Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 5;4(1):51.
doi: 10.1007/s44192-024-00103-3.

Suicidal behavior in ADHD: the role of comorbidity, psychosocial adversity, personality and genetic factors

Georg C Ziegler  1   2 , Silke Groß  3 , Andrea Boreatti  3 , Monika Heine  3 , Rhiannon V McNeill  3 , Thorsten M Kranz  4 , Marcel Romanos  5 , Christian P Jacob  3   6 , Andreas Reif  4   7 , Sarah Kittel-Schneider  3   8 , Klaus-Peter Lesch  3   9   5   10
Affiliations

Suicidal behavior in ADHD: the role of comorbidity, psychosocial adversity, personality and genetic factors

Georg C Ziegler et al. Discov Ment Health. .

Abstract

Adult ADHD is associated with increased risk for suicide attempts, as indicated by investigations of population- and community-based cohorts. However, there is little data regarding suicide attempts in a clinical setting. To address this, we used a comprehensively phenotyped clinical adult ADHD (aADHD) cohort to assess to which extent comorbidity, psychosocial adversity, personality, and ADHD symptoms contribute to suicidal behavior in ADHD. Furthermore, we investigated a triallelic variation in the serotonin transporter-linked polymorphic region (5-HTTLPR), which has previously been associated with suicidal behavior. Depression, substance use, eating, and posttraumatic stress disorders were independently associated with past suicide attempts, whereas anxiety, somatoform, and obsessive-compulsive spectrum disorders showed no association. Pulmonary diseases also showed an association with suicidal behavior. Psychosocial factors including occupational status, marital status/living situation, externalizing behavior and psychiatric family history were strongly associated with past suicide attempts. ADHD symptoms of inattention and hyperactivity/impulsivity were not associated with past suicide attempts after adjustment for psychiatric comorbidity and psychosocial adversity. However, the personality trait of neuroticism fully mediated the association between depression and suicidal behavior. 5-HTTLPR was not associated with suicidal behavior, but an interaction with ADHD symptoms and subtype was found. Our data suggest that psychiatric comorbidity and psychosocial adversity are key factors for suicidal behavior in aADHD, with neuroticism representing a critical mediator of the association between depression and suicidality. Further research, preferentially with longitudinal study designs is needed to better understand causal factors for suicidal behavior to enable effective preventive action.

Keywords: 5-HTTLPR; ADHD; Comorbidity; Psychosocial adversity; Serotonin; Suicide attempt.

PubMed Disclaimer

Conflict of interest statement

CPJ received speaker's fees from derCampus, Daiichi Sankyo, Jansse-Cilag, Eli Lilly and Co, Shire, Novartis, and Medice. SKS received author's and speaker's honoraria from Takeda and Medice Arzneimittel Pütter GmbH & Co KG. AR has received honoraria from and/or serves on advisory boards for Medice, Shire/Takeda, SAGE/Biogen, Janssen, Boehringer Ingelheim, and cyclerion. All declared COI are not directly related to this work. None of the other authors reports any financial conflict of interest related to this work.

Figures

Fig. 1
Fig. 1
Graphs depict probability of past suicide attempt dependent on psychiatric comorbidity and psychosocial adversity scores. *** p < 0.001
Fig. 2
Fig. 2
Neuroticism as a mediator between depression and suicidal behavior Probability of past suicide attempt dependent on NEO self-ratings of neuroticism without (A) and with differentiation between lifetime depressive disorder (B). Neuroticism fully mediates the association between lifetime depressive disorder and past suicide attempt (C), *** p < 0.001, solid lines are regression curves and shaded areas show 95% confidence intervals. Covariates: Age, sex, psychosocial adversity score, comorbidity score
Fig. 3
Fig. 3
ADHD subtype and symptom-dependent effect of 5-HTTLPR genotype on suicidal behavior. 5-HTTLPR genotype x ADHD subtype interaction under an S-dominant model (A) and interaction effect for 5-HTTLPR genotype x investigator-rated DSM-IV HI symptoms (B). * < 0.05, ** < 0.01, logistic regression with past suicide attempts as binary outcome, and 5-HTTLPR genotype, ADHD subtype or DSM-IV symptom counts (and respective interaction terms) as independent variables, covariates: age, sex, psychiatric comorbidity, psychosocial adversity scores
See this image and copyright information in PMC

References

    1. Bjerrum MB, Pedersen PU, Larsen P. Living with symptoms of attention deficit hyperactivity disorder in adulthood: a systematic review of qualitative evidence. JBI Database System Rev Implement Rep. 2017;15(4):1080–153. 10.11124/JBISRIR-2017-003357. - PubMed
    1. Cubillo A, Halari R, Smith A, Taylor E, Rubia K. A review of fronto-striatal and fronto-cortical brain abnormalities in children and adults with attention deficit hyperactivity disorder (ADHD) and new evidence for dysfunction in adults with ADHD during motivation and attention. Cortex. 2012;48(2):194–215. 10.1016/j.cortex.2011.04.007. - PubMed
    1. Jangmo A, Kuja-Halkola R, Perez-Vigil A, Almqvist C, Bulik CM, D’Onofrio B, et al. Attention-deficit/hyperactivity disorder and occupational outcomes: the role of educational attainment, comorbid developmental disorders, and intellectual disability. PLoS ONE. 2021;16(3): e0247724. 10.1371/journal.pone.0247724. - PMC - PubMed
    1. Eakin L, Minde K, Hechtman L, Ochs E, Krane E, Bouffard R, et al. The marital and family functioning of adults with ADHD and their spouses. J Atten Disord. 2004;8(1):1–10. - PubMed
    1. Biederman J, Faraone SV, Spencer TJ, Mick E, Monuteaux MC, Aleardi M. Functional impairments in adults with self-reports of diagnosed ADHD: A controlled study of 1001 adults in the community. J Clin Psychiatry. 2006;67(4):524–40. - PubMed

LinkOut - more resources