2026 ECNP Congress

PS04-4147

Impact of ADHD symptoms on quality of life: the mediating role of emotional dysregulation and substance use in university students

Francesco Maria Boccaccio — C.S. Guerrera, V. Torre, S. Varrasi, G.A. Platania, S. Castellano, M.C. Quattropani, C. Pirrone, S. Di Nuovo · University of Catania, Department of Educational Sciences, Catania, Italy

2026 ECNP Congress

Introduction

Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention and/or hyperactivity-impulsivity that are developmentally inappropriate and associated with significant functional impairment [1].. Although it has long been considered a childhood condition, ADHD often persists into adulthood, with an estimated prevalence of approximately 3% in adult populations [2]. Beyond its core symptoms, emotional dysregulation (ED) has emerged as a crucial feature of adult ADHD. Increasing evidence suggests that ED is strongly associated with greater impairment and represents one of the main contributors to reduced quality of life (QoL) [3]. Moreover, substance use (SU) may further exacerbate this burden. Individuals with ADHD are at increased risk of engaging in substance use behaviours, which may negatively affect well-being and functioning [4]. Both ADHD symptoms and substance use appear to be relatively common among university students, a population facing significant academic and psychosocial challenges [5]. These factors may interact in complex ways, further compromising QoL. Based on this framework, the present study aims to examine whether, and to what extent, emotional dysregulation and substance use contribute to the relationship between ADHD symptoms and quality of life in university students.

Methods

The study was conducted within the PROBEN-Unisth-Health project and included a sample of 1000 students from the University of Catania. Participants completed an online survey including standardized measures of ADHD symptoms (BAARS-IV), quality of life (WHOQoL-BREF), emotional dysregulation (RIPoSt-40), and substance use (ASSIST-Lite). Statistical analyses were performed using R software. Preliminary tests confirmed that the data were normally distributed. Pearson correlation analyses were conducted to explore associations among the main variables. Potential covariates, specifically age and sex, were examined in preliminary analyses. Subsequently, multiple linear regression models were employed to investigate the relationships between ADHD symptoms, emotional dysregulation, substance use, and QoL. Hierarchical regression analyses were used to assess the incremental contribution of ED and SU. Finally, mediation analyses were conducted to evaluate whether emotional dysregulation and substance use mediated the association between ADHD symptoms and QoL.

Results

ADHD symptoms were negatively associated with quality of life and positively associated with both emotional dysregulation and substance use. Regression analyses indicated that higher ADHD symptom levels predicted lower QoL and greater substance use. The inclusion of emotional dysregulation significantly increased the explained variance and reduced the direct effect of ADHD symptoms on QoL, suggesting a mediating role. In contrast, substance use showed a smaller contribution to the model. These findings remained consistent after controlling for age and sex. Mediation analyses confirmed that emotional dysregulation partially mediated the relationship between ADHD symptoms and QoL, even when accounting for substance use.

Conclusions

The results highlight emotional dysregulation as a key mechanism underlying reduced quality of life in university students with ADHD symptoms. While substance use also contributes, its role appears less prominent. These findings underscore the importance of targeted interventions aimed at improving emotional regulation in this population to enhance overall well-being and functioning.

References

  1. . American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR. American Psychiatric Association Publishing.
  2. . Popit, S., Serod, K., Locatelli, I., & Stuhec, M. (2024). Prevalence of attention-deficit hyperactivity disorder (ADHD): systematic review and meta-analysis. European Psychiatry, 67(1), e68. https://doi.org/10.1192/j.eurpsy.2024.1786
  3. . Beheshti, A., Chavanon, M.-L., & Christiansen, H. (2020). Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis. BMC Psychiatry, 20(1), 120. https://doi.org/10.1186/s12888-020-2442-7
  4. . Rohner, H., Gaspar, N., Philipsen, A., & Schulze, M. (2023). Prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among Substance Use Disorder (SUD) Populations: Meta-Analysis. International Journal of Environmental Research and Public Health, 20(2), 1275. https://doi.org/10.3390/ijerph20021275
  5. . Büber, A., Yücens, B., & Özdel, O. İ. (2026). Mental Health Symptom Levels and Associated Sociodemographic Factors in University Students: A Large-Scale Cross-Sectional Study. Psychological Reports, 00332941261436739. https://doi.org/10.1177/00332941261436739