Association of hyperactivity-impulsivity and inattention symptom profiles with suicide attempt: an 18-year population-based cohort study

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) symptomatology in childhood is associated with a high risk of suicide attempt later in life. However, symptom presentation in ADHD is heterogeneous, and little is known about how suicide risk varies according to different profiles of ADHD symptoms and sex.

Objective: The aim was to investigate the longitudinal associations between childhood profiles of ADHD symptoms (ie, hyperactivity-impulsivity and inattention) and youth suicide attempt in males and females, separately.

Methods: This population-based cohort study used data from three longitudinal cohorts: the Quebec Longitudinal Study of Child Development (QLSCD), the Quebec Longitudinal Study of Kindergarten Children (QLSKC) and the Quebec Newborn Twin Study (QNTS) for a total of 4399 participants (1490 from the QLSCD, 2134 from the QLSKC and 775 from the QNTS; 50% females) followed up from ages 6-23 years. Symptoms of hyperactivity-impulsivity and inattention were assessed by teachers five times from ages 6-12 years. Suicide attempt in adolescence and young adulthood (by age 23) was self-reported. Multitrajectory modelling was used to identify profiles of ADHD symptoms, and regression analysis was used to test their association with suicide attempt, adjusting for childhood socioeconomic and clinical characteristics.

Findings: We identified four ADHD symptom profiles with distinct associations with suicide attempt for males and females. Compared with those with persistently low symptoms, females with persistently high inattention and hyperactivity-impulsivity (OR: 2.54, CI 1.39 to 4.63) or high inattention and low hyperactivity-impulsivity (OR: 1.81, CI 1.21 to 2.70) were at higher risk of suicide attempt, while, among males, only those with decreasing hyperactivity-impulsivity and inattention over time (OR: 2.23, CI 1.20 to 4.13) were at higher risk of suicide attempt.

Conclusions: Risk of suicide attempt in children with ADHD symptoms varies according to both symptom profile and sex, the highest risk being for females with high inattention symptoms (with or without hyperactivity), and males with decreasing symptoms.

Clinical implications: Taking into account differences in both sex and ADHD symptoms profile may be relevant to more accurately identify and manage suicide risk in individuals with high ADHD symptoms, though caution is needed when generalising our population-based findings to clinical populations.

Keywords: Child & adolescent psychiatry; Suicide & self-harm.

Figure 1. Profiles of ADHD symptoms. The figure shows the observed (dots) and estimated (lines) course of hyperactivity–impulsivity (red) and inattention (blue) symptoms (y-axis) over the course of middle childhood (x-axis) for the four identified ADHD symptom profiles. The model was estimated using Mplus V.8.11. We used 20 initial stage random starts and retained 4 for final stage optimisations. The best log-likelihood value was replicated two times. Data were for the Québec Longitudinal Study of Child Development and were compiled from the compiled from the final master file of the (1998–2023), Gouvernement du Québec, Institut de la statistique du Québec. ADHD, attention-deficit/hyperactivity disorder.

Figure 2. Adjusted estimates for the associations between ADHD symptom profiles and suicide attempt (A) and interaction metrics (B). Data were for the Québec Longitudinal Study of Child Development and were compiled from the compiled from the final master file of the (1998–2023), Gouvernement du Québec, Institut de la statistique du Québec. ADHD, attention-deficit/hyperactivity disorder.