Association of symptoms of attention deficit-hyperactivity disorder and impulsive-aggression with severity of suicidal behavior in adult attempters

Abstract

Literature emphasizes the relationship between attention deficit-hyperactivity disorder (ADHD) and suicidal behavior (SB). However, the link between ADHD and the severity of SB is yet to be determined. We investigated the association between a probable diagnosis of ADHD and the severity of SB in 539 hospitalized suicide attempters, and determined the role of comorbid psychiatric diagnoses. The severity of SB was defined as the number of suicide attempts, age at first suicide attempt, seriousness and violence of suicide attempts. A diagnosis of probable adult ADHD (probable ADHD) was defined as the presence of both current ADHD symptoms and ADHD symptoms in childhood. We evaluated the combined effect of high impulsive-aggression levels and probable ADHD. Probable ADHD was not associated with early or frequent suicide attempts after adjustment for psychiatric disorders and treatment intake. High levels of impulsive-aggression increased the risk of an early suicide attempt, particularly in patients with ADHD symptoms, and independently of other clinical factors. The association between serious suicide attempts and probable ADHD remained significant after adjustment. Although ADHD is involved in suicidal vulnerability, psychiatric comorbidities and impulsive-aggression appear to largely explain the severity of SB in adult attempters with ADHD symptoms.

Trajectories of suicide attempts from early adolescence to emerging adulthood: prospective 11-year follow-up of a Canadian cohort

“…After mental health symptoms such as depression/anxiety and conduct were taken into account, ADHD symptoms remained associated with a trajectory of suicide attempts persisting into adulthood. Prior studies including systematic reviews in both adults and adolescents reported that mental health comorbidities largely explained the ADHD-suicide attempts link (Balazs & Kereszteny, 2017; Conejero et al 2019; Impey & Heun, 2012). Our results partly align with a population-based study of insurance claims showing stronger associations between ADHD diagnosis and repeated suicide attempts (hazard ratio 6.5), than for any attempts (hazard ratio 3.8), above and beyond comorbidities (Huang et al 2018).…”

Suicidal and non-suicidal self-injurious behaviour in patients with bipolar disorder and comorbid attention deficit hyperactivity disorder after initiation of central stimulant treatment: a mirror-image study based on the LiSIE retrospective cohort

“…One study of 539 patients who had attempted suicide showed that SA were not associated with ADHD per se but with impulsive aggression, particularly when there were ADHD symptoms. 67 In patients with ADHD, treatment with CS such as methylphenidate reduces impulsivity and aggressive behavior. 68 , 69 Methylphenidate increases dopamine and norepinephrine activity through reuptake inhibition of both neurotransmitters.…”

The Dark Side of ADHD: Factors Associated With Suicide Attempts Among Those With ADHD in a National Representative Canadian Sample

“…This is especially relevant for women with ADHD, in light of the fact that one-quarter of Canadian adults with ADHD have attempted suicide. Additionally, given the genetic basis for impulsivity (Gray et al, 2018) and its influence on both ADHD and suicide (Conejero et al, 2019), it may be worth exploring whether assessment of suicidality of first-degree relatives of individuals with ADHD is warranted.…”