Taipei City Psychiatric Center, Taipei City Hospital, Taipei City, Taiwan; Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei City, Taiwan.
Department of Psychiatry, National Taiwan University Hospital and College of Medicine, No. 7, Chung-Shan South road, Taipei 10002, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
J Affect Disord. 2019 Jan 1;242:96-104. doi: 10.1016/j.jad.2018.08.023. Epub 2018 Aug 24.
To explore the association between Attention-Deficit Hyperactivity Disorder ("ADHD") and suicidality in children. Mediating effects of family function and psychiatric co-morbidities were also explored.
This is a national representative cross-sectional survey of school-based sample of 4739 children aged 7-15. Logistic regression was used to assess the excess risks of suicidality (i.e., suicidal ideation, suicide plan, and suicide attempts) in 412 children with ADHD. Serial multiple mediator models were conducted to assess the mediating effects of family function and psychiatric comorbidities.
The prevalence of suicidality in children with ADHD was approximately 20% in Taiwan. After adjusting for potential confounders, the risk of suicidality among children with ADHD was approximately four times higher than among non-ADHD children [(adjusted Odds Ratio ["OR"] = 3.82, 95% Confidence Interval ("CI") (2.73, 5.34)] for suicidal ideation, adjusted OR = 4.18, 95% CI (2.57, 6.80) for suicide plan and adjusted OR = 4.45, 95% CI (1.99, 9.93) for suicide attempts. The mediating effects of anxiety/depression and conduct problems were about 20% and 8%, respectively, across all suicide outcomes. The mediating effects of family function were around 6-7% for suicidal ideation and 16-18% for suicide plan and suicide attempts. The effects of ADHD on suicidality, in general, remained after considering the mediating roles of family function and psychiatric comorbid conditions.
Children with ADHD are at a high risk of suicide. Although the family function and psychiatric co-morbidities partially mediate this association, ADHD in itself is a potent suicide risk factor and should be an important target for suicide prevention.
探讨儿童注意缺陷多动障碍（“ADHD”）与自杀意念之间的关联。还探讨了家庭功能和精神共病的中介作用。
这是一项针对全国范围内 4739 名 7-15 岁学龄儿童的基于学校的代表性横断面调查。使用逻辑回归评估 412 名 ADHD 儿童自杀意念（即自杀意念、自杀计划和自杀尝试）的超额风险。进行串联多重中介模型以评估家庭功能和精神共病的中介作用。
台湾 ADHD 儿童自杀意念的患病率约为 20%。在调整潜在混杂因素后，ADHD 儿童自杀的风险大约是非 ADHD 儿童的四倍[(调整后的优势比(“OR”)=3.82，95%置信区间(“CI”)(2.73,5.34)]自杀意念，调整后的 OR=4.18，95%CI(2.57,6.80)自杀计划和调整后的 OR=4.45，95%CI(1.99,9.93)自杀尝试。焦虑/抑郁和品行问题的中介作用约为 20%和 8%，适用于所有自杀结局。家庭功能的中介作用约为 6-7%，适用于自杀意念，16-18%，适用于自杀计划和自杀尝试。考虑到家庭功能和精神共病状况的中介作用，ADHD 对自杀意念的总体影响仍然存在。
患有 ADHD 的儿童自杀风险很高。尽管家庭功能和精神共病部分中介了这种关联，但 ADHD 本身就是一个强有力的自杀风险因素，应该成为预防自杀的重要目标。
