Suicidal ideation and clinician-rated suicide risk in veterans referred for ADHD evaluation at a VA Medical Center.

Abstract

The U.S. military veteran population experiences elevated rates of suicide relative to demographically matched community samples. Understanding suicide risk factors in veterans is therefore of critical importance. Accordingly, the Veterans Health Administration (VHA) has implemented elevated vigilance for suicidal ideation in its health care. One potential risk factor for suicidal ideation or behavior may be attention-deficit/ hyperactivity disorder (ADHD), which is frequently characterized by impaired impulse control and experience of intense emotions. To determine whether ADHD, as diagnosed by VHA assessment, may represent an independent or interactive risk factor for suicidal ideation or suicide attempt, we examined potential linkages between VHA-assessed symptomatology of ADHD and suicide attempts or ideation, either with or without the presence of comorbid VHA-assessed psychiatric symptomatology. In a retrospective chart review, we compared severity of clinician-rated suicide risk in 342 veterans (82.5% male) referred to a VHA medical center for ADHD assessment, of whom 198 were diagnosed with ADHD. Contrary to our preregistered hypotheses, there were no main or additive effects of ADHD in terms of increased suicidal ideation, clinician-rated suicide risk or in incidence of lifetime suicide attempt. Motoric impulsivity in neurocognitive testing also showed no relationship with suicide risk or attempts. Rather, consistent with previous literature, presence of a mood disorder or other non-ADHD psychopathology was linked to suicide risk ratings and attempts, irrespective of presence of ADHD symptoms. These data suggest that once comorbid symptomatology such as depression is controlled for, ADHD alone is not associated with elevated suicidal ideation or attempts in veterans. Impact StatementThese data indicate that among veterans seeking VHA evaluation for ADHD, depression, and other non-ADHD psychiatric disorders are more substantial determinants of suicide risk than diagnosis of ADHD.