24 December 2020

Suicide and ADHD

'The Dark Side of ADHD: Factors Associated With Suicide Attempts Among Those With ADHD in a National Representative Canadian Sample' by Esme Fuller-Thomson, Raphaël Nahar Rivière, Lauren Carrique and Senyo Agbeyaka in (2020) Archives of Suicide Research comments 

This study investigated the prevalence and odds of suicide attempts among adults with attention deficit hyperactivity disorder (ADHD) compared to those without and identified factors associated with suicide attempts among adults with ADHD. 


Secondary analysis of the nationally representative Canadian Community Health Survey–Mental Health (CCHS-MH) (n = 21,744 adults, of whom 529 had ADHD). Respondents were asked whether they received an ADHD diagnosis from a health care professional. Lifetime suicide attempt was based on self-report. 


Adults with ADHD were much more likely to have attempted suicide than those without (14.0% vs. 2.7%). One in four women with ADHD have attempted suicide. Sixty percent of the association between ADHD and attempted suicide was attenuated when lifetime history of depression and anxiety disorders were taken into account. Female gender, lower education attainment, substance abuse, lifetime history of depression, and childhood exposure to chronic parental domestic violence were found to be independent correlates of lifetime suicide attempts among those with ADHD.

The authors state

Attention deficit hyperactivity disorder (ADHD) is a complex mental illness that impacts several domains of a person’s life. The global prevalence of childhood ADHD has been estimated to be between 2% and 7%, and it is the third most common mental health condition affecting young people (Sayal, Prasad, Daley, Ford, & Coghill, 2018). The prevalence of ADHD in adults has been estimated to be between 2.9% in Canada (Hesson & Fowler, 2018) and 4.3% in the U.S. (London & Landes, 2019). ADHD is characterized by excessive and impaired levels of impulsivity, overactivity, and inattention (Polanczyk, Salum, Sugaya, Caye, & Rohde, 2015). With symptoms persisting for 1 in every 23 adults between the ages of 18 and 44 (Kessler et al., 2006), both children and adults with ADHD are more likely than their peers without ADHD to experience a variety of behavioral and mental health problems, in addition to significant difficulties in their social and family life (Agnew-Blais, Seidman, & Buka, 2013; Kessler et al., 2006). 

One of these problems that is of particular concern is the high incidence of suicidal behaviors among those with an ADHD diagnosis (Balazs & Kereszteny, 2017; Giupponi et al., 2018). A large cohort study found that those with a diagnosis of ADHD had 4.7 times higher rate of suicide-related behavior compared to those without an ADHD diagnosis (Fitzgerald, Dalsgaard, Nordentoft, & Erlangsen, 2019). Research also suggests gender differences in the psychopathological profile of ADHD and suicide-related behaviors. For example, females with ADHD are at significantly higher risk for suicidal ideation (Kakuszi, Bitter, & Czobor, 2018). 

As mentioned, ADHD symptoms can persist into adulthood and contribute to ongoing emotional and behavioral problems, including suicidality. A longitudinal study of youth and young adults with ADHD found that by young adulthood, the odds of suicidal ideation were approximately twice that of those without ADHD (Barkley & Fischer, 2005). A nationally representative sample of adults from England found that those with current ADHD had 50% higher odds of having attempted suicide in comparison to adults without (Agosti, Chen, & Levin, 2011). In an American population-based prospective study, the standardized mortality rate for death by suicide by an average age of 27 years was almost five times higher for those who had had ADHD diagnosed in childhood compared to peers without ADHD (Barbaresi et al., 2013). The existing literature seems to indicate that childhood ADHD is associated with an increased risk of suicidality.