Access to this full-text is provided by Springer Nature.
Content available from BMC Psychiatry
This content is subject to copyright. Terms and conditions apply.
Oscarssonetal. BMC Psychiatry (2022) 22:751
https://doi.org/10.1186/s12888-022-04409-w
RESEARCH
Stress andwork-related mental illness
amongworking adults withADHD: aqualitative
study
Martin Oscarsson1*, Martina Nelson2, Alexander Rozental2,3, Ylva Ginsberg3, Per Carlbring1 and Fredrik Jönsson1
Abstract
Background: Though many adults with ADHD underperform professionally, are more stressed, and have more days
of sickness absence compared to adults without ADHD, few studies have explored the experience of working as an
adult with ADHD. This study explores the general experience of working with ADHD, including stress and work-related
mental illness.
Methods: Semi-structured telephone interviews were conducted with 20 working adults with ADHD. Interview
topics included how the ADHD diagnosis and/or symptoms of ADHD may have affected participants on the job, how
work may have affected participants’ well-being, and the need for support and accommodation. Qualitative content
analysis was used to explore verbatim transcripts from the interviews.
Results: The analysis yielded three themes that describe some of the challenges of working with ADHD: Working and
living with ADHD, Needs, and Special abilities, with a total of eight subcategories. Subcategories were Specific challenges;
Relationships and cooperation; Negative consequences; Planning, prioritization, organization, and structure; Support, inter-
ventions, accommodations, and aids; Openness, understanding, and acceptance; Strategies; Strengths and qualities.
Conclusion: Further knowledge about the challenges of working with ADHD is needed in workplaces; where organi-
zational support is lacking, much in terms of accommodations and aids is up to the employee, and the disclosure of
diagnoses may be associated with great dilemma.
Keywords: Adult adhd, Work, Stress, Mental health, Qualitative content analysis
© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the
original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or
other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line
to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory
regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this
licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco
mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Background
During the last two decades, the proportion of sick leave
in Sweden due to psychiatric diagnoses has increased
drastically. In 2016, psychiatric diagnoses accounted for
27% of newly registered and 44% of ongoing sickness
cases [1]. In Sweden, psychiatric diagnoses are associ-
ated with the longest periods of sick leave, longer than for
cardiovascular disease and cancer [2]. Similar trends have
been observed in many OECD countries, at least since
the mid-1990s [3]. e increase in sick leave due to psy-
chiatric diagnoses has been attributed to several factors,
including changes in working life, health care, and other
aspects of everyday life. Lidwall etal. [4] point to a tran-
sition from physical to psychosocial strain, while Lidwall
and Voss [5] point specifically to difficulties balancing
full-time employment and family obligations.
Adults with attention deficit hyperactivity disorder
(ADHD) may have particular difficulties balancing work,
leisure, and family, and run a high risk of suffering from
mental illness. ADHD is characterized by symptoms of
inattention, hyperactivity, and impulsivity. It is one of
Open Access
*Correspondence: martin.oscarsson@psychology.su.se
1 Department of Psychology, Stockholm University, 106 91 Stockholm,
Sweden
Full list of author information is available at the end of the article
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 2 of 11
Oscarssonetal. BMC Psychiatry (2022) 22:751
the most common psychiatric disorders among chil-
dren and adolescents, and for most patients, symptoms
persist throughout adulthood, with associated nega-
tive outcomes on both individual and societal levels [6].
Worldwide estimated prevalence of adult ADHD varies
between studies, depending on population, methods, and
diagnostic criteria, but is estimated to be between two
and five percent (e.g., [7, 8]).
Many adults with ADHD underperform academically
and professionally, compared to their intellectual poten-
tial [9]. ADHD adults report significantly higher work
impairment than controls regarding performance and
effectiveness as well as attendance, teamwork, and inter-
action with supervisors [10]. According to Adamou etal.
[11], while adults with ADHD may be highly motivated
employees, ADHD-related difficulties will soon begin
to adversely affect work performance. Some manage to
compensate with administrative support or modifications
to the working environment, others with well-chosen
careers such as creative professions or elite sports, but
symptoms of inattention, hyperactivity, and impulsivity
are limiting in all but some workplaces. Many adults with
ADHD have more difficulty than others managing time,
organizing work, prioritizing tasks, following instruc-
tions, and regulating emotions. While some can hyper-
focus on interesting tasks, this may increase the risk for
workaholism.
e relationship between workaholism and ADHD
has been demonstrated by Andreassen etal. [12], among
others. In addition to the ability to hyperfocus, Andreas-
sen etal. also suggest a compensation hypothesis where
adults with ADHD may spend evenings and weekends
working to perform on par with their colleagues or to
work without distractions. Furthermore, Andreassen
etal. suggest that the inattentive nature of ADHD may
lead to procrastination and perfectionism, while the
impulsive nature may cause individuals to take on more
tasks than they can handle. is may be aggravated by
hyperactivity, which, combined with difficulties relaxing,
may lead to stress and occupational burnout.
e relationship between symptoms of ADHD and
stress has been demonstrated by Combs et al. [13],
among others. ey found inattention, rather than hyper-
activity, to be the most consistent predictor. Rogers etal.
[14] demonstrated that adults with ADHD were more
fatigued than controls, while Brattberg [15] showed a
strong association between ADHD, burnout, and long-
term sick leave. In a large population-based study of
twins, Friedrichs et al. [16] found that symptoms of
ADHD were associated with an increased risk for stress-
ful life events, such as divorce, loss of a job, or financial
loss. As previously mentioned, adults with ADHD also
run a high risk of suffering from mental illness. Several
studies have found that most adults with ADHD meet the
criteria for at least one comorbid psychiatric diagnosis
(e.g., [7, 17, 18].
Researchers studying the economic burden of adult
ADHD point to increased costs for sick leave [19]. De
Graaf etal. [20] found that workers with ADHD had an
average of 8.4 excess sickness absence days per year, com-
pared to otherwise similar respondents without ADHD.
In a sibling comparison cost analysis, Daley et al. [21]
found that adults with ADHD had an average of 34 sick-
ness absence days per year, compared to an 8-day average
among their siblings without ADHD. In a study on data
from a large manufacturing firm, Kessler etal. [22] found
that 20% of workers with ADHD had one or more sick-
ness absence days in the past 30days, compared to 10%
of workers without ADHD.
In a study of ADHD outpatients aged 19 to 29years,
38% received sickness absence recommendation, com-
pared to 2.4% in the general population receiving that
benefit [23]. All patients included in the study received
specialized treatment for ADHD, yet many had a signifi-
cantly impaired ability to work.
In Sweden, the position of professionals with ADHD
in the labor market has been emphasized by government
agencies (e.g., [24]), patient interest groups (e.g., [25]),
and clinicians. Internationally, similar calls of attention
have been made by researchers (e.g., [11]), global profes-
sional associations (e.g., [26]), and non-profit organiza-
tions (e.g., [27]). Even though many adults with ADHD
underperform professionally, are more stressed, have
more days of sickness absence, and more often receive
sickness absence recommendation, few studies have
explored the experience of working as an adult with
ADHD.
In one of the most comprehensive qualitative studies to
date, Brod, Pohlman, etal. [28] conducted focus groups
and interviews to study the general burden of illness for
adults with ADHD. Work and career were important
topics in all focus groups, with work requiring both cop-
ing skills and support. Among the identified obstacles
at work were disorganization, inattention, and problems
with authority.
Interviewing adults with ADHD between the ages of
21 and 38, Ek and Isaksson [29] found that work can be
supportive, through structure and demands, if adapted
to individual capacities. Participants appreciated rules
and limits for what activities to perform at work, facili-
tating focus and realization. Participants also described
how employment gave value to their lives and provided
a social context. Similar results were found in a study by
Goffer etal. [30]. In a sample of students, where many
combined studies with working, participants described
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 3 of 11
Oscarssonetal. BMC Psychiatry (2022) 22:751
how work provided relatedness, a sense of belonging, and
value beyond mere monetary compensation.
Studying experiences of young adults with ADHD
and the role of context, Lasky etal. [31] report that for
some, stressful and challenging work may alleviate symp-
toms, by forcing attention and keeping boredom at bay.
Interviewing successful adults with ADHD specifically,
Sedgwick etal. [32] identified several positive aspects of
ADHD. While many aspects were relevant to people in
general, a few were regarded as ADHD specific, including
divergent thinking, hyper-focus, and nonconformist.
Interviewing a well-educated, high-income sample
of older adults with ADHD, Brod, Schmitt, et al. [33]
report that participants described accumulated negative
ADHD effects on educational achievements, job perfor-
mance, and subsequent financial status. Participants also
described how the stress of ADHD exacerbated other
stressors in their lives, with an aggregated negative effect
on quality of life. Interviewing older adults with previ-
ously undiagnosed ADHD, Michielsen et al. [34] found
participants to be hard workers, with some working too
hard due to difficulties saying “no”. Some specifically
reported overstepping their physical boundaries, culmi-
nating in physical ailments due to stress.
Quantitative studies of occupational issues among
adults with ADHD tell us much about the negative con-
sequences of working with ADHD. While previous
qualitative studies provide further insight into the experi-
ences of working with ADHD, more research is needed
on how adults with ADHD experience their working life.
is includes specific occupational challenges, successful
strategies for coping, and the relationship between work
and mental health. is project aims to further study the
general experience of working with ADHD, specifically
explore stress and work-related mental illness among
adults with ADHD, and identify needs in preventing
these negative outcomes.
Methods
In-depth interviews with 20 adults with ADHD were
conducted between May and July 2021.
Participants
Participants were recruited primarily in collabora-
tion with a large Swedish ADHD patient interest group,
Riksförbundet Attention. Information about the study
was published on social media, together with a link to
a website where interested individuals were invited to
read more about the study. Terms and conditions were
detailed on the website. Before recruitment, the study
received ethics approval from the Swedish Ethical Review
Authority (Diary number: 2021–01029). Participants
were required to be 20–64years old (Swedish definition
of working age), have a diagnosis of ADHD, speak Swed-
ish, work half-time or more, and have work experience
equivalent to at least three years full-time. No compensa-
tion was awarded for participation. Provision of informed
consent was required to submit a notice of interest, thus,
written informed consent was obtained from all partici-
pants. With this notice, data were collected regarding
age, gender, education level, occupational status, work
experience, and ADHD diagnosis. Finally, participants
submitted their email addresses. In a few days, 90 notices
of interest were submitted, and the website was closed to
new submissions. All participants were given a random
identification code (e.g., 1a2b), and their contact infor-
mation was stored separately from all other data. us,
participation was pseudonymous.
Sampling
From the pool of notices of interests, 20 individuals were
chosen purposefully and stratified to reach a heterogene-
ous sample concerning demographics. Half identified as
women, half as men. Ages ranged from 23 to 60years,
education level ranged from high-school degrees to more
than three years of university studies, and work experi-
ence ranged from 5 to 40years. ese individuals were
contacted via email and invited to schedule an interview.
If unavailable, or not responding, another individual of
similar age and, if possible, the same gender was con-
tacted. In total, 61 individuals were contacted before 20
interviews had been scheduled and conducted. Table1
shows the characteristics of the final sample. As few men
submitted notices of interest, the final sample was pre-
dominantly female.
Data collection
Semi-structured interviews were conducted via tel-
ephone by authors M.O. and M.N. e interviews were
recorded using digital audio recorders. All recordings
Table 1 Participants’ Characteristics
Participants (n = 20)
Age (years): M (SD) 41.9 (8.61)
Gender: n (%)
Male 5 (25)
Female 15 (75)
Education level: n (%)
Elementary school 0 (0)
High school 3 (15)
University ≤ 3 years 5 (25)
University > 3 years 12 (10)
Work experience (years): M (SD) 17 (8.94)
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 4 of 11
Oscarssonetal. BMC Psychiatry (2022) 22:751
were transcribed verbatim by the interviewers. Identi-
fying information was substituted with generic analogs,
e.g., “employer”, “city”, or “care provider”.
An interview guide was used through all interviews
(see Additional file1). e guide was developed by the
authors, based on previous research and topics relevant
to the research aims. In the first part of the interview,
topics included experiences of current and previous
workplaces and jobs, how the ADHD diagnosis and/or
symptoms of ADHD affected participants on the job, and
experiences of support from colleagues, managers, fam-
ily, friends, and professionals, including accommodations
and resources in and around the workplace. In the second
part of the interview, topics included how work may have
affected participants’ well-being, how the ADHD diag-
nosis and/or symptoms of ADHD may have influenced
that relationship, and the current need for support and
accommodation in and around the workplace. Finally,
in preparation for an intended future study, participants
were asked about their interest in, and attitudes toward,
an internet-based psychological intervention targeting
stress and work-related mental illness among profession-
als with ADHD.
Analysis
A conventional approach to qualitative content analysis
was used to explore the content of the interviews [35].
e analysis was conducted by M.O. and M.N., under
the supervision of A.R. Both M.O. and M.N. are licensed
clinical psychologists, trained and experienced in the
assessment and treatment of adult ADHD.
First, all transcripts were read to the letter. Quotes rele-
vant to the research aims were highlighted and extracted,
i.e., all quotes regarding work and explicit, implicit, or
possible mental illness, including stress and potential
stressors. Quotes regarding the intended future study
were considered and included if the content also con-
cerned the current research aims. e selection of quotes
was continuously discussed between M.O. and M.N.,
with assistance from A.R. All quotes were then con-
densed into units of meaning, using the original word-
ing of the participants. roughout this process, some
quotes were shortened, and some excluded, with respect
to the research aims. Again, this included a continuous
discussion between M.O. and M.N., with regular con-
sultation of A.R. Finally, all units of meaning were coded
inductively, as true as possible to the original wording of
the participants.
Next, all codes from one interview were extracted,
organized, and categorized by M.O. and M.N., individu-
ally. Similarities and differences in the results were dis-
cussed until consensus was reached. e final categories
were compiled in a mind map, with their respective
codes. en, the remaining material was divided between
M.O. and M.N. Codes from all interviews were sepa-
rately extracted, organized, and categorized into mind
maps. e result of each categorization was thoroughly
reviewed in discussion between the coders until con-
sensus was reached. Finally, the results from all inter-
views were reviewed collectively, to develop concluding
themes. Categories from all interviews were gradually
clustered, with close attention paid to maintaining inter-
nal homogeneity and external heterogeneity between the
final themes [36].
Results
As presented in Fig.1, the analysis yielded three themes
that describe some of the challenges of working with
ADHD: Working and living with ADHD, Needs, and Spe-
cial abilities, with a total of eight subcategories.
Working andliving withADHD
Topics related to working and living with ADHD, natu-
rally, comprised large parts of the interviews. is
includes experiences and consequences of working with
symptoms of ADHD, before and after diagnosis, in differ-
ent workplaces, in different stages of life, and the circum-
stances that may mitigate or aggravate existence.
Specic challenges
All participants described specific challenges related
to working with ADHD, concerning symptoms and/or
situations. Among the prominent symptoms were those
commonly associated with ADHD, such as distract-
ibility, forgetfulness, restlessness, impulsivity, and impa-
tience. Also prominent were symptoms less typically
associated with ADHD, such as emotional dysregula-
tion. Many participants described a hypersensitivity to
criticism and failure, and a general sensitivity to changes
in mood and atmosphere in and around the workplace,
negatively affecting work performance and psychological
well-being:
I feel like I’m very sensitive to criticism, and to things
not going my way. I easily fall into believing I’m
drastically inferior to my colleagues, even though
I know I’m not. I take everything in, it becomes a
strong sensitivity to such things, which can cause a
dip in energy, or cause my motivation to drop, or
make me feel sad. (Participant A)
e sample was heterogeneous regarding professions,
and, as such, challenging situations varied between par-
ticipants. Recurring, however, were monotone and repet-
itive tasks, which caused under-stimulation, boredom,
and subsequent dejection. Another typical challenge were
meetings. Problems with meetings included difficulties
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 5 of 11
Oscarssonetal. BMC Psychiatry (2022) 22:751
staying focused and keeping up with the discussion, trou-
ble gathering one’s thoughts while conversations derail,
and stress building up as meetings go overtime:
I get really stressed out from knowing we won’t get
through the agenda. It makes it hard to focus on any-
thing else than seeing the time run out and knowing
we won’t finish. It also makes it impossible for me to
keep up with the discussion. I can’t keep up with the
discussion while focusing on what I think the meet-
ing should really be about. It’s too many discussions
and conversations at the same time, on different top-
ics in different areas. (Participant B)
Relationships andcooperation
A large majority of participants mentioned experiences
of working alongside and together with other people,
and how those encounters affected their experiences of
working with ADHD. Prominent was the sense of other’s,
imagined or true, judgment of oneself. Some participants
described coming across as lazy, ignorant, or incompe-
tent, when dysexecutive. Others described repeatedly
being perceived as too much or too straightforward.
Many also recalled a history of faux pas in the workplace,
as a result of tactlessness and indiscretion:
It’s taken a while for my colleagues. ey’ve thought
I’ve been angry or, well, been in the mood. ey feel
it’s a little uncomfortable. And I’ve told them what’s
what, that I’m saying whatever I’m feeling or think-
ing, out loud. (Participant C)
Negative consequences
Whether participants enjoyed their job, had a good rela-
tionship with colleagues, and felt support from manage-
ment in their vocational aspirations, they all described
indisputable negative consequences of ADHD, related
to their work. ese consequences included negative
effects on family and recreation, loss of jobs, unemploy-
ment, and symptoms of mental illness. Most prominent
among symptoms of mental illness were anxiety, stress,
and exhaustion. Several participants described a working
life marked by constant anxiety, with spikes in intensity
related to work and life events:
A feeling of impending danger, unease, but you never
know what for. It afflicts everything you’re thinking
about in that moment. (Participant D)
It’s not like you have anxiety for a moment and then
you’re good. It just lays there, like a tone, disturbing.
(Participant E)
Regarding stress, many participants described a gen-
eral sensitivity to stress and feelings of being easily over-
whelmed. is was related to feelings of not doing good
enough, not keeping up with tasks, and not staying on
top of things. For many, this was mediated by symptoms
of inattention, such as distractibility and forgetfulness.
Fig. 1 Themes and Subcategories in Data
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 6 of 11
Oscarssonetal. BMC Psychiatry (2022) 22:751
Some compensated by being exceedingly thorough or
working overtime, further depleting their energy reserve.
Several participants described being “weathered” by years
of stressful work and repeated relapses of exhaustion.
Just as work affected their mental health, many par-
ticipants also described how their mental health affected
their work, positively and negatively:
If I’m stressed out, and ashamed, and feel stupid, I
perform worse at work, too. e effect is crystal clear.
In the moments I’m a little happier or more positive,
I also perform better. (Participant B)
Other aggravating circumstances
Many participants described circumstances outside work
that aggravated the challenges of working with ADHD.
Most pronounced were trials related to family and par-
enthood. Several participants mentioned having chil-
dren with special needs of their own, and the challenges
of working while accommodating them. Not knowing if
your child will be able to get out of bed in the morning
when you have an important meeting, managing appoint-
ments with pediatricians, and always being on-call if
something happens at school, introduces another level
of strain. A number of participants described the work-
family balance as “unmanageable”, fighting to uphold a
low-arousal approach when returning home from work,
battered.
Needs
In contrast to specific challenges, negative consequences,
and aggravating circumstances, all participants shared
thoughts about their current needs, as well as their expe-
riences of successful and unsuccessful interventions,
accommodations, and collegial/managerial support.
Planning, prioritization, organization, andstructure
Many participants experienced great deficiencies in
organization and structure at their workplaces, encum-
bering not only themselves and fellow coworkers with
ADHD, but most, if not all, employees. Some described
lacking job descriptions and not knowing what to do,
leading to a loss of time and energy:
All the little things like deciding for yourself in what
order things should be done, how they should be
done, what exactly we are in need of… ose things
take a lot of time and energy for me, which it doesn’t
always do for my colleagues. (Participant F)
Participants with experiences of working with clear-
cut job descriptions, explicit routines, and consistent
implementation, on the other hand, recall thriving and
outperforming colleagues. For some, the benefits of
structure at work carried over to personal life:
e structure of having a job helps me out a lot in
my spare time. I never take more than ten days off
from work, because I don’t want to. I need the trot
of working, to maintain any kind of structure in my
life. (Participant D)
Support, interventions, accommodations, andaids
Experiences of managerial support varied greatly
between interviews. While many participants described
supervisors and managers as being supportive, the
responsibility for designing and implementing accommo-
dations was often appointed the individual:
e answer is always “what can you do to make it
better?”. I feel like I’m doing everything I can. (Par-
ticipant B)
While the experiences of managerial support varied,
many participants described supervisors and manag-
ers as important or crucial in their experience of work-
ing. Certain weight was given to the general attitude of
superiors regarding support, and several participants
described how a perceived lack of responsiveness could
be considerably discouraging. Some participants had
greater success working with colleagues to adjust rou-
tines and processes in the workplace. For example, some
participants had agreements with team members regard-
ing the distribution of tasks. Others found great support
in colleagues with similar or other special needs of their
own.
Although a small number of participants used assistive
technology, such as visual timers and screen readers, very
few had been in contact with an occupational therapist.
Most participants, however, used mobile and computer
applications to organize, plan, and prioritize their work,
including intelligent to-do lists, reminders, calendars,
and timers. In all cases, the selection and implementa-
tion of such applications were done by participants them-
selves, without professional assistance:
I have a very detailed to-do list on my computer. I
move things around on the list, rather than checking
them off, so that I can see I’ve made progress. … e
way I’ve set that up, I’ve come up with myself. (Par-
ticipant E)
Regarding healthcare support, many participants
described significant improvements in functioning at
work following pharmacological treatment of ADHD
symptoms. Experiences of other interventions in rou-
tine psychiatric care, however, were scarce, and generally
disappointing. For example, some participants recalled
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 7 of 11
Oscarssonetal. BMC Psychiatry (2022) 22:751
experiencing a lack of knowledge among healthcare
providers, beyond basic diagnostic criteria for ADHD.
Several participants desired interventions catered to rela-
tively functional adults, focused more on executive func-
tion rather than basic organization skills.
Openness, understanding, andacceptance
Many participants described how coming to terms with
their ADHD-related deficits, often through diagnosis and
subsequent (self-)education, enabled them to work con-
structively with their challenges at work. For some, it also
facilitated self-compassion. Experiences of disclosing the
diagnosis at work, however, varied. Some shared it con-
fidentially with select colleagues, some only with their
closest supervisor, and some spoke openly about it. Other
participants were vocal about specific deficits, symptoms,
and challenges, rather than disclosing their diagnosis:
I’ve gotten used to being open with my needs, both
with my colleagues and with my boss. I usually
don’t talk about my diagnosis, but I wouldn’t lie if
someone asked. However, I do feel that I have to be
open with the fact that I need help organizing things.
(Participant G)
Responses to disclosure also varied. Some participants
experienced significant relief and improved relationships
with coworkers. Others recall supervisors and manag-
ers not knowing how to deal with the information, and
a general lack of understanding of the challenges of adult
ADHD. Many participants described a dilemma sur-
rounding disclosure. On the one hand, disclosure may
facilitate accommodation, while raising awareness. On
the other hand, a diagnosis should not be a prerequisite
for accommodation, and the actual informational value
of a diagnosis is limited. Several participants also feared
discrimination or bias.
Special abilities
While there was a clear consensus among participants
that advantages of ADHD symptoms or an ADHD diag-
nosis were slim to none, nearly all participants described
acquired strategies, personal strengths, and unique quali-
ties that significantly improved function and sometimes
alleviated burden at work.
Strategies
Many participants employed formal analysis and rigorous
problem solving to understand and deal with challenging
situations and circumstances at work. Some described
performing it on the spot when faced with a challenge,
while others made notes of situations during the day to
later analyze and try to remedy:
During a day, I often make lists of things I feel dis-
content with. at way, I have them recorded to
return to, instead of carrying them with me and feel-
ing it’s something personal. You have to maintain a
more pragmatic view of things. (Participant H)
Together, the participants described a wealth of solu-
tions to challenges at work. Beyond positive effects of the
beforementioned analyses, efficient approaches included
stimulus control, frequent breaks, and intentional gaps in
the agenda. Many participants also mentioned successful
preventive strategies, including engagement in exercise,
outdoor life, and other valuable pastimes.
Strengths andqualities
Many participants described a certain creativity and
quick-wittedness. is would be expressed insituations
such as brainstorming meetings and problem solving,
as well as in social settings. For some participants, these
traits would go hand in hand with a perceived above-
average ability to think outside the box and come up with
effective solutions when colleagues and partners were
stuck:
I find it easy to come up with multiple ways to solve
a problem, and I’m able to choose between them.
Also, I never get stumped in a situation, whereas I
often see colleagues get completely paralyzed. (Par-
ticipant E)
However, many participants described their wealth of
ideas as both a blessing and a curse, as concurrent impul-
sivity could lead one to express ideas, including possibly
controversial ones, insituations where one would be bet-
ter off keeping quiet:
I have a huge number of ideas of things to do. I’ve
learned to keep quiet about that, sometimes, because
you always end up having to do them yourself. (Par-
ticipant E)
Some participants described a positive ability to hyper-
focus, being able to direct all their attention to the task,
activity, or client at hand, or being able to quickly assimi-
late crucial information on a topic. A few participants
also described certain positive effects of hypersensitiv-
ity, such as being able to instantly pick up on changes in
mood, attitude, or atmosphere in important meetings,
and being able to better empathize with clients.
Discussion
is study explored self-reported ADHD-specific expe-
riences of working with ADHD, including work-related
stress and mental illness. Qualitative content analysis
of transcripts from 20 interviews revealed three themes
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 8 of 11
Oscarssonetal. BMC Psychiatry (2022) 22:751
of common experiences. e results expand our knowl-
edge on how ADHD adults experience their working life,
including specific occupational challenges, experiences
of previous interventions, current needs, special abilities,
and strategies for coping.
Regarding living and working with ADHD, all partici-
pants described specific challenges concerning certain
symptoms and situations. In addition to the familiar
ADHD symptoms of inattention, hyperactivity, and
impulsivity, many participants described a prominent
burden of emotional dysregulation, as well as general
social hypersensitivity. While current diagnostic crite-
ria for ADHD does not include emotional dysregulation
as a core symptom, it has been extensively discussed in
the literature whether problems with emotional regula-
tion should be considered a primary symptom of (adult)
ADHD (e.g., [37–39]). Barkley and Fischer [40] argue
that emotional impulsiveness is as much part of ADHD
as inattention, hyperactivity, and impulsivity, with a
unique contribution to impairment. Barkley and Fischer
also demonstrate associations between emotional impul-
siveness and several measures of occupational outcome,
beyond the associations of traditional ADHD symptoms.
Social sensitivity was also prominent in the results of
Sedgwick etal. [32], though discussed not only as a bur-
den but as a complex phenomenon characterized, at its
best, by enthusiasm and energy. e clear incidence in
current data of issues and impairment related to emo-
tional dysregulation and general social hypersensitivity
further emphasize the need for future consideration of
these factors in studies on the assessment and treatment
of adult ADHD.
Concerning the consequences of living and work-
ing with ADHD, several participants described careers
characterized by persistent anxiety, stress, and relapses
of exhaustion. As previously shown, the association
between ADHD, stress, and mental illness, is well docu-
mented in quantitative studies. e results of the cur-
rent study expand our understanding of this relationship,
identifying feelings of being overwhelmed, not doing
good enough, not keeping up with tasks, and not stay-
ing on top of things, as related to perceived stress and
overload.
Regarding interventions, accommodations, and col-
legial support, many participants described negative
effects of inadequate organization and structure at their
workplaces, while some described thriving under bet-
ter managerial circumstances. e importance of clar-
ity in communication between managers and employees
with ADHD has been emphasized by ADHD experts
(e.g., [41]) and management scholars (e.g., [42]) alike.
ese results are also reminiscent of the support through
demands and structure described by Ek and Isaksson
[29]. e results of the current study further support the
notion that managerial and organizational factors play a
vital role in the well-being and prosperity of professionals
with ADHD.
While many participants described a significant
improvement in working ability after pharmacological
treatment of ADHD symptoms, experiences of any fur-
ther support in healthcare were few and unsatisfactory.
While the effectiveness of medications for adult ADHD
is well documented (e.g., [43]), national and international
guidelines consistently advise multimodal and multidis-
ciplinary treatment (e.g., [44–47]). e results from this
study indicate deficiencies in both the provision and
the acceptability of non-pharmacological treatment for
adult ADHD, among working adults. is includes occu-
pational therapy, as very few participants in the current
study had ever been in contact with an occupational ther-
apist, despite consensus among ADHD experts regard-
ing the importance of occupational therapists in ADHD
interventions [48].
For many participants, circumstances outside work,
including family and parental obligations, aggravated
the challenges of working with ADHD. However, nearly
all participants also described strategies, strengths, and
qualities that improved function and alleviated burden.
For many participants, formal analyses and problem
solving, combined with creativity and quick-wittedness,
was a recipe for progress at work. While planful problem
solving is a challenge for some with ADHD, these results
are in line with the adult-ADHD tendency to positively
reappraise current situations and “continually assess, re-
assess, compensate and adapt” ([49] p.814). e merit
of creativity and quick-wittedness is also in line with the
divergent thinking described by Sedgwick etal. [32].
Qualitative content analysis was used to explore the
content of the interviews. e interviews were conducted
and transcribed by the authors who later performed the
analysis, making for great familiarity with data and the
manifest content [50]. For trustworthiness, the analysis
process has been described in detail [51], facilitating the
readers’ evaluation of its transferability [52]. For cred-
ibility and dependability, all parts of the analysis were
continuously discussed between the authors, and rep-
resentative quotes from the transcripts are presented to
illustrate how categories and themes cover data [52, 53].
In addition, the process of recruitment and sampling has
been described, and the interview guide has been made
available.
In all qualitative research, researchers must take into
consideration their pre-understanding, i.e., their knowl-
edge of the subject and their familiarity with the context
[36]. In this study, the authors responsible for conduct-
ing the interviews and analyzing data were clinical
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 9 of 11
Oscarssonetal. BMC Psychiatry (2022) 22:751
psychologists experienced in the assessment and treat-
ment of adult ADHD, both having met many ADHD
patients struggling with stress and work-related mental
illness. Pre-understandings from this clinical work may
imply a risk for over-interpretation and confirmation
bias regarding the relationship between ADHD (symp-
toms) and work, and the relationship between work and
mental illness. However, it may also guide the evaluation
and linking of data, including the appraisal of the novelty
and relevance of the findings [54]. In the current analysis,
great care was also taken to use and stay true to the origi-
nal wording of the participants in condensation and cod-
ing, i.e., not reading or looking for something between
the lines.
e limitations of the current study include the recruit-
ment and sampling process. In the information about the
study, the aim of studying work-related stress and men-
tal illness was explicit. It is possible that this framing
attracted certain interest from adults with ADHD and a
more extensive history of stress and work-related mental
illness. While this was of interest in the study, perhaps
the sample would have been more heterogeneous had
the initial information been less specific. e sample did,
however, have an appropriate range regarding age, work
experience, education level, and profession.
Future studies may well consider ethnographic meth-
ods to further study the challenges of working with
ADHD. For example, researchers may consider observ-
ing adults with ADHD in the working environment, to
gain further knowledge of specific settings and situations
that prove challenging. Future research could also focus
on the managerial partners in organizations, e.g., expe-
riences of supervising employees with ADHD and man-
aging the challenges and consequences of ADHD in the
workplace.
Conclusions
e results of the current study suggest further knowl-
edge about the challenges of working with ADHD is
needed in workplaces; where organizational support
is lacking, much in terms of accommodations and aids
is up to the employee, and the disclosure of diagnoses
may be associated with great dilemma. e results of
the current study may also inform other social part-
ners, e.g., labor organizations and work environment
authorities, and advise regulations, recommendations,
and legislation. More knowledge is also needed in
health care, where, other than medications, common
interventions in routine psychiatric care seem to gener-
ally disappoint working adults with ADHD. While psy-
choeducational interventions on ADHD in general may
be provided, participants in the current study asked
for interventions catered to relatively high-functioning
patients, and the specific challenges they may be facing.
Abbreviation
ADHD: Attention deficit hyperactivity disorder.
Supplementary Information
The online version contains supplementary material available at https:// doi.
org/ 10. 1186/ s12888- 022- 04409-w.
Additional le1. Interview guide.
Acknowledgements
The authors would like to thank Riksförbundet Attention for help in recruit-
ment to the study.
Authors’ contributions
M.O. and A.R. initiated the idea for the study. Funding was secured by M.O.,
A.R, Y.G., P.C., and F.J., with F.J. as the main applicant and principal investigator
for the project. The purpose, research aims, and design were further concep-
tualized by M.N., Y.G., P.C., and F.J. Participants were recruited by M.O. and Y.G.
Interviews and analysis were conducted by M.O. and M.N., under supervision
by A.R. The manuscript was written by M.O. in consultation with M.N. Impor-
tant revisions were suggested by A.R., Y.G. P.C., and F.J. The final manuscript
was approved by all authors.
Authors’ information
Not applicable.
Funding
This study was made possible through a generous grant from Region Stock-
holm (FoUI-941466). The funder had no role in the study design, data collec-
tion and analysis, decision to publish, or preparation of the manuscript. Open
access funding provided by Stockholm University.
Availability of data and materials
Data from the current study are not publicly available due to them containing
information that could compromise research participant privacy. Participants
neither consented to data being made available. However, data is archived
for at least ten years in compliance with Stockholm University regulations.
Requests for any data should be addressed to the corresponding author.
Declarations
Ethics approval and consent to participate
Before recruitment started, the study received ethics approval from the
Swedish Ethical Review Authority (Diary number: 2021–01029). Provision of
informed consent was required to submit a notice of interest of participation,
thus, written informed consent was obtained from all participants. All meth-
ods were carried out in accordance with relevant guidelines and regulations.
Consent for publication
Not applicable.
Competing interests
In the past five years, Y.G. has participated in pharmacoepidemiological
research on ADHD medication sponsored by Shire (a Takeda company) and
received royalties from Studentlitteratur for a book concerning ADHD. M.N.
receives royalties from Natur & Kultur for two books concerning ADHD. The
remaining authors declare that they have no competing interests.
Author details
1 Department of Psychology, Stockholm University, 106 91 Stockholm, Sweden.
2 Department of Psychology, Uppsala University, Uppsala, Sweden. 3 Centre
for Psychiatry Research, Department of Clinical Neuroscience, Karolinska
Institutet, & Stockholm Health Care Services, Stockholm, Sweden.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 10 of 11
Oscarssonetal. BMC Psychiatry (2022) 22:751
Received: 2 March 2022 Accepted: 21 November 2022
References
1. Försäkringskassan. Socialförsäkringsrapport 2017:13. Stockholm (SE):
Försäkringskassan; 2017.
2. Försäkringskassan. Kor ta analyser 2017:1. Stockholm (SE): Försäkringskas-
san; 2017.
3. OECD. Sick on the Job? Paris: OECD; 2012. https:// doi. org/ 10. 1787/ 97892
64124 523- en.
4. Lidwall U, Bergendorff S, Voss M, Marklund S. Long-term sickness
absence: Changes in risk factors and the population at risk. Int J
Occup Med Environ Health. 2009;22:157–68. https:// doi. org/ 10. 2478/
v10001- 009- 0018-3.
5. Lidwall U, Voss M. Gender equality and sick leave among first-time par-
ents in Sweden. Scand J Public Health. 2020;48:164–71. https:// doi. org/
10. 1177/ 14034 94819 837791.
6. Kooij SJJ, Bejerot S, Blackwell A, Caci H, Casas-Brugué M, Carpentier PJ,
et al. European consensus statement on diagnosis and treatment of adult
ADHD: The European Network Adult ADHD. BMC Psychiatry. 2010;10:67.
https:// doi. org/ 10. 1186/ 1471- 244X- 10- 67.
7. Kessler RC, Adler L, Berkley R, Biederman J, Conners CK, Demler O, et al.
The prevalence and correlates of adult ADHD in the United States: results
from the National Comorbidity Survey Replication. Am J Psychiatry.
2006;163:716–23. https:// doi. org/ 10. 1176/ ajp. 2006. 163.4. 716.
8. Simon V, Czobor P, Bálint S, Mészáros Á, Bitter I. Prevalence and correlates
of adult attention-deficit hyperactivity disorder: meta-analysis. Br J Psy-
chiatry. 2009;194:204–11. https:// doi. org/ 10. 1192/ bjp. bp. 107. 048827.
9. Biederman J, Petty CR, Fried R, Kaiser R, Dolan CR, Schoenfeld S, et al.
Educational and occupational underattainment in adults With Attention-
Deficit/Hyperactivity Disorder. J Clin Psychiatry. 2008;69:1217–22. https://
doi. org/ 10. 4088/ JCP. v69n0 803.
10. Fuermaier ABM, Tucha L, Butzbach M, Weisbrod M, Aschenbrenner S,
Tucha O. ADHD at the workplace: ADHD symptoms, diagnostic status,
and work-related functioning. J Neural Transm. 2021;128:1021–31.
https:// doi. org/ 10. 1007/ s00702- 021- 02309-z.
11. Adamou M, Arif M, Asherson P, Aw T-C, Bolea B, Coghill D, et al. Occupa-
tional issues of adults with ADHD. BMC Psychiatry. 2013;13:59. https:// doi.
org/ 10. 1186/ 1471- 244X- 13- 59.
12. Andreassen CS, Griffiths MD, Sinha R, Hetland J, Pallesen S. The Relation-
ships between Workaholism and Symptoms of Psychiatric Disorders: A
Large-Scale Cross-Sectional Study. PLoS ONE. 2016;11:e0152978. https://
doi. org/ 10. 1371/ journ al. pone. 01529 78.
13. Combs MA, Canu WH, Broman-Fulks JJ, Rocheleau CA, Nieman DC. Per-
ceived stress and ADHD symptoms in adults. J Atten Disord. 2015;19:425–
34. https:// doi. org/ 10. 1177/ 10870 54712 459558.
14. Rogers DC, Dittner AJ, Rimes KA, Chalder T. Fatigue in an adult attention
deficit hyperactivity disorder population: a trans-diagnostic approach. Br
J Clin Psychol. 2017;56:33–52. https:// doi. org/ 10. 1111/ bjc. 12119.
15. Brattberg G. PTSD and ADHD: Underlying factors in many cases of burn-
out. Stress Heal. 2006;22:305–13. https:// doi. org/ 10. 1002/ smi. 1112.
16. Friedrichs B, Igl W, Larsson H, Larsson JO. Coexisting psychiatric problems
and stressful life events in adults with symptoms of ADHD-A large
swedish population-based study of twins. J Atten Disord. 2012;16:13–22.
https:// doi. org/ 10. 1177/ 10870 54710 376909.
17. Polyzoi M, Ahnemark E, Medin E, Ginsberg Y. Estimated prevalence and
incidence of diagnosed ADHD and health care utilization in adults in
Sweden – a longitudinal population-based register study. Neuropsychiatr
Dis Treat. 2018;14:1149–61. https:// doi. org/ 10. 2147/ NDT. S1558 38.
18. Wilens TE, Biederman J, Faraone SV, Martelon M, Westerberg D, Spencer
TJ. Presenting ADHD symptoms, subtypes, and comorbid disorders in
clinically referred adults with ADHD. J Clin Psychiatry. 2009;70:1557–62.
https:// doi. org/ 10. 4088/ JCP. 08m04 785pur.
19. Kleinman NL, Durkin M, Melkonian A, Markosyan K. Incremental
employee health benefit costs, absence days, and turnover among
employees with ADHD and among employees with children with ADHD.
J Occup Environ Med. 2009;51:1247–55. https:// doi. org/ 10. 1097/ JOM.
0b013 e3181 bca68c.
20. De Graaf R, Kessler RC, Fayyad J, Ten Have M, Alonso J, Angermeyer M,
et al. The prevalence and effects of adult attention-deficit/hyperactivity
disorder (ADHD) on the performance of workers: results from the WHO
world mental health survey initiative. Occup Environ Med. 2008;65:835–
42. https:// doi. org/ 10. 1136/ oem. 2007. 038448.
21. Daley D, Jacobsen RH, Lange A-M, Sørensen A, Walldorf J. The economic
burden of adult attention deficit hyperactivity disorder: a sibling compari-
son cost analysis. Eur Psychiatry. 2019;61:41–8. https:// doi. org/ 10. 1016/j.
eurpsy. 2019. 06. 011.
22. Kessler RC, Lane M, Stang PE, Van Brunt DL. The prevalence and work-
place costs of adult attention deficit hyperactivity disorder in a large
manufacturing firm. Psychol Med. 2009;39:137–47. https:// doi. org/ 10.
1017/ S0033 29170 80033 09.
23. Trantou A, Carlsen HK, Anderson C, Steingrimsson S. Sickness absence
recommendation among outpatients with ADHD and comorbidity: a
latent class analysis. J Atten Disord. 2021;25:209–16. https:// doi. org/ 10.
1177/ 10870 54718 780338.
24. Socialstyrelsen. Konsekvenser för vuxna med diagnosen adhd. Stockholm
(SE): Socialstyrelsen; 2019.
25. Riksförbundet Attention. ADHD på jobbet. Stockholm (SE): Riksförbundet
Attention; 2016.
26. Janove J. ADHD in the Workplace. SHRM. 2020. https:// www. shrm. org/
resou rcesa ndtoo ls/ hr- topics/ emplo yee- relat ions/ human ity- into- hr/
pages/ adhd- in- the- workp lace. aspx. Accessed 29 Nov 2021.
27. CHADD. Workplace Issues. CHADD. 2018. https:// chadd. org/ for- adults/
workp lace- issues. Accessed 29 Nov 2021.
28. Brod M, Pohlman B, Lasser R, Hodgkins P. Comparison of the burden
of illness for adults with ADHD across seven countries: a qualitative
study. Health Qual Life Outcomes. 2012;10:47. https:// doi. org/ 10. 1186/
1477- 7525- 10- 47.
29. Ek A, Isaksson G. How adults with ADHD get engaged in and perform
everyday activities. Scand J Occup Ther. 2013;20:282–91. https:// doi. org/
10. 3109/ 11038 128. 2013. 799226.
30. Goffer A, Cohen M, Maeir A. Occupational experiences of college stu-
dents with ADHD: A qualitative study. Scand J Occup Ther. 2022;29:403–
14. https:// doi. org/ 10. 1080/ 11038 128. 2020. 18561 82.
31. Lasky AK, Weisner TS, Jensen PS, Hinshaw SP, Hechtman L, Arnold LE, et al.
ADHD in context: Young adults’ reports of the impact of occupational
environment on the manifestation of ADHD. Soc Sci Med. 2016;161:160–
8. https:// doi. org/ 10. 1016/j. socsc imed. 2016. 06. 003.
32. Sedgwick JA, Merwood A, Asherson P. The positive aspects of attention
deficit hyperactivity disorder: a qualitative investigation of successful
adults with ADHD. ADHD Atten Deficit Hyperact Disord. 2019;11:241–53.
https:// doi. org/ 10. 1007/ s12402- 018- 0277-6.
33. Brod M, Schmitt E, Goodwin M, Hodgkins P, Niebler G. ADHD bur-
den of illness in older adults: a life course perspective. Qual Life Res.
2012;21:795–9. https:// doi. org/ 10. 1007/ s11136- 011- 9981-9.
34. Michielsen M, de Kruif JTCM, Comijs HC, van Mierlo S, Semeijn EJ, Beek-
man ATF, et al. The Burden of ADHD in older adults: a qualitative study.
J Atten Disord. 2018;22:591–600. https:// doi. org/ 10. 1177/ 10870 54715
610001.
35. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis.
Qual Health Res. 2005;15:1277–88. https:// doi. org/ 10. 1177/ 10497 32305
276687.
36. Bengtsson M. How to plan and perform a qualitative study using content
analysis. NursingPlus Open. 2016;2:8–14. https:// doi. org/ 10. 1016/j. npls.
2016. 01. 001.
37. Corbisiero S, Stieglitz R-D, Retz W, Rösler M. Is emotional dysregula-
tion part of the psychopathology of ADHD in adults? ADHD Atten
Deficit Hyperact Disord. 2013;5:83–92. https:// doi. org/ 10. 1007/
s12402- 012- 0097-z.
38. Faraone SV, Rostain AL, Blader J, Busch B, Childress AC, Connor DF, et al.
Practitioner review: emotional dysregulation in attention-deficit/hyper-
activity disorder - implications for clinical recognition and intervention.
J Child Psychol Psychiatry. 2019;60:133–50. https:// doi. org/ 10. 1111/ jcpp.
12899.
39. Hirsch O, Chavanon M, Riechmann E, Christiansen H. Emotional dys-
regulation is a primary symptom in adult Attention-Deficit/Hyperactivity
Disorder (ADHD). J Affect Disord. 2018;232:41–7. https:// doi. org/ 10. 1016/j.
jad. 2018. 02. 007.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Page 11 of 11
Oscarssonetal. BMC Psychiatry (2022) 22:751
•
fast, convenient online submission
•
thorough peer review by experienced researchers in your field
•
rapid publication on acceptance
•
support for research data, including large and complex data types
•
gold Open Access which fosters wider collaboration and increased citations
maximum visibility for your research: over 100M website views per year
•
At BMC, research is always in progress.
Learn more biomedcentral.com/submissions
Ready to submit your research
Ready to submit your research
? Choose BMC and benefit from:
? Choose BMC and benefit from:
40. Barkley RA, Fischer M. The unique contribution of emotional impulsive-
ness to impairment in major life activities in hyperactive children as
adults. J Am Acad Child Adolesc Psychiatry. 2010;49:503–13. https:// doi.
org/ 10. 1016/j. jaac. 2010. 01. 019.
41. Barkley RA. Recommendations for Employers Concerning the Manage-
ment of Employees with ADHD. ADHD Rep. 2013;21:6–13. https:// doi.
org/ 10. 1521/ adhd. 2013. 21.2.6.
42. Robbins R. The untapped potential of the ADHD employee in the work-
place. Cogent Bus Manag. 2017;4:1271384. https:// doi. org/ 10. 1080/ 23311
975. 2016. 12713 84.
43. Faraone SV, Glatt SJ. A Comparison of the Efficacy of Medications for
Adult Attention-Deficit/Hyperactivity Disorder Using Meta-Analysis of
Effect Sizes. J Clin Psychiatry. 2010;71:754–63. https:// doi. org/ 10. 4088/ JCP.
08m04 902pur.
44. Kooij JJS, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balázs J, et al. Updated
European Consensus Statement on diagnosis and treatment of adult
ADHD. Eur Psychiatry. 2019;56:14–34. https:// doi. org/ 10. 1016/j. eurpsy.
2018. 11. 001.
45. NICE. Attention deficit hyperactivity disorder: diagnosis and manage-
ment. London; 2018. https:// www. nice. org. uk/ guida nce/ NG87.
46. SFI. ADHD-indsatser - en forskningsoversigt. Copenhagen (DK): SFI; 2011.
47. Socialstyrelsen. Stöd till barn, ungdomar och vuxna med adhd – ett
kunskapsstöd. Stockholm (SE): Socialstyrelsen; 2014.
48. Adamou M, Asherson P, Arif M, Buckenham L, Cubbin S, Dancza K, et al.
Recommendations for occupational therapy interventions for adults with
ADHD: a consensus statement from the UK adult ADHD network. BMC
Psychiatry. 2021;21:72. https:// doi. org/ 10. 1186/ s12888- 021- 03070-z.
49. Young S. Coping strategies used by adults with ADHD. Pers Individ Dif.
2005;38:809–16. https:// doi. org/ 10. 1016/j. paid. 2004. 06. 005.
50. Bailey J. First steps in qualitative data analysis: transcribing. Fam Pract.
2008;25:127–31. https:// doi. org/ 10. 1093/ fampra/ cmn003.
51. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs.
2008;62:107–15. https:// doi. org/ 10. 1111/j. 1365- 2648. 2007. 04569.x.
52. Kyngäs H, Kääriäinen M, Elo S. The Trustworthiness of Content Analysis. In:
The Application of Content Analysis in Nursing Science Research. Cham:
Springer International Publishing; 2020. p. 41–8. https:// doi. org/ 10. 1007/
978-3- 030- 30199-6_5.
53. Graneheim U, Lundman B. Qualitative content analysis in nursing
research: concepts, procedures and measures to achieve trustworthiness.
Nurse Educ Today. 2004;24:105–12. https:// doi. org/ 10. 1016/j. nedt. 2003.
10. 001.
54. Alvesson M, Sandberg J. Pre-understanding: An interpretation-enhancer
and horizon-expander in research. Organ Stud. 2021;:017084062199450.
https:// doi. org/ 10. 1177/ 01708 40621 994507.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in pub-
lished maps and institutional affiliations.
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
1.
2.
3.
4.
5.
6.
Terms and Conditions
Springer Nature journal content, brought to you courtesy of Springer Nature Customer Service Center GmbH (“Springer Nature”).
Springer Nature supports a reasonable amount of sharing of research papers by authors, subscribers and authorised users (“Users”), for small-
scale personal, non-commercial use provided that all copyright, trade and service marks and other proprietary notices are maintained. By
accessing, sharing, receiving or otherwise using the Springer Nature journal content you agree to these terms of use (“Terms”). For these
purposes, Springer Nature considers academic use (by researchers and students) to be non-commercial.
These Terms are supplementary and will apply in addition to any applicable website terms and conditions, a relevant site licence or a personal
subscription. These Terms will prevail over any conflict or ambiguity with regards to the relevant terms, a site licence or a personal subscription
(to the extent of the conflict or ambiguity only). For Creative Commons-licensed articles, the terms of the Creative Commons license used will
apply.
We collect and use personal data to provide access to the Springer Nature journal content. We may also use these personal data internally within
ResearchGate and Springer Nature and as agreed share it, in an anonymised way, for purposes of tracking, analysis and reporting. We will not
otherwise disclose your personal data outside the ResearchGate or the Springer Nature group of companies unless we have your permission as
detailed in the Privacy Policy.
While Users may use the Springer Nature journal content for small scale, personal non-commercial use, it is important to note that Users may
not:
use such content for the purpose of providing other users with access on a regular or large scale basis or as a means to circumvent access
control;
use such content where to do so would be considered a criminal or statutory offence in any jurisdiction, or gives rise to civil liability, or is
otherwise unlawful;
falsely or misleadingly imply or suggest endorsement, approval , sponsorship, or association unless explicitly agreed to by Springer Nature in
writing;
use bots or other automated methods to access the content or redirect messages
override any security feature or exclusionary protocol; or
share the content in order to create substitute for Springer Nature products or services or a systematic database of Springer Nature journal
content.
In line with the restriction against commercial use, Springer Nature does not permit the creation of a product or service that creates revenue,
royalties, rent or income from our content or its inclusion as part of a paid for service or for other commercial gain. Springer Nature journal
content cannot be used for inter-library loans and librarians may not upload Springer Nature journal content on a large scale into their, or any
other, institutional repository.
These terms of use are reviewed regularly and may be amended at any time. Springer Nature is not obligated to publish any information or
content on this website and may remove it or features or functionality at our sole discretion, at any time with or without notice. Springer Nature
may revoke this licence to you at any time and remove access to any copies of the Springer Nature journal content which have been saved.
To the fullest extent permitted by law, Springer Nature makes no warranties, representations or guarantees to Users, either express or implied
with respect to the Springer nature journal content and all parties disclaim and waive any implied warranties or warranties imposed by law,
including merchantability or fitness for any particular purpose.
Please note that these rights do not automatically extend to content, data or other material published by Springer Nature that may be licensed
from third parties.
If you would like to use or distribute our Springer Nature journal content to a wider audience or on a regular basis or in any other manner not
expressly permitted by these Terms, please contact Springer Nature at
onlineservice@springernature.com
