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. GUTIÉRREZ-GRACÍA, Penelope HASKING, Coral LAPSLEY, Christine LOCHNER, Ronald C. KESSLER, WHO WMH-ICS Collaborators, Oi Ling SIU

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

22 Citations (Scopus)


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
Pages (from-to)1078-1096
Number of pages19
JournalJournal of Attention Disorders
Issue number8
Early online dateNov 2021
Publication statusPublished - 1 Jun 2022

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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