Psychiatric Comorbidities Predict Elevated Suicidal Symptoms in Children with ADHD
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Introduction
Suicide in childhood is a growing clinical concern, and Attention-Deficit/Hyperactivity Disorder (ADHD) is increasingly recognized as a potential contributor. However, the role of psychiatric comorbidities, particularly depression, anxiety, and bipolar disorders, in shaping suicide risk in children with ADHD remains insufficiently understood
Methods
We analyzed data from 10,862 children aged 8–11 in the ABCD Study. Descriptive analyses were used to estimate the prevalence of suicidal behaviors and psychiatric comorbidities in children with and without ADHD, stratified by sex. Logistic regression models were applied to assess suicide risk associated with ADHD and comorbid psychiatric diagnoses, adjusting for age and sex.
Results
Children with ADHD had significantly higher rates of suicidal behaviors than controls. Passive suicidal ideation was reported in 15.6 % of females and 7.6 % of males with ADHD, versus 7.0 % and 4.7 % in controls (p < 0.001). Logistic regression identified Major Depressive Disorder (OR≈10–19) and Bipolar Disorder Type 2 (OR≈7–13) as the strongest predictors across outcomes. ADHD independently increased risk for most behaviors but moderated risk when comorbid with depression or Generalized Anxiety Disorder. Sex differences showed greater Bipolar Disorder Type 2- and Generalized Anxiety Disorder-related risk in females, and greater Bipolar Disorder Type 1- and depression-related risk in males.
Discussion
Children with ADHD have higher rates of suicidal thoughts and behaviors than controls, with Major Depressive Disorder and Bipolar Disorder Type 2 as the strongest independent predictors. However, ADHD moderates the risk from Major Depressive Disorder and General Anxiety Disorder, likely due to earlier recognition and intervention. Lastly, sex-specific patterns show higher BD2- and GAD-related risk in females, BD1-related risk in males.
Conclusion
ADHD significantly increases the risk of suicidal ideation in children. However, when present with comorbid conditions, ADHD may offer a clinical advantage by prompting earlier diagnosis and access to care. Improving ADHD recognition in pediatric settings could serve as a critical step in suicide prevention and early psychiatric intervention.
PLAIN LANGUAGE SUMMARY
Our study looked at more than 10,000 children aged 8–11 to see how ADHD and other mental health conditions affect suicidal thoughts and behaviors. Children with ADHD were more likely to have suicidal thoughts and behaviors than those without ADHD. Depression and Bipolar Disorder Type 2 were the strongest risk factors. Interestingly, when ADHD occurred alongside depression or Generalized Anxiety Disorder, the risk was often lower, possibly because ADHD leads to earlier detection and treatment. Risk patterns also differed by sex, suggesting that suicide prevention should be tailored to each child.
