ADHD Comorbidity Structure and Impairment: Results of the WHO World Mental Health Surveys International College Student Project (WMH-ICS)

Arthur D. P. MAK, Sue LEE, Nancy A. SAMPSON, Yesica ALBOR, Jordi ALONSO, Randy P. AUERBACH, Harald BAUMEISTER, Corina BENJET, Ronny BRUFFAERTS, Pim CUIJPERS, David D. EBERT, Raúl A. GUTIERREZ-GRACIA, Penelope HASKING, Coral LAPSLEY, Christine LOCHNER, Ronald C. KESSLER, WHO WMH-ICS Collaborators, Oi Ling SIU

Research output: Journal PublicationsJournal Article (refereed)peer-review


Objective: To examine the prevalence of ADHD and the association of comorbid disorders, and multivariate disorder classes with role impairment in college students.

Method: About 15,991 freshmen (24 colleges, 9 countries, WMHICS) (response rate=45.6%) completed online WMH-CIDI-SC surveys for 6-month ADHD and six 12-month DSMIV disorders. We examined multivariate disorder classes using latent class analysis (LCA) and simulated a population attributable risk proportions (PARPs) of ADHD-related impairment.

Results: About 15.9% had ADHD, of which 58.4% had comorbidities. LCA classified ADHD respondents to pure (42.9%), internalizing (36.0%), bipolar comorbidities (11.3%), and externalizing disorder classes (9.8%). ADHD, comorbidities, and multivariate disorder classes independently predicted severe impairment. PARPs: eliminating ADHD hypothetically reduced severe impairment by 19.2%, 10.1% adjusted for comorbidities, 9.5% for multivariate disorder classes.

Conclusions: ADHD and comorbid disorders are common and impairing in college students. Personalized transdiagnostic interventions guided by multivariate disorder classes should be explored.
Original languageEnglish
Article number108705472110572
JournalJournal of Attention Disorders
Publication statusE-pub ahead of print - Nov 2021

Bibliographical note

[Prof. SIU Oi-ling is a member of "The WHO World Health Survey International College Student Collaborator".]

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The World Mental Health International College Student (WMH-ICS) initiative is carried out as part of the WHO World Mental Health (WMH) Survey Initiative. WMH-ICS is funded, in part, by the US National Institute of Mental Health (R56MH109566); the Belgian Fund for Scientific Research (11N0514N/11N0516N/ 1114717N), the King Baudouin Foundation (2014-J2140150-102905), and Eli Lilly (IIT-H6U-BX-I002); BARMER, a health care insurance company, for project StudiCare; Consejo Nacional de Ciencia y Tecnología (CONACyT) grant CB-2016-01-28554; ZonMw (Netherlands Organisation for Health Research and Development; grant number 636110005) and the PFGV (PFGV; Protestants Fonds voor de Geestelijke Volksgezondheid) in support of the student survey project; South African Medical Research Council through its Division of Research Capacity Development under the Mid-Career Scientist Program (MCSP) (awarded to J. Bantjes), and the Ithemba Foundation; Fondo de Investigación Sanitaria, Instituto de Salud Carlos III - FEDER (PI13/00343), ISCIII (Río Hortega, CM14/00125), ISCIII (Sara Borrell, CD12/00440), Ministerio de Sanidad, Servicios Sociales e Igualdad, PNSD (Exp. 2015I015); DIUE Generalitat de Catalunya (2017 SGR 452), FPU (FPU15/05728) (JA); Fondo de Investigación Sanitaria, Instituto de Salud Carlos III- FEDER (PI13/00506); European Union Regional Development Fund (ERDF) EU Sustainable Competitiveness Programme for Northern Ireland, Northern Ireland Public Health Agency (HSC R&D), and Ulster University; Suicide Prevention Australia (awarded to P.Hasking); National Health and Medical Research Council, Australia (Investigator Grant 1173043, awarded to M.Boyes).

Publisher Copyright:
© The Author(s) 2021.


  • ADHD
  • college students
  • epidemiology
  • mental disorder
  • role impairment


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