Effectiveness of psychological therapies for depression and anxiety in adults with and without ADHD in England: a retrospective cohort study

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Background People with ADHD disproportionately experience depression and anxiety across the lifespan than people without. To date interventions have focused on managing ADHD. This study aimed to evaluate the effectiveness of therapies designed to alleviate depression and anxiety. Methods We used linked electronic healthcare records of over 3 million adults over 18 years old who received a course of therapy in NHS Talking Therapies for depression and anxiety in England between 2012 and 2022. We identified a cohort of N=13,693 adults with diagnosed ADHD and calculated pre-post effect sizes (Cohen's d av ). We then identified a propensity-matched comparison group of N=13,693 adults without diagnosed ADHD, and conducted logistic regressions to compare outcomes between the two groups; and ran exploratory subgroup analyses to evaluate whether known associations between therapy outcomes and socio-demographic factors were modified by ADHD diagnosis status. Findings On average, people with ADHD experienced moderate-to-large reductions in their depression (pre-post effect size Cohen's d av = −0.72 [95% CI −0.75 to −0.70]) and anxiety (Cohen's dav=−0.72 [95% CI −0.74 to −0.69]) symptoms between before, and after therapy. People with ADHD had poorer therapy outcomes, regardless of matching and adjustment for covariates (Reliable improvement from depression and anxiety symptoms: OR=0.77, 95% CI 0.73–0.81, Reliable recovery: OR=0.69 95% CI 0.65–0.72, Reliable deterioration: OR=1.38, 95% CI 1.25–1.50). There was no strong evidence that associations between therapy outcomes and socio-demographic factors were affected by ADHD status, but small sample sizes limited interpretations for older people and people from minority ethnic groups. Interpretation People with ADHD may benefit from interventions designed to improve their mental health as opposed to managing ADHD. There is a need for evidence-based guidelines to adapt mental health interventions for this group, and a better understanding of how systemic barriers to care and diagnosis may affect outcomes. Funding Medical Research Foundation (MRF).

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