The association between attempted suicide and ADHD in adolescents: A large-scale population-based study

Suicide is the second leading cause of death among adolescents. Although suicide attempts are most frequently associated with mood, sleep, and personality disorders, attention-deficit/hyperactivity disorder (ADHD) may also confer risk. We hypothesized that ADHD is independently associated with suicide attempts beyond the effects of psychiatric comorbidities.

We conducted a retrospective, population-based case-control study using electronic medical records from Clalit Health Services (N = 1,652,752) among adolescents aged 12-18 years. The study group comprised 1763 adolescents who presented to emergency departments for attempted suicide between 2010 and 2022. Diagnoses were based on ICD-10 and DSM-5 criteria. Logistic regression analyses assessed associations between ADHD and attempted suicide while adjusting for comorbid psychiatric disorders.

Adolescents who attempted suicide exhibited a markedly higher female-to-male ratio (80%:20%) than the general population (51%:49%). Higher socioeconomic status among adolescents with ADHD was significantly associated with increased attempted suicide risk. Comorbidities, including major depressive disorder, anxiety, and personality disorders, were also linked to suicide attempts. Importantly, ADHD remained an independent risk factor for attempted suicide even after excluding significant psychiatric comorbidities (e.g., without depression: OR 2.12, 95% CI 1.91-2.35; without borderline personality disorder: OR 2.39, 95% CI 2.15-2.65).

ADHD significantly increases the risk of suicide attempts in adolescents, independent of common psychiatric comorbidities. These findings underscore the need for targeted screening and prevention strategies in this high-risk population.