The Moderated Moderation Effect of ADHD Symptoms and Self-Esteem on the Relationship between Daily Life Stress and Depression among Adolescents

Background: This study examined the moderated moderation effect of attention deficit/hyperactivity disorder (ADHD) symptoms and self-esteem on the relationship between daily life stress and depression among adolescents.Methods: Data from 5,937 school-attending adolescents, obtained from the 2021 Mental Health Survey of Adolescents, were analyzed using the PROCESS Macro.Results: First, daily life stress had a significantly positive influence on depression. Second, ADHD symptoms moderated the relationship between daily life stress and depression such that higher levels of ADHD symptoms amplified the deleterious effect of stress on depression. Third, a moderated moderation effect was confirmed, indicating that self-esteem further conditioned the moderating influence of ADHD symptoms. Specifically, higher levels of self-esteem mitigated the synergistic risk effect of stress and ADHD symptoms on depression.Conclusions: Based on these findings, this study suggests strategies to enhance psychological protective factors to prevent depression among adolescents with ADHD.