Many young adults with attention-deficit/hyperactivity disorder (ADHD) are at risk for depression. Yet, questions remain about factors associated with the development of depression in young adults with ADHD. This study examined the effects of sex and emotion regulation difficulties on depression in a sample of young adults with ( n = 172) and without ( n = 730) ADHD. Two aspects of emotion regulation difficulties were examined—impairments in emotional insight (i.e., lack of emotional awareness, nonacceptance of emotion, and lack of emotional clarity) and impairments in behavioral response to emotion (i.e., impulse control difficulties, difficulties engaging in goal-directed behavior, and limited access to emotion regulation strategies). Significant correlations between ADHD and all indices of emotion regulation difficulty emerged. Sex moderated the association between ADHD and lack of emotional awareness, difficulties engaging in goal-directed behavior, and limited access to emotion regulation strategies. Specifically, ADHD was significantly associated with limited emotion regulation awareness for women but not men, while ADHD was associated with greater difficulties engaging in goal-directed behavior and limited access to emotion regulation strategies for women compared to men. These three areas of emotion regulation dysfunction simultaneously mediated the association between ADHD and depression. The findings indicate the importance of considering emotion regulation and sex in understanding depression in young adults with ADHD.
This study explores the feasibility of using mobile phone ecological momentary assessment to evaluate negative emotion in adolescent girls with attention-deficit/hyperactivity disorder (ADHD). A total of 13 girls with ADHD, ages 12–16 years old (38.5% with comorbid depression), and their mothers completed several daily surveys assessing the intensity and variability of youth negative emotion using mobile phone-based ecological momentary assessment for approximately one week. The rate of response to survey prompts by youth and maternal reports was examined. In addition, associations between girls’ and mothers’ ratings of negative emotion were calculated. Finally, the severity and fluctuation in negative emotion were compared between girls with and without depression. Girls and their mothers demonstrated a high level of compliance with assessment procedures, and maternal and youth ratings were significantly correlated. In addition, girls with comorbid depression and their mothers endorsed significantly more intense and variable negative emotion compared to girls with ADHD alone. These preliminary findings show that ecological momentary assessment is a feasible and valid method for collecting information on emotion regulation among girls with ADHD and their mothers that can be applied to future work aimed at collecting ecologically valid assessments of functioning in girls with ADHD.
Over two-thirds of women will experience breast pain in their lifetime. As one of the leading breast symptoms for which women seek medical attention, breast pain is suspected to be underreported and under-studied. Cyclical breast pain is related to hormonal changes. Noncyclical breast pain is independent of the menstrual cycle and can be idiopathic and related to chronic pain syndromes, infections, ill-fitting bras, musculoskeletal abnormalities, pregnancy, perimenopause, and postsurgical causes. Breast pain can also present in transgender patients and may require additional considerations as to the underlying cause. Imaging of mastalgia depends upon the suspected etiology. Inappropriate imaging for breast pain is associated with significant utilization of health care resources. Cyclical breast pain does not require an imaging work-up. The work-up of focal, noncyclical breast pain includes ultrasound for women aged younger than 40 years, and mammography and ultrasound for women aged 40 years and older. Management of breast pain is often supportive, as most breast pain resolves spontaneously. If pain persists, imaging and management should follow a step-wise approach. If conservative measures fail, second-line therapy is topical nonsteroidal anti-inflammatory drugs. If breast pain is severe and resistant to conservative methods, additional third-line therapies can be added by breast care specialists with specific knowledge of the potential deleterious side effects of these medications. While the causes of mastalgia are overwhelmingly benign, breast pain can significantly impact quality of life, and the breast radiologist should be familiar with causes, management, and treatment recommendations from a multidisciplinary approach.
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