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Haan E, Krebs K, Võsa U, Brikell I, Larsson H, Lehto K. Associations between attention-deficit hyperactivity disorder genetic liability and ICD-10 medical conditions in adults: utilizing electronic health records in a Phenome-Wide Association Study. Psychol Med 2024:1-14. [PMID: 38563284 DOI: 10.1017/s0033291724000606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Attention-deficit hyperactivity disorder (ADHD) is often comorbid with other medical conditions in adult patients. However, ADHD is extremely underdiagnosed in adults and little is known about the medical comorbidities in undiagnosed adult individuals with high ADHD liability. In this study we investigated associations between ADHD genetic liability and electronic health record (EHR)-based ICD-10 diagnoses across all diagnostic categories, in individuals without ADHD diagnosis history. METHODS We used data from the Estonian Biobank cohort (N = 111 261) and generated polygenic risk scores (PRS) for ADHD (PRSADHD) based on the ADHD genome-wide association study. We performed a phenome-wide association study (PheWAS) to test for associations between standardized PRSADHD and 1515 EHR-based ICD-10 diagnoses in the full and sex-stratified sample. We compared the observed significant ICD-10 associations to associations with (1) ADHD diagnosis and (2) questionnaire-based high ADHD risk analyses. RESULTS After Bonferroni correction (p = 3.3 × 10-5) we identified 80 medical conditions associated with PRSADHD. The strongest evidence was seen with chronic obstructive pulmonary disease (OR 1.15, CI 1.11-1.18), obesity (OR 1.13, CI 1.11-1.15), and type 2 diabetes (OR 1.11, CI 1.09-1.14). Sex-stratified analysis generally showed similar associations in males and females. Out of all identified associations, 40% and 78% were also observed using ADHD diagnosis or questionnaire-based ADHD, respectively, as the predictor. CONCLUSIONS Overall our findings indicate that ADHD genetic liability is associated with an increased risk of a substantial number of medical conditions in undiagnosed individuals. These results highlight the need for timely detection and improved management of ADHD symptoms in adults.
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Affiliation(s)
- Elis Haan
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
- Viljandi Hospital, Psychiatric Clinic, Viljandi, Estonia
| | - Kristi Krebs
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Urmo Võsa
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Isabell Brikell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Deparment of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Kelli Lehto
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
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Ditmars HL, Logue MW, Toomey R, McKenzie RE, Franz CE, Panizzon MS, Reynolds CA, Cuthbert KN, Vandiver R, Gustavson DE, Eglit GML, Elman JA, Sanderson-Cimino M, Williams ME, Andreassen OA, Dale AM, Eyler LT, Fennema-Notestine C, Gillespie NA, Hauger RL, Jak AJ, Neale MC, Tu XM, Whitsel N, Xian H, Kremen WS, Lyons MJ. Associations between depression and cardiometabolic health: A 27-year longitudinal study. Psychol Med 2022; 52:3007-3017. [PMID: 33431106 PMCID: PMC8547283 DOI: 10.1017/s003329172000505x] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Clarifying the relationship between depression symptoms and cardiometabolic and related health could clarify risk factors and treatment targets. The objective of this study was to assess whether depression symptoms in midlife are associated with the subsequent onset of cardiometabolic health problems. METHODS The study sample comprised 787 male twin veterans with polygenic risk score data who participated in the Harvard Twin Study of Substance Abuse ('baseline') and the longitudinal Vietnam Era Twin Study of Aging ('follow-up'). Depression symptoms were assessed at baseline [mean age 41.42 years (s.d. = 2.34)] using the Diagnostic Interview Schedule, Version III, Revised. The onset of eight cardiometabolic conditions (atrial fibrillation, diabetes, erectile dysfunction, hypercholesterolemia, hypertension, myocardial infarction, sleep apnea, and stroke) was assessed via self-reported doctor diagnosis at follow-up [mean age 67.59 years (s.d. = 2.41)]. RESULTS Total depression symptoms were longitudinally associated with incident diabetes (OR 1.29, 95% CI 1.07-1.57), erectile dysfunction (OR 1.32, 95% CI 1.10-1.59), hypercholesterolemia (OR 1.26, 95% CI 1.04-1.53), and sleep apnea (OR 1.40, 95% CI 1.13-1.74) over 27 years after controlling for age, alcohol consumption, smoking, body mass index, C-reactive protein, and polygenic risk for specific health conditions. In sensitivity analyses that excluded somatic depression symptoms, only the association with sleep apnea remained significant (OR 1.32, 95% CI 1.09-1.60). CONCLUSIONS A history of depression symptoms by early midlife is associated with an elevated risk for subsequent development of several self-reported health conditions. When isolated, non-somatic depression symptoms are associated with incident self-reported sleep apnea. Depression symptom history may be a predictor or marker of cardiometabolic risk over decades.
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Affiliation(s)
- Hillary L. Ditmars
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Mark W. Logue
- Research Service, VA Boston Healthcare System, Boston, MA
- Biomedical Genetics Program, Boston University School of Medicine, Boston, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Rosemary Toomey
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Ruth E. McKenzie
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
- School of Education and Social Policy, Merrimack College, North Andover, MA, USA
| | - Carol E. Franz
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA
| | - Matthew S. Panizzon
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA
| | - Chandra A. Reynolds
- Department of Psychology, University of California, Riverside, Riverside, CA
| | - Kristy N. Cuthbert
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | - Richard Vandiver
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
| | | | - Graham M. L. Eglit
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA
- VA San Diego Healthcare System, San Diego, CA
| | - Jeremy A. Elman
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA
| | - Mark Sanderson-Cimino
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology
| | - McKenna E. Williams
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
- San Diego State University/UC San Diego Joint Doctoral Program in Clinical Psychology
| | - Ole A. Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine University of Oslo Oslo, Norway
- Division of Mental Health and Addiction, Oslo University Hospital Oslo, Oslo, Norway
| | - Anders M. Dale
- Department of Radiology, School of Medicine, University of California, San Diego, La Jolla, CA
- Department of Neurosciences, University of California, San Diego, La Jolla, CA
| | - Lisa T. Eyler
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Christine Fennema-Notestine
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
- Department of Radiology, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Nathan A. Gillespie
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
| | - Richard L. Hauger
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA
| | - Amy J. Jak
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA
| | - Michael C. Neale
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
- Department of Human and Molecular Genetics, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA
| | - Xin M. Tu
- Department of Family Medicine and Public Health, VA San Diego Healthcare System, San Diego, CA
| | - Nathan Whitsel
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
| | - Hong Xian
- Department of Epidemiology & Biostatistics, Saint Louis University College for Public Health & Social Justice
| | - William S. Kremen
- Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA
- Center for Behavior Genetics of Aging, University of California, San Diego, La Jolla, CA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, CA
| | - Michael J. Lyons
- Department of Psychological and Brain Sciences, Boston University, Boston, MA
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