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Incidence, prevalence, and global burden of ADHD from 1990 to 2019 across 204 countries: data, with critical re-analysis, from the Global Burden of Disease study

Molecular Psychiatry (2023)Cite this article

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Abstract

Data on incidence, prevalence and burden of ADHD are crucial for clinicians, patients, and stakeholders. We present the incidence, prevalence, and burden of ADHD globally and across countries from 1990 to 2019 from the Global Burden of Disease (GBD) study. We also: (1) calculated the ADHD prevalence based on data actually collected as opposed to the prevalence estimated by the GBD with data imputation for countries without prevalence data; (2) discussed the GBD estimated ADHD burden in the light of recent meta-analytic evidence on ADHD-related mortality. In 2019, GBD estimated global age-standardized incidence and prevalence of ADHD across the lifespan at 0.061% (95%UI = 0.040–0.087) and 1.13% (95%UI = 0.831–1.494), respectively. ADHD accounted for 0.8% of the global mental disorder DALYs, with mortality set at zero by the GBD. From 1990 to 2019 there was a decrease of −8.75% in the global age-standardized prevalence and of −4.77% in the global age-standardized incidence. The largest increase in incidence, prevalence, and burden from 1990 to 2019 was observed in the USA; the largest decrease occurred in Finland. Incidence, prevalence, and DALYs remained approximately 2.5 times higher in males than females from 1990 to 2019. Incidence peaked at age 5–9 years, and prevalence and DALYs at age 10–14 years. Our re-analysis of data prior to 2013 showed a prevalence in children/adolescents two-fold higher (5.41%, 95% CI: 4.67–6.15%) compared to the corresponding GBD estimated prevalence (2.68%, 1.83–3.72%), with no significant differences between low- and middle- and high-income countries. We also found meta-analytic evidence of significantly increased ADHD-related mortality due to unnatural causes. While it provides the most detailed evidence on temporal trends, as well as on geographic and sex variations in incidence, prevalence, and burden of ADHD, the GBD may have underestimated the ADHD prevalence and burden. Given the influence of the GBD on research and policies, methodological issues should be addressed in its future editions.

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Fig. 1: Age standardized prevalence and DALY rates.
Fig. 2: Temporal trends.
Fig. 3: Age patterns.

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Acknowledgements

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI22C1976; DKY) and National Research Foundation of Korea (NRF, MSIT; RS-2023-00248157; DKY). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author information

Author notes

  1. These authors contributed equally: Samuele Cortese, Minjin Song, Luis C. Farhat, Dong Keon Yon, Seung Won Lee.

Authors and Affiliations

  1. Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK

    Samuele Cortese, Corentin J. Gosling & Marco Solmi

  2. Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK

    Samuele Cortese

  3. Solent NHS Trust, Southampton, UK

    Samuele Cortese

  4. Hassenfeld Children’s Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA

    Samuele Cortese

  5. Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK

    Samuele Cortese

  6. Yonsei University College of Medicine, Seoul, South Korea

    Minjin Song & Seoyeon Park

  7. Universidade de Sao Paulo, Sao Paulo, SP, Brazil

    Luis C. Farhat & Guilherme V. Polanczyk

  8. Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea

    Dong Keon Yon

  9. Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea

    Seung Won Lee

  10. Department of digital health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Samsung Medical Center, Seoul, Republic of Korea

    Min Seo Kim

  11. Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Jae Won Oh & San Lee

  12. Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea

    San Lee

  13. Division of Child and Adolescent Psychiatry, Department of Psychiatry, Severance Hospital, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea

    Keun-Ah Cheon

  14. Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK

    Lee Smith

  15. DysCo Lab, Department of Psychology, Université Paris Nanterre, Nanterre, France

    Corentin J. Gosling

  16. Laboratoire de Psychopathologie et Processus de Santé, Université de Paris, Boulogne-Billancourt, France

    Corentin J. Gosling

  17. School of Medical Sciences, Örebro University, Faculty of Medicine and Health, Örebro, Sweden

    Henrik Larsson

  18. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

    Henrik Larsson

  19. ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clinica de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil

    Luis A. Rohde

  20. UNIEDUK, National Institute of Developmental Psychiatry, São Paulo, Brazil

    Luis A. Rohde

  21. Department of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA

    Stephen V. Faraone

  22. Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, ISCIII, Barcelona, Spain

    Ai Koyanagi

  23. ICREA, Pg. Lluis Companys, Barcelona, Spain

    Ai Koyanagi

  24. Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden

    Elena Dragioti

  25. Institut d’Investigacions Biomediques August Pi i Sunyer, CIBERSAM, Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain

    Joaquim Radua

  26. IMPACT (Innovation in Mental and Physical Health and Clinical Treatment) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia

    Andre F. Carvalho

  27. Department of Pediatrics, Yonsei University College of Medicine, Seoul, Republic of Korea

    Jae Il Shin

  28. Severance Underwood Meta-research Center, Institute of Convergence Science, Yonsei University, Seoul, Republic of Korea

    Jae Il Shin

  29. Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada

    Marco Solmi

  30. Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada

    Marco Solmi

  31. School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada

    Marco Solmi

  32. Ottawa Hospital Research Institute (OHRI), Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada

    Marco Solmi

  33. Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany

    Marco Solmi

  34. Research Laboratory Psychology of Patients, Families and Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece

    Elena Dragioti

Authors
  1. Samuele Cortese
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  2. Minjin Song
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Contributions

All authors contributed and approved the study’s protocol. SC created the first draft of the manuscript. MS, LCF, DKY, SWL, MSK, SP, JWO, SL, and KAC extracted and analysed data. SC, MS, and JIS provided overall guidance. Finally, all authors read, edited, and approved the final version of the manuscript.

Corresponding authors

Correspondence to Samuele Cortese or Jae Il Shin.

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Competing interests

Dr. Cortese declares honoraria and reimbursement for travel and accommodation expenses for lectures from the following non- profit associations: Association for Child and Adolescent Central Health (ACAMH), Canadian ADHD Alliance Resource (CADDRA), British Association of Pharmacology (BAP), and from Healthcare Convention for educational activity on ADHD. Dr. Faraone received income, potential income, travel expenses continuing education support and/or research support from Aardvark, Aardwolf, Tris, Otsuka, Ironshore, KemPharm/Corium, Akili, Supernus, Atentiv, Noven, Sky Therapeutics, Axsome, Johnson & Johnson and Genomind. With his institution, he has US patent US20130217707 A1 for the use of sodium-hydrogen exchange inhibitors in the treatment of ADHD. He also receives royalties from books published by Guilford Press: Straight Talk about Your Child’s Mental Health, Oxford University Press: Schizophrenia: The Facts and Elsevier: ADHD: Non-Pharmacologic Interventions. He is Program Director of www.adhdinadults.com and www.ADHDEvidence.org. Dr. Larsson reports receiving grants from Shire Pharmaceuticals; personal fees from and serving as a speaker for Medice, Shire/Takeda Pharmaceuticals and Evolan Pharma AB; and sponsorship for a conference on attention-deficit/hyperactivity disorder from Shire/Takeda Pharmaceuticals and Evolan Pharma AB, all outside the submitted work. Dr. Polanczyk has served as a consultant/speaker to Abbott, Ache, Medice, Novo Nordisk, and Takeda, and has received royalties from Editora Manole. Dr. Rohde has received grant or research support from, served as a consultant to, and served on the speakers’ bureau of Abbott, Aché, Bial, Medice, Novartis/Sandoz, Pfizer/Upjohn, and Shire/Takeda in the last three years. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by Dr Rohde have received unrestricted educational and research support from the following pharmaceutical companies in the last three years: Novartis/Sandoz and Shire/Takeda. Dr Rohde has received authorship royalties from Oxford Press and ArtMed. Dr. Solmi received honoraria/has been a consultant for AbbVie, Angelina, Lundbeck, Otsuka.

Ethics approval

We followed the standard procedure recommended to register additional publication from GBD2019 project after publication of capstone paper. Our study was also approved by the Institutional Review Board at Yonsei University Health System for the data use.

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Cortese, S., Song, M., Farhat, L.C. et al. Incidence, prevalence, and global burden of ADHD from 1990 to 2019 across 204 countries: data, with critical re-analysis, from the Global Burden of Disease study. Mol Psychiatry (2023). https://doi.org/10.1038/s41380-023-02228-3

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