Sex Differences in the Comorbidity between Attention Deficit-Hyperactivity Disorder and Posttraumatic Stress Disorder: A Systematic Literature Review and Meta-Analysis.

Objective: Attention Deficit-Hyperactivity Disorder (ADHD) and Posttraumatic Stress Disorder (PTSD) are often comorbid and share a common core of symptoms. However, sex and gender-related factors significantly influence their prevalence, clinical presentation, and diagnosis. Here, we conducted a systematic literature review and meta-analysis to examine sex differences in ADHD/PTSD comorbidity during childhood and adulthood.

Methods: A scoping review of PsycINFO and PubMed yielded 13 eligible studies with complete outcome data. We conducted fixed-effects meta-analyses of the sex-stratified prevalence of ADHD/PTSD using pooled odds ratios (OR) with a 95% confidence interval (CI). Fixed-effects subgroup analyses were performed using age as a subgroup. Effect size heterogeneity was assessed using the I index and Cochran's Q test.

Results: In the whole sample (N= 13,585; F= 7005, M= 6580), the diagnosis of ADHD/PTSD was significantly higher in females than in males (OR = 1.32, = 0.02). Between-study heterogeneity was low-to-moderate and not significant (I = 41%; = 0.06), validating the fixed-effects model. Age-stratified subgroup analyses revealed higher ADHD/PTSD odds in females compared to males only in adult populations (OR=1.41; 0.01). Additionally, females were more likely to be diagnosed with both disorders in studies where ADHD was the primary diagnosis (OR = 1.60; 0.002), and in studies employing structured clinical interviews as diagnostic tools (OR = 1.46; 0.009).

Conclusions: Our study is the first to show that the association between ADHD and PTSD is stronger in females, suggesting that ADHD may increase risk for PTSD in a sex-specific manner.