perception of themselves on social competence and behavioral conduct using the Harter self-


perception profile for children and for adolescents. The results showed that children with ADHD

showed bias in social competence over a six-year period.

One protective factor for depression is social support with studies reporting that social

support has a negative association with depressive symptoms (Newman et al., 2007) and that

family and friends support play a big role in reducing depression (Weber et al., 2010; Assche et

al., 2016; Jensen et al., 2014). For instance, high social support was found to be associated with

lower depression among HIV effected adolescents (Lee et al., 2007) Moreover, social support

has been found to be negatively related to anxiety (Lewis et al., 2012).

A relation has been found between ADHD and social support, whereas studies have

found that children with ADHD or those children with characteristics of ADHD report lower

social support than the comparison children without ADHD (Mastoras et al., 2015; Demaray et

al., 2001).

Given that it is well established that self-esteem and social support is associated with

depression and anxiety it is possible that the relationship between ADHD and depression and

anxiety may be moderated or mediated by self-esteem and social support? Moderating and

mediation role of self-esteem and social support on the relationship between ADHD and

depression and anxiety appear not to be sufficiently examined in the literature. However, a

longitudinal study conducted by McQuade and colleagues (2011) found that boys with ADHD

who showed reduction in self-perception were at a greater risk for developing depression. This

study indicates that self-perception moderated the relationship between ADHD and depression.

There is a need to further evaluate if self-esteem and social support buffer the impact of ADHD

on depression and anxiety or if social support and self-esteem are potential mechanisms whereby

ADHD affect depression and anxiety.


The current study consists of two hypotheses: first, individuals with ADHD will report

higher levels of depression and anxiety than individuals without ADHD and second, girls with

ADHD will report higher levels of depression and anxiety than boys with ADHD. In addition,

we’ll examine if self-esteem or social support mediate or moderate the relationship between

ADHD and depression and anxiety.

Method

Participants

Valid responses were obtained from 11.388 students in a national survey carried out in all

secondary schools in Iceland the year of 2010 (boys: 5439; girls: 5837). N: 112 did not disclose

their gender. The sample obtained for this study was randomly selected from the 2010 survey

and comprised of 2051 students (boys: 950; girls; 1078). N: 23 did not disclose their gender. The

participant’s average age was 17 years old.

Materials

The data utilized for this study comes from a cross-sectional national survey which was

conducted in every secondary schools in Iceland in 2010. The survey was developed and carried

out by the Icelandic centre for social Research and analysis (ISCRA) at Reykjavik University, in

cooperation with the Icelandic ministry of education. The initial survey contained 110 questions

on 34 pages. Thirty-six questions that were related to the present aims were included in the

analysis below. The questions included ADHD diagnosis, level of depression and anxiety and

measures of self-esteem and social support.

Procedure


An anonymous questionnaires and envelopes were distributed to all secondary schools in

Iceland in 2010. Teachers presented in the classrooms administered the survey questionnaires to

all students attending class on that day. Participants were specifically informed that some of the

questions were of sensitive nature and that they were free to skip questions that they felt

uncomfortable with answering and that they could withdraw from participation at any time. To

maintain anonymity students were instructed not to write their name or social security number on

the questionnaire or response sheet. They were instructed to complete the whole questionnaire in

good faith and ask for help if needed any clarification. Upon completion, students were asked to

place their questionnaires in the envelope they received and to seal it before handing it in to the

teacher.

Measures (independent and dependent variables)

Attentive-deficit/hyperactivity disorder

One questions were used to assess diagnosis of ADHD (independent variable) (see

appendix A). The responses were on a dichotomous scale, with a “Yes” response indicating

presence of ADHD and “No” response indicating the absence of ADHD (Yes = 1, no = 2). Of

the 2051 participants, 1919 answered this question and of those 198(9.7%) reported being

diagnosed with ADHD

Depressed mood and anxiety

The anxiety and depression subscales of the SCL-90 was used to assess depression and

anxiety (Zhang et al., 2013). Ten questions assessed depression and twelve questions assessed

anxiety (dependent variables). Participants responded to the items using a four-point scale


(“Nearly never” = 1, “seldom” = 2, “sometimes” = 3, “often” = 4), with higher score indicating

more severity of depression (see appendix A). The scale demonstrated good internal consistency

with a Cronbach’s alpha of .904. Responses, for anxiety, were on a four-point scale (“Nearly

never” = 1, “seldom” = 2, “sometimes” = 3, “often” = 4), with higher score indicating more

anxiety (see appendix A). The items were combined into a scale, with Cronbach’s alpha of .869.

Moderator and mediator

Self-esteem

Self-esteem was measured with 10 statements from the Rosenberg self-esteem scale

(RSES; Rosenberg, 1989). The items were answered on a four-point Likert scale (1= strongly

disagree to 4 = strongly agree), with higher score indicating a higher level of self-esteem (see

appendix A). Internal consistency was high with a Cronbach’s alpha of .896.

Social support

Ten questions were used to assess perceived social support (Sigfusdottir et al., 2004;

Thorlindsson et al., 2007). Responses ranged from 1-4, on a four-point scale (“Very difficult” =

1, “difficult” = 2, “easy” = 3, “very easy” = 4), with higher score indicated higher perceived

social support (see appendix A). Internal consistency was good, with Cronbach’s alpha of .880

Results

One-way Anova was used to examine the relationship between ADHD and depression

and anxiety and gender difference and the relationship between ADHD and self-esteem and

social support. Linear regression was used to assess mediation effect and General Linear Model

(GML) was used to assess moderation effect of self-esteem and social support.


ADHD, depression and anxiety and gender difference

A statistically significant relationship (seen in Table. 1) was found between ADHD and

depression, F (1, 1882) = 17.681, p < .001, and anxiety, F (1, 1855) = 31.102, p < .001.

Participants with ADHD reported more depression and anxiety than participants without ADHD.

The analysis for gender differences presented in fig. 1, revealed that there was a significant main

effect of gender on depression, F (1, 1953) = 66.518, p < .001. This indicates that girls with

ADHD (M = 14.5, SD = 5.7) reported being more depressed than boys with ADHD (M = 12.5,

SD = 5.2). In addition, as presented in fig. 2, there was a significant main effect of gender on

anxiety, F (1, 1923) = 164.022, p < .001. Girls with ADHD reported more anxiety (M = 29.1, SD

= 8.4) than boys with ADHD (M = 24.2, SD = 8.1).

Table 1.

Mean and standard deviation of ADHD on depression and anxiety

ADHD + ADHD -

n M(SD) n M(SD)

Depression 189 15.1(6.5) 1694 13.3(5.4)

Anxiety 187 30.1(10.0) 1669 26.5(8.2)

*Depression, p <.001

*Anxiety, p <.001


ADHD, self-esteem and social support

A statistically significant relationship was found between ADHD and self-esteem, F (1,

1838) = 14.987, p < .001 and social support, F (1, 1888) = 31.927, p <. 001 (seen in table 2).

Participants with ADHD reported slightly lower self-esteem and lower social support than

participants without ADHD.

Boys Girls11.5

12

12.5

13

13.5

14

14.5

15

12.5

14.5

ADHD +

Gender

Mea

n of

dep

ress

ion

Boys Girls0

5

10

15

20

25

30

35

24.2

29.1

ADHD +

Gender

Mea

n of

anx

iety

Figure 2. Mean difference of gender on anxiety


Table 2.

Self-esteem and social support for participants with and without ADHD

ADHD + ADHD -

N M(SD) n M(SD)

Self-esteem*

Social support**

178

192

29.9(6.2)

32.8(6.5)

1661

1697

31.7(6.1)

34.9(4.9)

*p <.001

**p <.001

Does self-esteem mediate the relationship between ADHD and depression and anxiety?

The first mediation model presented in fig 3, examined the hypothesis that self-esteem

would mediated the relationship between ADHD and depression. The overall model was

significant, F (2, 1814) = 308.045, p < .001 and accounted for 50.4% of the variance in

depression. In the first step of the mediation model, the regression of ADHD on depression,

ignoring the mediator, was significant, F (1, 1813) = 15.098, p < .001. The second step showed

that regression of ADHD on the mediator, self-esteem, was significant, F (1, 1815) = 18.784, p <

.001 (a-path). The third step of the mediation process showed that the mediator (self-esteem),

controlling for ADHD, was significant, F (2, 1813) = 331.613, p < .001 (b-path). Moreover, step

four revealed that, controlling for the mediator (self-esteem), ADHD was a non-significant

predictor of depression, F (1, 1813) = 2.760, p = .097 (c'-path). A Sobel test was conducted and

found mediation in the model (z = -4.26, p =.000). The effect size was -.937, with a 95%

confidence interval which did not included zero. This results suggest that self-esteem partially

mediate the relationship between ADHD and depression.


The second mediation model presented in fig 4, examined the hypothesis that self-esteem

would mediate the relationship between ADHD and anxiety. The overall model was significant,

F (2, 1785) = 164.994, p < .001 and accounted for 39.5% of the variance in anxiety. In step one

of the mediation model, the regression of ADHD on anxiety, ignoring the mediator, was

significant, F (1, 1786) = 29.956, p < .001. Step two showed that the regression of ADHD on the

mediator, self-esteem, was also significant, F (1, 1786) = 17.872, p < .001 (a-path). Step three of

the mediation process showed that the mediator (self-esteem), controlling for ADHD, was

significant, F (2, 1784) = 151.367, p < .001 (b-path). Step four of the analysis revealed that,

controlling for the mediator (self-esteem), ADHD was still a significant predictor of anxiety, F

(1, 1784) = 16.341, p < .001 (c'-path). Self-esteem was not found to mediate the relationship

between ADHD and anxiety

A Sobel test was conducted and found no mediation in the model (z = -4.09, p =.000). The effect

size was -1,068, with a 95% confidence interval which included zero. It was found that self-

esteem did not mediated the relationship between ADHD and anxiety.


Figure 3. Indirect effect of ADHD on depression through self-esteem

Figure 4. Indirect effect of ADHD on anxiety through self-esteem

Does social support mediate the relationship between ADHD and depression and anxiety?

Mediation model presented in fig. 5, examined the hypothesis that social support would

mediate the relationship between ADHD and depression. The overall model was significant, F


(2, 1852) = 65.765, p < .001 and accounted for 25.8% of the variance in depression. In step one

of the mediation model, the regression of ADHD on depression, ignoring the mediator, was

significant, F (1, 1853) = 16.489, p < .001. The second step showed that the regression of ADHD

on the mediator (social support), was also significant, F (1, 1853) = 21.390, p < .001 (a-path).

The third step of the mediation process showed that the mediator (social support), controlling for

ADHD, was significant, F (2, 1851) = 57.454, p < .001 (b-path). The step 4 revealed that,

controlling for the mediator (social support), ADHD was still a significant predictor of

depression, F (1, 1851) = 8.891 p = .003 (c'-path). The Sobel test found no mediation (z = -4.23,

p = .000). The effect size was -.473, with a 95% confidence interval which did include zero.

These results suggest that social support did not mediate the relationship between ADHD and

depression.


Mediation model presented in fig 6, examined the hypothesis that social support would

mediate the relationship between ADHD and anxiety. The overall model was significant, F (2,

1829) = 29.921, p < .001 and accounted for 17.8% of the variance in anxiety. The first step of the

mediation model showed that the regression of ADHD on anxiety, ignoring the mediator, was

significant, F (1, 1830) = 29. 136, p < .001. Step 2 showed that the regression of ADHD on the

mediator (social support), was significant, F (1, 1830) = 18.937, p < .001 (a-path). Step 3 of the

mediation process showed that the mediator (social support), controlling for ADHD, was

significant, F (2, 1828) = 15.150, p < .001 (b-path). Step 4 of the analysis revealed that,

controlling for the mediator (social support), ADHD was a significant predictor of anxiety, F (1,

1828) = 23.634, p < .001 (c'). The Sobel test found no mediation in the model (z = -3.38, p

= .000). The effect size was -.363, with a 95% confidence interval which did include zero. This

indicates that social support did not mediate the relationship between ADHD and anxiety.

Figure 5. Indirect effect of ADHD on depression through social support


Figure 6. Indirect effect of ADHD on anxiety through social support

Does self-esteem moderate the effects of ADHD on depression and anxiety?

The analysis for depression presented in fig. 7, revealed that there was a nonsignificant

main effect for the presence and absence of ADHD on depression, F (1, 1811) = 1.852, p = .174.

The average depression of participants with and without ADHD was fairly similar. On the other

hand, there was a significant main effect of levels of self-esteem on depression, F (2, 1811) =

139.421, p < .001, whereas those participants who reported low self-esteem were more depressed

compared to those reporting higher self-esteem. In addition, there was a nonsignificant

interaction between presence and absence of ADHD on levels of self-esteem, F (2, 1811) = .198,

p = .820. The effect of self-esteem on depression was similar for those participants with and

without ADHD.

The analysis for anxiety presented in fig 8, revealed that there was a significant main

effect of the presence and absence of ADHD on anxiety, F (1, 1782) = 15.678, p < .001, with

participants with ADHD reporting more anxiety than those participants without ADHD.


Furthermore, there was a significant main effect of levels of self-esteem on anxiety, F (2, 1782)

= 65.103, p < .001. Different levels of self-esteem had an influence on anxiety, where

participants with lower self-esteem reported more anxiety than participants with higher self-

esteem. The interaction between the presence and absence of ADHD on levels of self-esteem

was not significant, F (2, 1782) = .831, p = .436. The effect of self-esteem on anxiety was similar

for ADHD participants and non-ADHD participants. Therefore, it can be concluded from these

results that the relationship between ADHD and depression and anxiety did not change as a

function of self-esteem. In another word, having low self-esteem did not cause depression and

anxiety in those participants with ADHD.

Low Medium High0

24

68

10

121416

1820

ADHD +ADHD -

Self-esteem

Mea

n of

dep

ress

ion

Figure 7 Moderating effect of self-esteem on ADHD and depression


Does social support moderate the effects of ADHD on depression and anxiety?

The analysis for depression presented in fig. 9, revealed that there was a significant main

effect of presence and absence of ADHD on depression, F (1, 1849) = 5.972, p = .015 with

participants with ADHD reporting more depression than those participants without ADHD. In

addition, there was a significant main effect of levels of social support on depression, F (2, 1849)

= 27.142, p < .001. with participants who reported more social support reported less depression

compared to those participants who reported low social support. The interaction between

presence and absence of ADHD on levels of social support, F (2, 1849) = 1.107, p = .331 was

not significant. Social support did not buffer the effects of ADHD on depression.

The analysis for anxiety presented in fig. 10, revealed that there was a significant main

effect of the presence and absence of ADHD on anxiety, F (1, 1826) = 18.355, p < .001.

Participants with ADHD reported more anxiety than participants without ADHD. Along with

that, there was a significant main effect of levels of social support on anxiety, F (2, 1826) =

12.703, p < .001. The different levels of social support had an influence on anxiety. The

participants who reported low social support had higher anxiety compared to participants who

Low Medium High0

5

10

15

20

25

30

35

40

ADHD +ADHD -

Self-esteem

Mea

n of

anx

iety


reported higher social support. However, there was a nonsignificant interaction between presence

and absence of ADHD on levels of social support, F (2, 1826) = 2.395, p = .091. The effect of

social support on anxiety was similar for those participants with and without ADHD. Therefore,

the relationship between ADHD and depression and anxiety did not change as a function of

social support. Like with self-esteem, having high social support did not buffer the effects of

ADHD on depression or anxiety.

Low Medium High0

5

10

15

20

25

30

35

ADHD +ADHD -

Social support

Mea

n of

anx

iety

Low Medium High02468

1012141618

ADHD +ADHD -

Social support

Mea

n of

dep

ress

ion

Figure 9. Moderating effect of social support on ADHD and depression

Figure 10. Moderating effect of social support on ADHD and anxiety


Discussion

The results showed that adolescents with ADHD reported higher levels of depression and anxiety

and lower levels of self-esteem and social support. Further, girls with ADHD were found to have

more depression and anxiety than boys with ADHD. Self-esteem and social support did not

buffer the impact of ADHD on depression or anxiety. However, self-esteem partially mediated

the effects of ADHD on depression, but not anxiety.

The findings that adolescents with ADHD reported higher levels of anxiety and

depression than those without ADHD is in line with previous studies showing (Wang et al.,

2006; Lee et al., 2016; Bowen et al. 2008; Overgaard et al., 2010; Zwaan et al., 2012) strong

association between having ADHD and being more susceptible for depression and anxiety.

However, these results, like with previous studies are correlational and therefore do not

demonstrate a causal relationship.

Adolescents with ADHD reported lower levels of self-esteem compared to non-ADHD

adolescents. This finding in consistent with the studies conducted by Kelly and colleagues (1989)

and Barber and colleagues (2005) that found a relationship between ADHD and self-esteem.

Moreover, the study conducted by Edbom and colleagues (2006) found a longitudinal

relationship between ADHD symptoms and lower self-esteem. However, these findings are

inconsistent with studies showing that children with ADHD had rated themselves as having

excellent self-perception (Hoza et al., 2004; Hoza et al., 2000) compared to non-ADHD children.

These discrepant findings might be due to illusory bias, that is children with ADHD may

overestimate their own abilities (Owens et al., 2007) that can in turn protect their self-esteem.

Furthermore, a significant relationship was found between ADHD and social support.

That is, adolescents with ADHD reported lower perceived social support than the adolescents


without ADHD. This finding is in line with previous studies (Mastoras et al., 2015; Demaray et

al., 2001) showing lower social support among children with ADHD compared to non-ADHD

children. Social support is an important factor in promoting self-concept and well-being.

Therefore, it is important that we give social support value when we seek to lessening the

relationship between ADHD and depression and anxiety.

One of the aims of the current study was to examine the role of self-esteem and social

support in the relationship between ADHD and depression and anxiety. The results showed that

the relationship between ADHD and depression and anxiety was not moderated by either self-

esteem or social support. The effects that self-esteem and social support had on participants was

similar for those participants with and without ADHD. In another words, the relationship

between ADHD and depression and anxiety did not depend on self-esteem or social support.

This finding, with regards to self-esteem, is inconsistent with a study mention above which was

conducted by McQuade and colleagues (2010) which found that relationship between ADHD

and depression did depend on self-perception. These conflicting results might be due to the fact

that the study after McQuade was a longitudinal study conducted over 3 periods and examined

only boys. Furthermore, different measurement tool was used to assess self-esteem and

depression.

With regards to the mediation effect it was found that the relationship between ADHD

and depression was partially mediated by self-esteem. That is, self-esteem partially explained the

nature of the relationship between ADHD and depression and facilitated a better understanding

of that relationship. By saying that self-esteem partially mediated the relationship implies that

there is a relationship between self-esteem and depression, but there is also some direct

relationship between ADHD and depression. On the other hand, self-esteem did not explain the


relationship between ADHD and anxiety. Moreover, social support was not found to explain the

relationship between neither ADHD and depression nor ADHD and anxiety. According to these

findings only self-esteem played a role in the nature of the relationship between ADHD and

depression.

Future studies should focus on identifying mediators and moderators of depression and

anxiety among adolescents with ADHD as that will aid in developing and testing interventions to

reduce depression and anxiety. It’s not an easy or simple matter to explain what causes people

with ADHD to have depression and anxiety and there are probably many factors that can come

into play. It might be a combinations of things that causes these relationships to occur.

Reference

Assche, V. E., Moons, T., Leeuwen, V. K., Colpin, H., Verschueren, K., Noortgate, D. V.,

Goosens, L., & Claes, S. (2016). Depressive symptoms in adolescence: The role of

perceived parental support, psychological control, and proactive control in interaction

with 5-HTTLPR. European Psychiatry, 35 (2016) 55–63.

http://dx.doi.org/10.1016/j.eurpsy.2016.01.2428


Barber, S., Grubbs, L., & Cottrell, B. (2005). Self-Perception in Children with Attention

Deficit/Hyperactivity Disorder. Journal of Pediatric Nursing, 20(4), 235–245.

http://doi.org/10.1016/j.pedn.2005.02.012

Bowen, R., Chavira, D. A., Bailey, K., Stein, M. T., & Stein, M. B. (2008). Nature of anxiety

comorbid with attention deficit hyperactivity disorder in children from a pediatric

primary care setting. Psychiatry Research, 157(1–3), 201–209.

http://doi.org/10.1016/j.psychres.2004.12.015

Catalá-López, F., Peirdó, S., Ridao, M., Sanfélix-Gimeno, G., Génova-Maleras, R., & Catalá, A.,

M. (2012). Prevalence of attention deficit hyperactivity disorder among children and

adolescents in Spain: a systematic review and meta-analysis of epidemiological studies.

BMC Psychiatry, 12:168

Davey, G. (2008). Psychopathology: Research, assessment and treatment in clinical psychology.

Uk: British Psychological Society and Blackwell Publishing Ltd

de Man, A. F., Gutierrez, B. I. B., & Sterk, N. (2001). Stability of Self-esteem as Moderator of

the Relationship Between Level of Self-esteem and Depression. North American Journal

of Psychology, 3(2), 303.

Demaray, K., M., & Elliot, N., S. (2001). Perceived social support by children with

characteristics of Attention-Deficit/Hyperactivity Disorder. School Psychology Quarterly,

Vol 16(1), 2001, 68-90. http://dx.doi.org/10.1521/scpq.16.1.68.19156

Edbom, T., Lichtenstein, P., Granlund, M., & Larsson, J.-O. (2006). Long-term relationships

between symptoms of Attention Deficit Hyperactivity Disorder and self-esteem in a

prospective longitudinal study of twins. Acta Paediatrica, 95(6), 650–657.

http://doi.org/10.1080/08035250500449866


Fischer, A. G., Bau, C. H. D., Grevet, E. H., Salgado, C. A. I., Victor, M. M., Kalil, K. L. S., …

Belmonte-de-Abreu, P. (2007). The role of comorbid major depressive disorder in the

clinical presentation of adult ADHD. Journal of Psychiatric Research, 41(12), 991–996.

http://doi.org/10.1016/j.jpsychires.2006.09.008

Gudjonsson, H., G, Sigurdsson, F, Sigfusdottir, D., I., & Young, S. (2012). An epidemiological

study of ADHD symptoms among young persons and the relationship with cigarette

smoking, alcohol consumption and illicit drug use. Journal of Child Psychology and

Psychiatry, pp 304–312. http://doi:10.1111/j.1469-7610.2011.02489

Houck, G., Kendall, J., Miller, A., Morrell, P., & Wiebe, G. (2011). Self-Concept in Children

and Adolescents with Attention Deficit Hyperactivity Disorder. Journal of Pediatric

Nursing, 26(3), 239–247. http://doi.org/10.1016/j.pedn.2010.02.004

Hoza, B., & Gerdes, A. (2004). Self-perception of competence in children with ADHD and

comparison children. Journal of Consulting and Clinical Psychology, 72(3), 382

Hoza, B., Murray-Close, D. Arnold, L., Hinshaw, S., Hechtman, L. (2010). Time-dependent

changes in positively biased self-perceptions of children with

attention-deficit/hyperactivity disorder: A developmental psychopathology perspective.

Developmental and Psychopathology 22, 375-390.

http://doi:10.1017/S095457941000012X

Hoza, B., & Waschbusch, D. A. (2000). Attention-Deficit/Hyperactivity Disordered and Control

Boys’ Responses to Social Success and Failure. Child Development, 71(2), 432.

Jensen, P. M., Smith, E. A., Bombardier, H. C., Yorkston, M., K, Miro, J., & Molton, R. I.

(2014). Social support, depression, and physical disability: Age and diagnostic group


effects. Disability and Health. Journal 7 (2014) 164e172.

http://doi.org/10.1016/j.dhjo.2013.11.001

Kelly, C. P., Cohen, L. M., Walker, O. W., Caskey, L. O., & Atkinson, W. A. (1989). Self-

esteem in children medically managed for attention deficit disorder. Pediatrics,

83(2):211-7.

Lee, M.-J., Yang, K.-C., Shyu, Y.-C., Yuan, S.-S., Yang, C.-J., Lee, S.-Y., … Wang, L.-J.

(2016). Attention-deficit hyperactivity disorder, its treatment with medication and the

probability of developing a depressive disorder: A nationwide population-based study in

Taiwan. Journal of Affective Disorders, 189, 110–117.

http://doi.org/10.1016/j.jad.2015.09.015

Lee, J., Detels, R., Rotheram-Borus, J. M., Duan, N., & Lord, L. (2007). Depression and Social

Support among HIV-affected Adolescents. AIDS PATIENT CARE and STDs Volume 21,

Number 6. http://doi: 10.1089/apc.2006.0066

Lewis, M. K., Byrd, A. D., & Ollendick, H. T. (2012). Anxiety symptoms in African-American

and Caucasian youth: relations to negative life events, social support, and coping.

Journal of Anxiety Disorder, 26(2012) 32-39. http://doi: 10.1016/j.janxdis.2011.08.007

Mastoras, M., S, Saklofske, H., D, Schwean, L., V., & Climie, A., E. (2015). Social Support in

Children with ADHD an Exploration of Resilience. Journal of Attention Disorders.

http://doi:10.1177/1087054715611491

McQuade, J. D., Hoza, B., Murray-Close, D., Waschbusch, D. A., & Owens, J. S. (2011).

Changes in Self-Perceptions in Children with ADHD: A Longitudinal Study of


Depressive Symptoms and Attributional Style. Behavior Therapy, 42(2), 170–182.

http://doi.org/10.1016/j.beth.2010.05.003

Newman, M. B., Newman, R. P., Griffen, S., O'Connor, K., & Spas, J. (2007). The relationship

of social support to depressive symptoms during the transition to high school.

ADOLESCENCE, Vol. 42, No. 167.

Owens, J., Goldfine, M., Evangelista, N., Hoza, B., Kaiser, N.(2007). A critical review of self-

perceptions and the positive illusory bias in children with ADHD. Clin child Fam

Psychol Rev, 10:335-351. http://doi 10.1007/s10567-007-0027-3

Øvergaard, K., Zeiner, P., & Aase, H. (2010). Anxiety disorders in preschoolers with and

without symptoms of attention deficit hyperactivity disorder. European Child &

Adolescent Psychiatry, 19, S87–S88. http://doi.org/10.1007/s00787-010-0117-5

Rosenberg, M. 1989. Society and the Adolescent Self-Image. rev. ed., 325–327. Middletown,

CT: Wesleyan University Press.

Rucklidge, J. J. (2008). Gender differences in ADHD: implications for psychosocial treatments.

Expert Review of Neurotherapeutics, 8(4), 643–55.

http://doi.org/http://dx.doi.org/10.1586/14737175.8.4.643

RUCKLIDGE, J. J., & TANNOCK, R. (2001). Psychiatric, Psychosocial, and Cognitive

Functioning of Female Adolescents with ADHD. Journal of the American Academy of

Child & Adolescent Psychiatry, 40(5), 530–540. http://doi.org/10.1097/00004583-

200105000-00012

Schmitz, N., Kugler, J., & Rollnik, J. (2003). On the relation between neuroticism, self-esteem,

and depression: results from the National Comorbidity Survey. Comprehensive


Psychiatry, 44(3), 169–76. http://doi.org/http://dx.doi.org/10.1016/S0010-

440X(03)00008-7

Sharma, S., & Agarwala, S. (2013). Contribution of Self-Esteem and Collective Self-Esteem in

Predicting Depression. Psychological Thought, 6(1), 117–123.

http://doi.org/10.5964/psyct.v6i1.50

Sigfusdottir, I.D., Farkas, G., Silver, E. (2004). The Role of Depressed Mood and Anger in the

Relationship Between Family Conflict and Delinquent Behavior. Journal of Youth and

Adolescence, 33: 509-522.

Skogli, E. W., Teicher, M. H., Andersen, P. N., Hovik, K. T., & Øie, M. (2013). ADHD in girls

and boys - gender differences in co-existing symptoms and executive function measures.

BMC Psychiatry, 13, 298. http://doi.org/http://dx.doi.org/10.1186/1471-244X-13-298

Thorlindsson, Th., Bjarnason, Th., Sigfusdottir, I.D. (2007). Individual and Community

Processes of Social Closure: A study of adolescent academic achievement and alcohol

use. Acta Sociologica, 50: 161-178.

van Tuijl, L. A., de Jong, P. J., Sportel, B. E., de Hullu, E., & Nauta, M. H. (2014). Implicit and

explicit self-esteem and their reciprocal relationship with symptoms of depression and

social anxiety: A longitudinal study in adolescents. Journal of Behavior Therapy and

Experimental Psychiatry, 45(1), 113–121. http://doi.org/10.1016/j.jbtep.2013.09.007

Wang, L.-J., Shyu, Y.-C., Yuan, S.-S., Yang, C.-J., Yang, K.-C., Lee, T.-L., & Lee, S.-Y. (2016).

Attention-deficit hyperactivity disorder, its pharmacotherapy, and the risk of developing

bipolar disorder: A nationwide population-based study in Taiwan. Journal of Psychiatric

Research, 72, 6–14. http://doi.org/10.1016/j.jpsychires.2015.10.014


Weber, S. Puskar, R. K., & Ren, D. (2010). Relationships Between Depressive Symptoms and

Perceived Social Support, Self-Esteem, & Optimism in a Sample of Rural Adolescents.

Issues in Mental Health Nursing, 31:584–588. http://doi: 10.3109/01612841003775061

Zhang, J., & Zhang, X. (2013). Chinese college students’ SCL-90 scores and their relations to

the college performance. Asian Journal of Psychiatry 6, 134–140.

http://doi:10.1016/j.ajp.2012.09.009

Zwaan, M., Gruß, B., Müller, A., Graap, H., Martin, A., Glaesmer, H., … Philipsen, A. (2012).

The estimated prevalence and correlates of adult ADHD in a German community sample.

European Archives of Psychiatry & Clinical Neuroscience, 262(1), 79–86.

http://doi.org/10.1007/s00406-011-0211-9

Appendix AQuestionnaires

Greind(ur) með athyglisbrest með ofvirkni

DepressionHve of sl. 30 d: leið(ur) eða hafðir lítinn mátt

Hve of sl. 30 d: litla matarlyst


Hve of sl. 30 d: einmana

Hve of sl. 30 d: grést auðveldlega eða langaði til að gráta

Hve of sl. 30 d: erfitt með að sofna eða halda þér sofandi

Hve of sl. 30 d: niðurdregin(n) eða dapur/döpur

Hve of sl. 30 d: ekki spenntu(ur) fyrir að gera nokkurn hlut

Hve of sl. 30 d: fannst þú hægfara eða hafa lítinn mátt

Hve of sl. 30 d: fannst framtíðin vonlaus

Hve of sl. 30 d: hugsaðir um að stutta þér aldur

Anxiety

Hve of sl. 30 d: höfuðverk

Hve of sl. 30 d: svima

Hve of sl. 30 d: verk í bak

Hve of sl. 30 d: ógleði eða ólgu í maga

Hve of sl. 30 d: doða eða sting

Hve of sl. 30 d: verk í maga

Hve of sl. 30 d: liðverkir

Hve of sl. 30 d: skjálfta

Hve of sl. 30 d: verk í höndum eða fótum

Hve of sl. 30 d: taugaóstyrk(ur)

Hve of sl. 30 d: skyndileg hræðsla

Hve of sl. 30 d: uppspennt(ur)

Self-esteem

Hversu vel á við um þig: mér finnst ég vera að minnsta kosti jafn mikils virði og aðrir

Hversu vel á við um þig: mér finnst ég hafa marga góða eiginleika

Hversu vel á við um þig: þegar allt kemur til alls sýnist mér ég vera misheppnaður/-heppnuð

Hversu vel á við um þig: ég get gert hlutina jafn vel og flestir aðrir

Hversu vel á við um þig: mér finnst ekki margt sem ég get verið stolt(ur) af

Hversu vel á við um þig: ég hef jákvæða afstöðu til sjálfs/sjálfrar mín


Hversu vel á við um þig: þegar allt kemur til alls er ég ánægð(ur) með sjálfa(n) mig

Hversu vel á við um þig: ég vildi óska að ég gæti borið meiri virðingu fyrir sjálfum mér

Hversu vel á við um þig: stundum finnst ég mér sannarlega vera einskis nýt(ur)

Hversu vel á við um þig: stundum finnst ég mér einskis virði

Social support

Hver auðvelt er að fá frá foreldrum: Umhyggju og hlýju

Hver auðvelt er að fá frá foreldrum: Samræður um persónuleg málefni

Hver auðvelt er að fá frá foreldrum: Ráðleggingar varðandi námið

Hver auðvelt er að fá frá foreldrum: Ráðleggingar varðandi önnur verk

Hver auðvelt er að fá frá foreldrum: Aðstoð við ýmis verk

Hver auðvelt er að fá frá vinum: Umhyggju og hlýju

Hver auðvelt er að fá frá vinum: Samræður um persónuleg málefni

Hver auðvelt er að fá frá vinum: Ráðleggingar varðandi námið

Hver auðvelt er að fá frá vinum: Ráðleggingar varðandi önnur verk

Hver auðvelt er að fá frá vinum: Aðstoð við ýmis verk

Date post:	23-Jul-2021
Category:	Documents
Upload:	others
View:	1 times
Download:	0 times

skemman.is°1_(… · Web view2019. 8. 30. · It is well established that individuals with...

Documents