Tobacco use among college students in Kerala, India.

Background & objectives: Despite tobacco use among college students being a major health concern, data remain sparse from India. It is in this background that this study aimed to report the prevalence of tobacco use and its psychosocial correlates among college students in the State of Kerala, India. Methods: A total of 5784 students from 58 colleges from Ernakulam district, Kerala, selected by cluster random sampling and were provided with self-administered questionnaire. In addition to socio-demographic profile, the questionnaire incorporated alcohol, smoking, and substance involvement screening test (ASSIST, for assessing tobacco use and its severity, lifetime use of other substances); Kessler's scale (psychological distress) and Barkeley's scale (attention deficit hyperactivity disorder symptoms). Screening questions were used for assessing lifetime suicidality and sexual abuse. Results: The lifetime prevalence of tobacco use was 8.6 per cent (21.5% males and 1.4% female). Among users, hazardous and dependent use defined using ASSIST scores was 63.3 and 2.9 per cent, respectively. Tobacco use was associated with older age, being male, urban residence, having a part-time job, use of alcohol and illicit drugs and academic failures. Interpretation & conclusions: Although the prevalence of tobacco use in our study was relatively low, the proportionately higher rates of hazardous use and its association with the negative correlates suggest that more needs to be done to prevent its deleterious consequences.

Long-term Outcomes of Intensive Inpatient Care for Severe, Resistant Obsessive-Compulsive Disorder: Résultats à long terme de soins intensifs à des patients hospitalisés pour un trouble obsessionnel-compulsif grave et résistant.

OBJECTIVE: A substantial proportion of severely ill patients with obsessive-compulsive disorder (OCD) do not respond to serotonin reuptake inhibitors (SRIs) and are unable to practice cognitive behavioral therapy (CBT) on an out-patient basis. We report the short-term (at discharge) and long-term (up to 2 years) outcome of a multimodal inpatient treatment program that included therapist-assisted intensive CBT with adjunctive pharmacotherapy for severely ill OCD patients who are often resistant to SRIs and are either unresponsive or unable to practice outpatient CBT. METHODS: A total of 420 patients, admitted between January 2012 and December 2017 were eligible for the analysis. They were evaluated using the Mini International Neuropsychiatric Interview, the Yale-Brown Obsessive Compulsive Scale (YBOCS), and the Clinical Global Impression (CGI) scale. All patients received 4 to 5 therapist-assisted CBT sessions per week along with standard pharmacotherapy. Naturalistic follow-up information at 3, 6, 12, and 24 months were recorded. RESULTS: At baseline, patients were mostly severely ill (YBOCS = 29.9 ± 4.5) and nonresponsive to ≥2 SRIs (83%). Mean duration of inpatient stay was 42.7 ± 25.3 days. At discharge, there was a significant decline in the mean YBOCS score (29.9 ± 4.5 vs. 18.1 ± 7.7, P < .001, Cohen's d = 1.64); 211/420 (50%) were responders (≥35% YBOCS reduction and CGI-I≤2) and an additional 86/420 (21%) were partial responders (25% to 35% YBOCS reduction and CGI-I≤3). Using latent class growth modeling of the follow-up data, 4 distinct classes were identified, which include "remitters" (14.5%), "responders" (36.5%), "minimal responders" (34.7%), and "nonresponders" (14.6%). Shorter duration of illness, better insight, and lesser contamination/washing symptoms predicted better response in both short- and long-term follow-up. CONCLUSION: Intensive, inpatient-based care for OCD may be an effective option for patients with severe OCD and should be considered routinely in those who do not respond with outpatient treatment.

Do High School Students in India Gamble? A Study of Problem Gambling and Its Correlates.

Studies from the West suggest that significant numbers of high school students gamble, despite it being illegal in this age group. To date, there have been no studies on the prevalence of gambling among senior high school and higher secondary school students in India. This study reports point prevalence of gambling and its psychosocial correlates among high school students in the State of Kerala, India. 5043 high school students in the age group 15-19 years, from 73 schools, were selected by cluster random sampling from the district of Ernakulam, Kerala, South India. They completed questionnaires that assessed gambling, substance use, psychological distress, suicidality, and symptoms of Attention Deficit Hyperactivity Disorder (ADHD). Of a total of 4989 completed questionnaires, 1400 (27.9 %) high school students reported to have ever gambled and 353 (7.1 %) were problem gamblers. Of those who had ever gambled, 25.2 % were problem gamblers. Sports betting (betting on cricket and football) was the most popular form of gambling followed by the lottery. Problem gamblers when compared with non-problem gamblers and non-gamblers were significantly more likely to be male, have academic failures, have higher rates of lifetime alcohol and tobacco use, psychological distress, suicidality, history of sexual abuse and higher ADHD symptom scores. Gambling among adolescents in India deserves greater attention, as one in four students who ever gambled was a problem gambler and because of its association with a range of psychosocial variables.

Prevalence & correlates of tobacco use among adolescents in Kerala, India.

BACKGROUND & OBJECTIVES: Most tobacco users who initiate its use during adolescence are likely to continue the use into adulthood and contribute to the 90 per cent of premature deaths among tobacco users. In this context the prevalence, patterns and correlates of tobacco use were studied among adolescent school students in Kerala, India. METHODS: Total 7560 students from classes 8, 10 and 12, within the age group of 12-19 yr, across 73 schools in Ernakulam district, Kerala, India, selected by cluster random sampling, completed a self-administered questionnaire incorporating standardized instruments. RESULTS: Of the 7350 valid questionnaires, the overall lifetime prevalence of tobacco use was 6.9 per cent (12.5% males and 1.2% females). The prevalence of tobacco use increased from 3.1 per cent at 12-13 yr to 15.1 per cent at 18-19 yr. The mean age of onset of tobacco use was 14.0±2.2 yr. The prevalence was higher among students from urban backgrounds, lower socio-economic status and those with part-time jobs. Tobacco users had significantly higher rates of use of alcohol (67.8 vs. 11%) and illicit drugs (33 vs. 6.1%). They had poorer academic performance (24.7 vs. 9.1%), more severe psychological distress (10.8 vs. 4.5%), suicidal attempts (10.2 vs. 3.5%), higher scores of ratings of attention deficit hyperactivity disorder (8.3 vs. 2.5%) and history of sexual abuse (12.5 vs. 3.8%). INTERPRETATION & CONCLUSIONS: The prevalence of tobacco use in adolescents reported in this study was relatively lower than those reported from other Indian States. However, it correlates with multiple negative outcomes suggesting a need to promote specific interventions to prevent adolescent tobacco use.

An epidemological study of obsessive compulsive disorder in adolescents from India.

OBJECTIVES: There is scarce data on the prevalence of OCD among adolescents in India. This study reports point prevalence of OCD among school students (age 12-18years) in the Kerala state of India and examines its association with ADHD, psychological distress, tobacco/alcohol abuse, suicide risk and history of sexual abuse. METHOD: 7560 students of 73 schools were self-administered the OCD subsection of Clinical Interview Schedule-Revised, the Composite International Diagnostic Interview (CIDI) for obsessive compulsive symptoms and other relevant instruments to identify OCD and related clinical measures. A diagnosis of ICD-10 OCD was derived through the CIS-R algorithm which required duration of at least 2weeks and at least a thought/behavior to be resisted along with a cut-off score for severity and impairment. RESULTS: In the sample, 50.3% were males with a mean age of 15.2years (range of 12-18years). The response rate was 97.3% (7380 valid responses). 0.8% (n=61) fulfilled criteria for OCD with a male predominance (1.1 vs. 0.5%, p=0.005). Prevalence was higher among Muslims and increased with age. Taboo thoughts (62.3%) and mental rituals (45.9%) were the commonest symptoms. Those with OCD had significantly higher suicidal thoughts (59 vs. 16.3%, p<0.01) suicide attempts (24.6 vs. 3.8%, p<0.01), ADHD (28 vs. 4%, p<0.001), sexual abuse (24.6 vs. 4.2%, p<0.01), and tobacco use (23 vs. 6.8%, p=0.01). They also reported greater psychological distress and poorer academic performance. CONCLUSIONS: OCD is common among adolescents in India. Its associations with ADHD, sexual abuse, psychological distress, poorer academic performance and suicidal behavior are additional reasons for it to be recognized and treated early.

Exploring the early history of convulsive therapies at the Mysore Government Mental Hospital (currently NIMHANS).

OBJECTIVE: The paper describes the introduction, and early use of chemically and electrically induced convulsive therapies, at the Mysore Government Mental Hospital (MGMH), now the National Institute of Mental Health and Neuro Sciences, Bangalore, India. Cardiazol and ammonium chloride were used at MGMH before the introduction of electroconvulsive therapy (ECT). The study examines the early history, clinical correlates and outcome of convulsive therapies and attempts to contextualize how local conditions influenced implementation. METHOD: Three sets of archival case-records from 1938 to 1948, each of a period of 9 months following the implementation of a particular mode of convulsive therapy were reviewed. RESULTS: During the examined timeframe, 40 patients received cardiazol, 95 ammonium chloride and 50 unmodified ECT. Schizophrenia was the commonest clinical indication for convulsive therapy across all modalities of treatment. When outcomes were examined, 45%, 48.4% and 62% of patients were clinically reported to have been either cured/improved after receiving cardiazol, ammonium chloride and ECT respectively. Those receiving cardiazol had a high mortality of 22.5%, compared to 3.1% for ammonium chloride and 4% with ECT. CONCLUSIONS: Convulsive therapies were one of the first somatic psychiatric treatments, introduced around 1930s and 1940s all over the world, including in India. Our archival records suggest that many international ideas about somatic treatments were quickly adopted in India. Electroconvulsive therapy and other novel neuromodulatory interventions continue to be used and actively researched in India.

Lifetime child sexual abuse assessed at age 18: A survey of college students from Kerala, India.

Estimates of child sexual abuse (CSA) during adolescence may undercount exposure and retrospective recollection in adulthood may be prone to recall bias. Thus, a more accurate and CSA may be possible if the question is examined in a large sample of 18 years old. This study examined the prevalence and psychosocial correlates of CSA among college-going 18 years olds. This is a cross-sectional survey of college students. 1424 students from 58 colleges selected by cluster random sampling completed a self-administered questionnaire incorporating standardized instruments. Prevalence rates were calculated. Chi-square test was used to compare categorical variables and binary logistic regression analysis was used to examine the correlates of CSA. CSA was reported by 13.2% and significantly more common among males compared to females (18.4% vs. 10.4%, P < 0.05). In the full model of binary logistic regression analysis, students who reported sexual abuse were significantly more likely to report psychological distress and suicidal thoughts. The finding was replicated even when male and female students were analyzed separately. To conclude, CSA is common among college students. With an increasing number of young people enrolling in colleges in India, timely interventions on campuses are important to reduce the psychological morbidity in this population.

Risk estimates of anxiety and depressive disorders among primary care patients with chronic medical illness - A Indian study.

Risk estimates of depression and anxiety disorders in primary care patients was studied in 7017 patients from 71 primary health centres in Kerala, India. When compared to those without, patients with a single chronic medical illness had approximately 3-4-fold higher rates of depression and anxiety disorders; this increases to 6-fold when the number of medical illnesses is two or more. Patients with hypertension, diabetes, epilepsy, tuberculosis, asthma, and arthritis had higher odds of depression after controlling for socio-demographic variables and co-occurring medical illnesses. The findings were replicated for anxiety disorders except for tuberculosis. Findings highlight the need for integrated interventions.

Does academic streams influence alcohol use in colleges?

BACKGROUND: Alcohol use among college students is a major public health priority owing to its high prevalence and numerous negative outcomes. Most interventions targeting alcohol use among college students consider them as a homogenous entity. There is preliminary evidence from high-income countries that patterns of alcohol use differ across academic streams. This remains unstudied in India. AIMS: To compare the prevalence and correlates of alcohol use among students enrolled in various collegiate educational streams (medical, nursing, engineering, arts and science, and others [law/fisheries]) in the state of Kerala, India. SETTINGS AND DESIGN: This is a cross-sectional survey conducted among college students. MATERIALS AND METHODS: 5784 students completed a self-administered questionnaire assessing alcohol use and its correlates in the psycho-social domains. STATISCAL ANALYSIS: Lifetime prevalence and severity of alcohol use was determined across examined academic streams. A multivariable logistic regression analysis was done separately for each course, to identify factors influencing alcohol use. RESULTS: The lifetime prevalence of alcohol use varied between 10.6% among nursing students to 41.7% among students pursuing "other" stream (law/fisheries). Students pursuing medicine and nursing had a relatively lower proportion of hazardous users. Consistently across all academic streams, being male and using tobacco increased the risk, while those from the Muslim community had a lower risk of alcohol use. Other examined psychosocial correlates showed varying relationship across courses. CONCLUSION: The prevalence and psychosocial correlates of alcohol use vary among students pursuing various academic streams. This finding has public health importance as the incorporation of course level characteristics in intervention programs will improve effectiveness.

Prevalence of hoarding disorder among primary care patients.

OBJECTIVES: Despite the inclusion of hoarding disorder (HD) in the DSM-5, there is little epidemiological data on hoarding from low and middle-income countries. This study, the first from India, examines the prevalence and correlates of HD among primary care patients in the state of Kerala, India. METHODS: To assess correlates, the Hoarding Rating Scale-Interview (HRS-I) and other structured instruments were administered to 7,555 subjects selected by stratified random sampling from 71 primary health centers. RESULTS: The prevalence of HD was 1.02% (95%CI 0.8-1.3). Those with HD were more likely to be older and live alone. In the binary logistic regression analysis, after controlling for significant sociodemographic variables, subjects with HD had a higher odds of reporting chronic illness, depression, anxiety disorder, alcohol abuse, and tobacco dependence. Subjects with HD had significantly higher disability scores than unaffected individuals. CONCLUSION: Although HD is not uncommon in India, this disorder is rarely reported in specialty settings in India, which suggests that awareness and detection should be improved, considering the co-occurring negative correlates and disability among affected individuals.

Identification of biomarkers that predict response to subthalamic nucleus deep brain stimulation in resistant obsessive-compulsive disorder: protocol for an open-label follow-up study.

INTRODUCTION: Deep brain stimulation (DBS) of bilateral anteromedial subthalamic nucleus (amSTN) has been found to be helpful in a subset of patients with severe, chronic and treatment-refractory obsessive-compulsive disorder (OCD). Biomarkers may aid in patient selection and optimisation of this invasive treatment. In this trial, we intend to evaluate neurocognitive function related to STN and related biosignatures as potential biomarkers for STN DBS in OCD. METHODS AND ANALYSIS: Twenty-four subjects with treatment-refractory OCD will undergo open-label STN DBS. Structural/functional imaging, electrophysiological recording and neurocognitive assessment would be performed at baseline. The subjects would undergo a structured clinical assessment for 12 months postsurgery. A group of 24 healthy volunteers and 24 subjects with treatment-refractory OCD who receive treatment as usual would be recruited for comparison of biomarkers and treatment response, respectively. Baseline biomarkers would be evaluated as predictors of clinical response. Neuroadaptive changes would be studied through a reassessment of neurocognitive functioning, imaging and electrophysiological activity post DBS. ETHICS AND DISSEMINATION: The protocol has been approved by the National Institute of Mental Health and Neurosciences Ethics Committee. The study findings will be disseminated through peer-reviewed scientific journals and scientific meetings.

Tobacco Use Among College Students Across Various Disciplines in Kerala, India.

BACKGROUND: Tobacco use is a major public health concern in India. Its use in young people is linked to increased severity, longer duration, and reduced efforts to seek treatment for tobacco use. A significant proportion of young people are enrolled in colleges, and early prevention during this period has better effectiveness. There is preliminary evidence that prevalence may vary across courses even among students of the same sociocultural background. Hence, we compared the prevalence and correlates of tobacco use among college students enrolled in five common streams of collegiate education (medical, nursing, engineering, arts/science and others, law/fisheries) in Kerala, India. METHODS: 5784 college students from 58 colleges (medical, nursing, engineering, arts, and law and fisheries) selected by cluster random sampling in the district of Ernakulum, Kerala, completed a self-administered questionnaire incorporating standardized instruments. R software was used for analyses. Lifetime prevalence and severity of tobacco use were determined. Sociodemographic variables of tobacco users and nonusers enrolled in various courses were compared using chi-square test and two-way ANOVA. Furthermore, for each course, factors influencing tobacco use were identified using multivariable logistic regression analysis. RESULTS: The mean age of the sample was 19.5 ± 1.9 years, with the majority being female (65.3%). Lifetime prevalence of tobacco use varied from 0.5% in nursing students, 4.2% in medical students, 8.2% in students of arts and science, 12.5% in engineering students, and 22.8% among other students (law/fisheries). Approximately two-thirds of all tobacco users across courses showed signs of nicotine dependence. Dependent users also showed variance with none in nursing, 2.6% among medicine, 1.6% among arts and science, 1.9% among engineering, and 6.3% among others. Male gender and alcohol use were consistently associated with tobacco use across courses, whereas other examined psychosocial correlates showed variance. CONCLUSIONS: To conclude, it appears that among college students, course-level characteristics may influence risk of tobacco use. This has public health importance as it suggests that interventions need to be tailored bearing this in mind. Future research needs to examine campus-level characteristics that may explain variance.

Gender-Specific Correlates of Alcohol Use Among College Students in Kerala, India.

BACKGROUND: Studies of alcohol use among college students in India have reported a male preponderance, but a recent large study suggested that alcohol use is increasing in young females. This increase in use among the young females is of concern as they experience poorer outcomes and a higher risk for addiction. Hence, we aimed to examine the gender-specific correlates of alcohol use among college students in the district of Ernakulum, Kerala. METHODS: From 58 colleges, 5,784 students completed a self-administered questionnaire that assessed use of alcohol, use of tobacco and illicit drugs, psychological distress, suicidality, symptoms of attention deficit hyperactivity disorder, and history of sexual abuse. RESULTS: Of the questionnaires, 342 had incomplete responses and had to be discarded, and the rest (n = 5,442, 94.1%) were analyzed. lifetime alcohol use was reported by 39% males and 12.6% females. In the multivariable logistic regression analysis using a full model, male students using alcohol compared to male non-users were older, non-Muslim, had poor academic performance, and used other substances. Female users, compared to female non-users, were non-Muslim, had urban residence, used tobacco, and had higher psychological distress, higher suicidal thoughts, and higher lifetime exposure to sexual abuse. CONCLUSION: Gender-specific differences extend across sociodemographic and psychological domains. Incorporation of these may improve the effectiveness of public health strategies addressing alcohol use.

Clinical utility of repeated intravenous ketamine treatment for resistant obsessive-compulsive disorder.

Glutamate modulators are used to treat OCD resistant to serotonin reuptake inhibitors (SRIs). Ketamine has shown some promise in treating OCD. Data on the use of ketamine in SRI-resistant OCD is limited, with no studies on the role of multiple ketamine infusions in this disorder. We report our experience of treating SRI- resistant OCD with multiple ketamine infusions. We reviewed the clinical charts of 14 adult inpatients with a diagnosis of SRI-resistant OCD and treated them with repeated ketamine infusions [mean (SD) = 5.4 (2.5)]. There was a significant reduction in the Yale-Brown Obsessive-Compulsive Scale (YBOCS) total score following intravenous ketamine infusions. One patient showed a dramatic response (a drop in the YBOCS to '0') and two patients showed a partial response (25-35 % reduction in the YBOCS). Eleven patients showed no clinical improvement. Ketamine may, therefore, be somewhat effective in a subset of OCD patients who are resistant to SRIs. Our findings suggest the need to examine the efficacy of ketamine in controlled studies with larger samples. It may be possible to identify predictors of response to ketamine in larger studies.

Insomnia Among Elderly Primary Care Patients in India.

OBJECTIVE: To assess insomnia and its health correlates among elderly primary care patients in India. METHODS: A multicenter, cross-sectional survey was administered to 1,770 elderly primary care patients from 71 government primary health centers in Kerala, India, from May to December 2016. Insomnia was evaluated using the Insomnia Severity Index. Basic demographics and information about medical illness were collected. Study instruments included the Patient Health Questionnaire-Somatic, Anxiety, and Depression Symptoms; Alcohol Use Disorders Identification Test; Fagerström Test for Nicotine Dependence; 12-item World Health Organization Disability Assessment Schedule; and World Health Organization Quality of Life-BREF. RESULTS: Valid responses were received from 1,574 (89%) patients, of whom the mean age was 68.6 years and 55.5% were women. Clinical insomnia was reported by 11.8%, whereas 30.4% had subclinical insomnia. Primary care attendees with subclinical as well as clinical insomnia had increased odds of being older and female and having chronic medical illness compared with those without insomnia. Patients with clinical insomnia had increased odds of common mental disorders (anxiety, depression, and somatization) and greater disability compared with the subclinical or no insomnia groups. Those with subclinical insomnia had poor satisfaction with life compared to those with no insomnia. CONCLUSIONS: Insomnia in the elderly is frequent in primary care patients in India and has multiple negative health correlates. This study reiterates the need for more awareness with regard to detection and management of insomnia in the elderly population.

Prevalence and Correlates of Self-Reported ADHD Symptoms in Children Attending School in India.

Objective: To study the prevalence and correlates of self-reported ADHD symptoms among school-going adolescents from Kerala, India. Method: Seven thousand five hundred sixty students from Classes 8, 10, and 12, aged 12 to 19 years, across 73 schools selected by cluster random sampling, were invited to participate, but only 7,150 successfully completed the questionnaire incorporating standardized instruments. Results: Three hundred five (4.3%) self-reported symptoms for ADHD combined type, 131 (1.8%) for ADHD hyperactive-impulsive type, and 102 (1.4%) for ADHD inattentive type with a male predominance. Binary logistic regression analysis showed that those with symptoms of ADHD (combined type) compared with the non-ADHD group had poorer academic performance, significantly higher substance use, psychological distress, suicidality, and sexual abuse. Conclusion: The high prevalence of self-reported ADHD symptoms and its association with negative correlates previously reported in literature in those with a diagnosis of ADHD suggests that clinically significant self-reported ADHD symptoms could be as disabling as ADHD.

Sex differences in Indian patients with obsessive-compulsive disorder.

Sex has been postulated as one of the factors mediating heterogeneity in obsessive-compulsive disorder (OCD). This study investigated the sex differences in OCD with respect to sociodemographics, symptom profile, and comorbidity including spectrum disorders. Two hundred thirty-one subjects diagnosed with OCD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria were included in the study. The subjects were evaluated by extensive clinical and semistructured interviews by expert clinical psychiatrists, and diagnosis was made by consensus. Male (n = 166) and female (n = 65) subjects with OCD were compared with respect to the data obtained. Males with OCD tended to have an earlier onset and had more symmetry/religious obsessions and miscellaneous compulsions. Males also showed a tendency to have attention deficit hyperactivity disorder. Female subjects were more likely to be married, have cleaning compulsions and be associated with trichotillomania. The findings support the hypothesis that there are sex differences in OCD, but the results are only partly comparable with other studies, suggesting that the phenotypic expression of OCD is possibly dependent on a complex interaction among biologic, personal, and cultural factors.

Antipsychotic augmentation in the treatment of obsessive-compulsive disorder.

Most studies suggest that obsessive-compulsive disorder runs a chronic course. Only 40%-70% of patients respond to first-line treatment with selective serotonin reuptake inhibitors (SSRIs). The most common pharmacological strategy used in clinical practice for partial responders to SSRIs is augmentation with an atypical antipsychotic. This article aims to review the efficacy, tolerability, and comparative efficacy of antipsychotics as augmenting agents in patients who showed inadequate response to SSRIs. In addition to case reports and case series, 15 randomized controls trials, 6 meta-analyses, and 3 expert guidelines have been examined. The findings suggest that one in three SSRI nonresponders improve with antipsychotic augmentation. The presence of comorbid tics and/or schizotypal disorder may predict a better response to antipsychotic augmentation. Among antipsychotics, risperidone, and aripiprazole have the best evidence, with haloperidol being considered second in-line owing to its unfavorable side effect profile. Guidelines recommend that antipsychotics be administered at a low-to-medium dosage for a duration not exceeding 3 months, with mandatory discontinuation if there is no response. Larger studies and head-to-head trials are needed to further explore this treatment strategy.

Association of Childhood Attention Deficit Hyperactivity Disorder Symptoms with Academic and Psychopathological Outcomes in Indian College Students: a Retrospective Survey.

OBJECTIVE: To survey the prevalence of retrospectively recalled clinically significant symptoms of attention deficit hyperactivity disorder (ADHD) in childhood and determine the association of ADHD symptoms in childhood with current academic achievement and psychopathological outcomes among college students in the state of Kerala, India. METHODS: A self-administered questionnaire was distributed to 5784 students from 58 colleges selected by cluster random sampling. The Barkley Adult ADHD Rating Scale-IV was used for recollection of childhood ADHD symptoms; a total score of ≥60 (indicating the 99 percentile) was taken as the cut-off for clinically significant ADHD symptoms in childhood. The Alcohol, Smoking and Substance Involvement Screening Test was used to assess lifetime use of alcohol and tobacco. The Kessler Psychological Distress Scale was used to assess non-specific psychological distress. Lifetime suicidality and exposure to sexual abuse were assessed by asking relevant questions. Students who recalled having clinically significant ADHD symptoms in childhood were compared with those who did not. RESULTS: Of 5784 students, 639 (11.5%) did not complete the questionnaire. Of the remaining 5145 students, 1750 (34.8%) were men and 3395 (65.2%) were women, with a mean age of 19.4 years. 143 (2.8%) students reported clinically significant ADHD symptoms in childhood. Childhood ADHD symptoms were significantly more common in men and in those living in urban areas. In the bivariate analysis, those with clinically significant ADHD symptoms in childhood had significantly higher odds of poorer academic performance, alcohol use, tobacco use, psychological distress, suicidal thoughts, suicidal attempts, and contact and non-contact sexual abuse, after adjusting for sex and residence. CONCLUSIONS: Clinical evaluation and appropriate management may be warranted for adults who retrospectively recall clinically significant ADHD symptoms in childhood.