Severity of ADHD Symptoms Correlates with Suicidal Thoughts (Board#24)

Abstract : Research

Aims: Attention-deficit/hyperactivity disorder (ADHD) affects around 4% of the adult population and 11% of children in the United States. Among adults with ADHD, 18.6% have a concomitant mood disorder, including major depressive disorder, and individuals with ADHD are more likely to engage in risky behaviors and self-harm. Given the association between ADHD, comorbid mental health disorders, and suicidal ideation (SI), this study aimed to find a relationship between ADHD symptom severity and SI.


Methods: Data consisted of 188,329 clinical visits occurring between May 2022 and November 2024 from 15,152 adult and 3,225 child patients (age range: 4-96; mean age [SD] = 35.1 [16.2]). Before every visit, patients took the Patient Health Questionnaire-9 (PHQ-9) and the ADHD Symptom and Side Effect Tracking (ASSET) scale. The PHQ-9 is a nine-item self-report tool to screen for depression. Question 9 asks the patient how often in the past two weeks they have been bothered by “thoughts that you would be better off dead, or thoughts of hurting yourself in some way” on a scale from 0 (“not at all”) to 3 (“nearly every day”). The ASSET is a 10-item self-report scale to screen for ADHD, with two subscales of Inattentiveness and Hyperactivity. Each question on the ASSET uses a 6-point severity rating from 1 (“no problem present”) to 6 (“severe impact”). An Ordinary Least Squares regression was conducted to describe the relationship between the total ASSET factor score, representing ADHD severity, and degree of SI from Question 9 on the PHQ-9.


Results: The regression analysis revealed a strong connection between SI and ADHD severity, as measured by Question 9 of the PHQ-9 and the ASSET factor score. More severe ADHD predicted a higher reported SI rate (F(1, 151,762) = 3.12, p < 0.001). Overall, ADHD severity accounted for 5% of total variance in reported SI rate (R2 = 0.050).


Conclusions: The present analysis utilized a large dataset of psychiatric screening measures in an outpatient psychiatric center and found a strong relationship between ADHD severity and heightened risk of suicidality. The dataset included adult and child patients as young as four to as old as 96 years old, demonstrating the widespread effects of ADHD and depressive symptoms in an age-diverse population. From these results, clinicians are urged to administer regular suicidality screenings, especially among patients with more severe ADHD symptoms. Early detection of SI in vulnerable patients can help initiate treatment sooner to reduce the risk of symptom progression.