Current comorbid psychiatric symptoms in the statistical indirect association between childhood attention-deficit/hyperactivity disorder symptoms and functional impairment among university students

This study investigated whether current comorbid psychiatric symptoms were involved in statistical indirect associations between childhood attention-deficit/hyperactivity disorder (ADHD) symptoms (CAS) and functional impairment in university students. Data were collected from 110 university students who scored above the clinical threshold on the Wender Utah Rating Scale (WURS). Functional impairment was assessed using the Weiss Functional Impairment Rating Scale-Self-Report (WFIRS-S), and comorbid psychiatric symptoms were measured using the Brief Symptom Inventory (BSI). Regression analyses and statistical indirect-association models were used to examine the associations between CAS, comorbid psychiatric symptoms, and functional impairment across several domains. Multivariate analyses showed that CAS was significantly associated with functional impairment in the family domain ( p = 0.008). Current comorbid psychiatric symptoms, particularly depressive symptoms, were more strongly associated with functional impairment in the domains of life skills, self-concept, and social functioning ( p = 0.042, p < 0.001, and p = 0.016, respectively). Univariate analyses indicated that anxiety levels were significantly associated with functional impairment in these domains (all p values < 0.001). Statistical indirect-association analyses showed significant indirect associations through comorbid psychiatric symptoms between CAS and functional impairment across all domains except the family domain. Specifically, depression showed a significant indirect association in the model linking CAS with overall functional impairment, whereas both anxiety and depression showed indirect associations in the models linking CAS with school functioning. These findings suggest that comorbid psychiatric symptoms, especially depression and anxiety, may be useful to consider when interpreting functional impairment among university students with CAS. Because the study was cross-sectional and observational, implications regarding continued ADHD-related care and depression/anxiety-focused support should be viewed as hypotheses for future longitudinal and intervention studies rather than as demonstrated clinical effects. Not applicable.