Structure Equation Modeling Relationship between Symptoms of ADHD based on Depression and Anxiety and Mediating Role of Mind-Wandering and Motivation

Document Type : Original Article

Authors

1 Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran

2 Department of Statistic, Faculty of Mathematics and Statistics, University of Isfahan, Isfahan, Iran

Abstract

Introduction: Many people with Attention Deficit/Hyperactivity Disorder (ADHD) suffer from comorbidity of depression or anxiety. Also, in ADHD patients Mind-Wandering (MW) and lack of motivation are common. This study aimed to examine the mediating role of motivation and MW in the relationship between depression and anxiety with ADHD symptoms.
Method: This research was a correlational study which was run within the Structural Equation Modelling framework. The statistical population consisted of all university students of Isfahan in 2020-2021 with ADHD symptoms, of whom 211 were selected based on the stratified method at first and then by using the multi-stage clustering sampling method. The research instruments included the Barkley Adult ADHD Rating Scale-IV (BAARS-IV), Diagnostic Interview for Adult ADHD (DIVA), Mental Health questionnaire (SCL-90), Mind-Wandering questionnaire (MW), Internal Motivation Inventory (IMI), and Cattell Culture Fair Intelligence Test (CFIQ). The Maximum Likelihood Estimation and the Bootstrap test were used to evaluate the hypothesized model and indirect effects. The statistical procedures were run in SPSS24 and AMOS24.
Results: Findings revealed that the hypothesized model fit the observed data with good domain indices. Also, there was a significant indirect relationship between depression and anxiety with ADHD symptoms through the mediating role of MW. Moreover, there were significant direct relationships between depression and motivation, anxiety and MW, MW and ADHD symptoms.
Conclusion: The study findings confirmed the hypothesized model’s goodness of fit. Therefore, the use of this model is recommended to identify the factors affecting ADHD symptoms in university students.  

Keywords


  1. Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychological medicine. 2006;36(2):159-65. DOI: 10.1017/S003329170500471X
  2. Hashemi Malekshah S, Alizadeh H, Rezayi S, Asgari M. Development of Physical-motor Activities Training Package and Evaluation of its Effectiveness on Handwriting Problems in Children With Attention Deficit/Hyperactivity Disorder. The Scientific Journal of Rehabilitation Medicine. 2021;10(4):848-65. DOI: 10.32598/SJRM.10.4.18
  3. Becker SP, Willcutt EG. Advancing the study of sluggish cognitive tempo via DSM, RDoC, and hierarchical models of psychopathology. European Child & Adolescent Psychiatry. 2019;28(5):603-13. DOI: 10.1007/s00787-018-1136-x
  4. Das D, Cherbuin N, Butterworth P, Anstey KJ, Easteal S. A population-based study of attention deficit/hyperactivity disorder symptoms and associated impairment in middle-aged adults. PloS one. 2012;7(2):e31500. DOI: 10.1371/journal.pone.0031500
  5. Evren B, Evren C, Dalbudak E, Topcu M, Kutlu N. The impact of depression, anxiety, neuroticism, and severity of Internet addiction symptoms on the relationship between probable ADHD and severity of insomnia among young adults. Psychiatry research. 2019;271:726-31. DOI: 10.1016/j.psychres.2018.12.010
  6. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of psychiatry. 2006;163(4):716-23. DOI: 10.1176/ajp.2006.163.4.716
  7. Sobanski E, Brüggemann D, Alm B, Kern S, Deschner M, Schubert T, et al. Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD). European archives of psychiatry and clinical neuroscience. 2007;257(7):371-7. DOI: 10.1007/s00406-007-0712-8
  8. Mochrie KD, Whited MC, Cellucci T, Freeman T, Corson AT. ADHD, depression, and substance abuse risk among beginning college students. Journal of American college health. 2020;68(1):6-10. DOI: 10.1080/07448481.2018.1515754
  9. Powell V, Agha SS, Jones RB, Eyre O, Stephens A, Weavers B, et al. ADHD in adults with recurrent depression. Journal of affective disorders. 2021;295:1153-60. DOI: 10.1016/j.jad.2021.09.010
  10. Tai Y-M, Gau C-S, Gau SS-F, Chiu H-W. Prediction of ADHD to anxiety disorders: an 11-year national insurance data analysis in Taiwan. Journal of Attention Disorders. 2013;17(8):660-9. DOI: 10.1177/1087054712437581
  11. Fraporti TT, Bandeira CE, Tovo-Rodrigues L, Martins-Silva T, Hutz MH, Rohde LA, et al. Caffeine-related genes influence anxiety disorders in children and adults with ADHD. Journal of Psychiatric Research. 2022;145:353-60. DOI: 10.1016/j.jpsychires.2021.11.004
  12. Dalvi-Garcia F, Fonseca LL, Vasconcelos ATR, Hedin-Pereira C, Voit EO. A model of dopamine and serotonin-kynurenine metabolism in cortisolemia: Implications for depression. PLoS computational biology. 2021;17(5):e1008956. DOI: 10.1371/journal.pcbi.1008956
  13. Grahek I, Shenhav A, Musslick S, Krebs RM, Koster EH. Motivation and cognitive control in depression. Neuroscience & Biobehavioral Reviews. 2019;102:371-81. DOI: 10.1016/j.neubiorev.2019.04.011
  14. Buitelaar JK, Kan CC, Asherson P. ADHD in adults: Characterization, diagnosis, and treatment: Cambridge University Press; 2011.
  15. Haugan A, Sund A, Thomsen P, Lydersen S, Nøvik T. Executive functions mediate the association between ADHD symptoms and anxiety in a clinical adolescent population. Frontiers in psychiatry. 2022;13. DOI: 10.3389/fpsyt.2022.834356
  16. Niederkrotenthaler T, Laido Z, Kirchner S, Braun M, Metzler H, Waldhör T, et al. Mental health over nine months during the SARS-CoV2 pandemic: Representative cross-sectional survey in twelve waves between April and December 2020 in Austria. Journal of affective disorders. 2022;296:49-58. DOI: 10.1016/j.jad.2021.08.153
  17. Demontis D, Walters RK, Martin J, Mattheisen M, Als TD, Agerbo E, et al. Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nature genetics. 2019;51(1):63-75. DOI: 10.1038/s41588-018-0269-7
  18. Faraone SV, Larsson H. Genetics of attention deficit hyperactivity disorder. Molecular psychiatry. 2019;24(4):562-75. DOI: 10.1038/s41380-018-0070-0
  19. Zainal NH, Newman MG. Inflammation mediates depression and generalized anxiety symptoms predicting executive function impairment after 18 years. Journal of Affective Disorders. 2022;296:465-75. DOI: 10.1016/j.jad.2021.08.077
  20. Castañeda QE, Matthews CN. Ethnographic archaeologies: reflections on stakeholders and archaeological practices: Rowman Altamira; 2008.
  21. Ajourloo Z, Moghadasin M, Hasani J. Structural relation between depression and anxiety with symptoms of ADHD in adulthood: mediation of emotion regulation and deficit in types of cognitive attention. 2018. IJBS.Vol16.N3.06.1846.docx
  22. Zare H, Moradi K, Ghazi ShSN LR. Comparison of selective attention between depressed, obsessive-compulsive, anxiety and normal people. Quarterly Journal of Lorestan University of Medical Sciences. 2015;16:66-2. IJBS.Vol16.N3.06.1846.docx
  23. Bozhilova NS, Michelini G, Kuntsi J, Asherson P. Mind wandering perspective on attention-deficit/hyperactivity disorder. Neuroscience & Biobehavioral Reviews. 2018;92:464-76. DOI: 10.1016/j.neubiorev.2018.07.010
  24. Lanier J, Noyes E, Biederman J. Mind wandering (internal distractibility) in ADHD: A literature review. Journal of attention disorders. 2021;25(6):885-90. DOI: 10.1177/1087054719865
  25. Seli P, Risko EF, Smilek D, Schacter DL. Mind-wandering with and without intention. Trends in cognitive sciences. 2016;20(8):605-17. DOI: 10.1016/j.tics.2016.05.010
  26. Rostami S, Borjali A, Eskandari H, Rostami R, Northoff G. Novel approach to mind wandering in major depressive disorder and bipolar disorder patients: does the direction of thoughts matter? International Journal of Behavioral Sciences. 2021;15(1):66-72. DOI: 10.30491/IJBS.2021.250747.1383
  27. Smallwood J, O'Connor RC. Imprisoned by the past: unhappy moods lead to a retrospective bias to mind wandering. Cognition & emotion. 2011;25(8):1481-90. DOI: 10.1080/02699931.2010.545263
  28. Storbeck J, Clore GL. Affective arousal as information: How affective arousal influences judgments, learning, and memory. Social and personality psychology compass. 2008;2(5):1824-43. DOI: 10.1111/j.1751-9004.2008.00138.x
  29. Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical psychology review. 2010;30(2):217-37. DOI: 10.1016/j.cpr.2009.11.004
  30. Crosswell AD, Coccia M, Epel ES. Mind wandering and stress: When you don’t like the present moment. Emotion. 2020;20(3):403. DOI: 10.1037/emo0000548
  31. Figueiredo T, Lima G, Erthal P, Martins R, Corção P, Leonel M, et al. Mind-wandering, depression, anxiety and ADHD: Disentangling the relationship. Psychiatry research. 2020;285:112798. DOI: 10.1016/j.psychres.2020.112798
  32. Deci EL, Ryan RM. Self-determination theory: A macrotheory of human motivation, development, and health. Canadian psychology/Psychologie canadienne. 2008;49(3):182. DOI: 10.1037/a0012801
  33. May CN, Juergensen J, Demaree HA. Yum, cake!: How reward sensitivity relates to automatic approach motivation for dessert food images. Personality and Individual Differences. 2016;90:265-8. DOI: 10.1016/j.paid.2015.11.022
  34. Luman M, Oosterlaan J, Sergeant JA. The impact of reinforcement contingencies on AD/HD: a review and theoretical appraisal. Clinical psychology review. 2005;25(2):183-213. DOI: 10.1016/j.cpr.2004.11.001
  35. Modesto-Lowe V, Chaplin M, Soovajian V, Meyer A. Are motivation deficits underestimated in patients with ADHD? A review of the literature. Postgraduate medicine. 2013;125(4):47-52. DOI: 10.3810/pgm.2013.07.2677
  36. Morsink S, Sonuga-Barke E, Mies G, Glorie N, Lemiere J, Van der Oord S, et al. What motivates individuals with ADHD? A qualitative analysis from the adolescent’s point of view. European child & adolescent psychiatry. 2017;26(8):923-32. DOI: 10.1007/s00787-017-0961-7
  37. Millan MJ, Agid Y, Brüne M, Bullmore ET, Carter CS, Clayton NS, et al. Cognitive dysfunction in psychiatric disorders: characteristics, causes and the quest for improved therapy. Nature reviews Drug discovery. 2012;11(2):141-68. DOI: 10.1038/nrd3628
  38. Pervichko EI, Babaev YA, Podstreshnaya AK, Zinchenko YP. Motivational conflicts and the psychological structure of perfectionism in patients with anxiety disorders and patients with essential hypertension. Behavioral Sciences. 2020;10(1):25. DOI: 10.3390/bs10010025
  39. Katzman MA, Bilkey T, Chokka PR, Fallu A, Klassen LJ. Re: Is adult attention-deficit hyperactivity disorder being overdiagnosed? The Canadian Journal of Psychiatry. 2016;61(1):60-1. DOI: 10.1177/0706743715620143
  40. BaronandD R. A. Kenny,“The Moderator-mediator Variable Distinction in Social Psychological Research: Conceptual, Strategic, and Statistical Considerations,”. Journal of Personality and Social Psychology. 1986;51(6):1173-82. DOI: 10.1037//0022-3514.51.6.1173
  41. Bentler PM, Chou C-P. Practical issues in structural modeling. Sociological methods & research. 1987;16(1):78-117.DOI: 10.1177/0049124187016001004
  42. Kline RB. Principles and practice of structural equation modeling: Guilford publications; 2015.
  43. Kooij JS, Buitelaar JK, FURER JW, RIJNDERS CAT, HODIAMONT PP. Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychological medicine. 2005;35(6):817-27. DOI: 10.1017/s003329170400337x
  44. Barkley RA. Barkley Adult ADHD Rating Scale-IV (BAARS-IV): Guilford Press; 2011.
  45. Sadeghi M, Sadeghi-Bazargani H, Amiri S. Psychometric evaluation of the Persian version of Barkley adult attention deficit/hyperactivity disorder screening tool among the elderly. Scientifica. 2017;2017. DOI: 10.1155/2017/9109783
  46. Derogatis L. SCL-90-R: Administration, scoring and procedures manual. National Computer Systems. Inc, Minneapolis. 1994.
  47. Ardakani A, Seghatoleslam T, Habil H, Jameei F, Rashid R, Zahirodin A, et al. Construct validity of symptom checklist-90-revised (SCL-90-R) and general health questionnaire-28 (GHQ-28) in patients with drug addiction and diabetes, and normal population. Iranian journal of public health. 2016;45(4):451. IJBS.Vol16.N3.06.1846.docx
  48. Ghannad Z, Allipour S, Shehni Yailagh M, Hajiyakhchali A. Evaluation of the causal relationship model of mindfulness with anxiety and depression by mediating unintentional mind wandering. Journal of Fundamentals of Mental Health. 2019;21(4):262-71. DOI: 10.22038/JFMH.2019.14657
  49. Deci EL, Ryan RM. Intrinsic motivation and self-determination in human behavior: Springer Science & Business Media; 2013.
  50. Cattell RB, Feingold SN, Sarason SB. A culture-free intelligence test: II. Evaluation of cultural influence on test performance. Journal of Educational Psychology. 1941;32(2):81. DOI: 10.1037/h0058456
  51. Troche SJ, Wagner FL, Schweizer K, Rammsayer TH. The structural validity of the culture fair test under consideration of the item-position effect. European Journal of Psychological Assessment. 2016.
  52. Hooman H, KOOSHKI S, BAHARI P. Cattell's culture fair intelligence test II psychometric properties and It's relationship with Raven's progressive matrices. 2013.
  53. Hu Lt, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural equation modeling: a multidisciplinary journal. 1999;6(1):1-55. DOI: 10.1080/10705519909540118
  54. Hayduk LA, Glaser DN. Jiving the four-step, waltzing around factor analysis, and other serious fun. Structural Equation Modeling. 2000;7(1):1-35. DOI: 10.1207/S15328007SEM0701_01
  55. Chen F, Curran PJ, Bollen KA, Kirby J, Paxton P. An empirical evaluation of the use of fixed cutoff points in RMSEA test statistic in structural equation models. Sociological methods & research. 2008;36(4):462-94. DOI: 10.1177/0049124108314720