Psychiatric comorbidity, burden of sickness absence and sex-specific characteristics of working individuals with ADHD treated in primary care in the Finnish occupational health system: cross-sectional register study.

BACKGROUND

Previous research on attention-deficit hyperactivity disorder (ADHD) research has overlooked high-functioning workers managed in occupational health settings.

AIMS: To investigate clinical characteristics, service use, and sex-related differences in medication and work disability among employees with ADHD.

METHOD: This study was a cross-sectional descriptive analysis of psychiatric comorbidities in 2117 patients (53.8% men, 46.2% women) with a clinical diagnosis of ADHD (ICD-10 F90.0) in the Finnish occupational health system (2018-2022). We explored service use, medication and sickness absence periods (using multinomial regression models) in a subset with available data (n = 1447).

RESULTS

Psychiatric comorbidity affected 80.5% of patients, most commonly involving anxiety disorders (51.8%) and depression (43.9%). Service use was high: 87.0% consulted a psychiatrist and 70.1% a psychologist. Medication profiles differed by sex (Cramer's V = 0.15): men more frequently received psychostimulants only (27.4% v. 18.4%), whereas women were more likely to receive antidepressants only or antidepressant-anxiolytic combinations. Women demonstrated substantially higher levels of psychiatric sickness absence compared with men across all duration categories, with relative risk ratio (RRR) = 2.08 (95% CI 1.37-3.14) for short (1 to 7 days) absences, RRR = 2.03 (95% CI 1.42-2.90) for intermediate (8 to 30 days) absences and RRR = 2.75 (95% CI 2.16-3.52) for long-term (>30 days) absences.

CONCLUSIONS

Working adults with ADHD carry a heavy comorbidity burden and use specialised services extensively. Women are more frequently managed with comorbidity-focused medications rather than stimulants only and experience disproportionately higher psychiatric-related work disability. Sex-specific clinical pathways may be needed to preserve workability in this population.