Suicidal spectrum behaviors (SSBs) are a concern in adolescents and adults with attention-deficit/hyperactivity disorder (ADHD); however, according to co-lead authors, Amalie Austgulen and Nanna Karen Gilberg Skram, data on risk factors for SSBs in this population are sparse. The authors performed the first, to their knowledge, systematic review and meta-analysis on suicidal behavior risk factors in patients with ADHD.
According to the report, published in BMC Psychiatry, the study found that ADHD symptom severity and persistence, female gender, family history of ADHD, childhood and parental influences, and social functioning were all factors that increased the risk of SSBs in patients with ADHD. Authors added that adolescents and adults with ADHD still carried an increased risk of SSBs after adjusting for psychiatric comorbidities.
SSB Risk Factors Include Symptom Burden, Gender
Investigators reviewed studies published by February 2022 that included data on mediating factors of SSBs in patients with a clinical diagnosis of ADHD. Search terms related to SSBs included self-harm, self-injury, self-mutilation, self-poisoning, and suicide. Following the review, 40 out of the 604 total reports retrieved were selected for meta-analysis.
ADHD was associated with an increased chance of suicidal ideation, with odds ratios (ORs) ranging from 1.83 (95% CI, 1.69-1.97) to 8.48 (95% CI, 1.00-74.07). One study did not support this association (OR, 1.4; 95% CI, 1.74-6.15). Analysts also noted patients with ADHD reported suicidal ideation much more frequently than controls, with a rate of 46.0% versus 5.9%, respectively (P<.001).
Authors did emphasize that limitations of the study require consideration; some risk factors were evaluated in very few studies, for instance, and other studies had small sample sizes or imbalanced patient demographics.
“Overall, ADHD emerges as an independent risk factor for SSBs,” the authors closed. “Awareness of psychiatric comorbidities, symptom expression, and other risk factors associated [with] SSBs should have clinical implications in terms of screening and suicide prevention strategies in adolescents and adults with ADHD.”