ADHD and Suicidality in Adolescents: A Systematic Review of Moderators and Mediators

In the United States, suicide is the second leading cause of death for those aged 10-14 and the third for those aged 15-24. Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at an increased risk for suicide compared to adolescents without ADHD. However, the strength of the relation between ADHD and suicide and the mechanisms at play in this association are unclear and need further investigation. This systematic review examined the literature to determine whether there is a direct association between ADHD and suicidality in adolescents, and which factors moderate or mediate this relation. A systematic literature search, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, was carried out on December 20th, 2024. Relevant publications were identified via electronic searches of PsycInfo and Web of Science databases. Studies were included if they assessed ADHD, suicidality, and at least one additional construct analyzed as a moderator or mediator. Studies had to include participants with a mean age between 10 and 19 years (i.e., an adolescent sample). The literature search yielded 405 articles, with 28 included in the final study selection. ADHD emerged as an independent risk factor for suicide among adolescents. Various constructs, including psychological, demographic, family, peer and social, subjective well-being, and trauma and adversity factors, served as moderators or mediators to varying degrees. Our review can inform adolescent suicide prevention efforts by highlighting the importance of addressing specific risk factors. Further research is needed to examine understudied factors, with emphasis on strengths-based factors to improve well-being.