Beyond core symptoms: emotion dysregulation and depression as sequential mediators of quality of life in adult women with attention-deficit/hyperactivity disorder

Background: Emotion regulation modulates emotional responses to situational demands. Increasing evidence identifies emotion dysregulation as a transdiagnostic mechanism in psychiatric disorders, including attention-deficit/hyperactivity disorder.[1,2] In adults with this disorder, emotional symptoms such as irritability, heightened reactivity, and low frustration tolerance contribute substantially to impairment beyond core symptoms.[2] Quality of life, defined by the World Health Organization as an individual’s perception of their position in life within cultural and value contexts, is consistently reduced.[3] However, the mechanisms linking symptom severity to quality of life remain unclear, and emotion dysregulation may represent a key mechanism.[1,4] Aim: This study examined the impact of attention-deficit/hyperactivity disorder symptoms on quality of life in adult women and evaluated the roles of emotion dysregulation, depression and anxiety in this relationship. Methods: A total of 128 adult female participants were included in the study. The mean age of participants was 30.33 ± 8.20 years. Data were collected via face-to-face and online assessments. Participants completed standardized self-report measures assessing attention-deficit/hyperactivity disorder symptoms, childhood symptoms, depression, anxiety, emotion dysregulation, and quality of life. Hierarchical regression and serial mediation analyses were conducted using bootstrapping procedures with 10,000 samples and 95% confidence intervals. Results: Depression, emotion dysregulation, anxiety were negatively associated with quality of life, whereas attention-deficit/hyperactivity disorder symptoms were positively associated with emotion dysregulation and depression. In hierarchical regression analyses, sociodemographic variables did not significantly predict quality of life. In the second step, inclusion of attention-deficit/hyperactivity disorder symptoms and childhood symptoms resulted in a significant model, explaining 22.3% of the variance. With the addition of emotion dysregulation, the explained variance increased to 33.8%, and emotion dysregulation and childhood symptoms remained significant predictors. When depression and anxiety were added to the model, the explained variance increased to 64.9%, with only depression scores remaining significant. In mediation analyses, a serial mediation model (symptoms → emotion dysregulation → depression → quality of life) was tested. The model was significant and explained 61.6% of the variance in quality of life. Total effect of symptoms on quality of life was significant (β = −1.46, p = .008), whereas the direct effect was not (β = .05, p = .912), indicating full mediation. Only the sequential indirect pathway was significant. Symptom severity significantly increased emotion dysregulation (β = .59, p < .001), which in turn increased depression levels (β = .27, p < .001), and depression significantly reduced quality of life (β = −3.73, p < .001). Single indirect effects were not significant. Anxiety, included as a covariate in the model, showed significant effects on emotion dysregulation (β = .27, p = .003) and depression (β = .49, p < .001), but its effect on quality of life was not significant (β = .49, p = .157). Conclusion: The findings indicate that the impact of attention-deficit/hyperactivity disorder symptoms on quality of life operates through a sequential psychopathological pathway rather than direct or independent effects. Emotion dysregulation may function as an upstream vulnerability factor, whereas depression appears to be the most proximal determinant of quality of life impairment.[1,3,4]

References

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