Department of Psychiatry, The Hospital for Sick Children, Toronto M5G 1X8, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Psychiatry, The Hospital for Sick Children, Toronto M5G 1X8, ON, Canada; Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
J Affect Disord. 2020 Mar 15;265:200-206. doi: 10.1016/j.jad.2020.01.022. Epub 2020 Jan 9.
Attention-deficit/hyperactivity disorder (ADHD) is associated with increased suicidality risk. Yet, potential mechanisms transmitting the effect of ADHD to suicidality remain unclear. We investigated whether depression, irritability and anxiety symptoms mediate between ADHD symptoms and suicidality.
ADHD, depression, irritability and anxiety symptoms as well as suicidality (composited of suicidal ideation, attempts or self-harm) were measured in an outpatient clinic for ADHD (N = 1,516, 6-17 years old, 61.1% diagnosed with ADHD) using parent and teacher questionnaires. Multiple mediator models adjusted for age, sex and psychosocial adversities were constructed separately for parent- and teacher-report.
Parents reported higher rates of suicidality than did teachers (12.1% and 3.8%, p < .001). Suicidality was associated with parent (OR = 1.10, 95%CI: 1.07-1.14) and teacher (OR = 1.08, 95%CI: 1.03-1.15) reported ADHD symptoms. The association between ADHD symptoms and suicidality was mediated by both parent- and teacher-reported depression (39.1% and 45.3% of total effect, respectively) and irritability symptoms (36.8% and 38.4% of total effect, respectively). Anxiety symptoms mediated between ADHD and suicidality for parent- but not teacher-report (19.0% of total effect). No direct effect of ADHD symptoms was found once depression, irritability and anxiety were controlled.
The cross-sectional design limits the ability to determine causal order between mediators and outcome.
Our results confirmed the association between ADHD symptoms and suicidality. However, this association was indirect and fully mediated by symptoms of depression, irritability and anxiety. Assessing these symptoms may enable an estimate of suicidality and help managing suicidal risk in ADHD.
注意力缺陷多动障碍（ADHD）与自杀风险增加有关。然而，将 ADHD 对自杀的影响传递的潜在机制仍不清楚。我们研究了抑郁、易怒和焦虑症状是否在 ADHD 症状和自杀之间起中介作用。
使用家长和教师问卷，在 ADHD 门诊（N=1516，年龄 6-17 岁，61.1%被诊断为 ADHD）中测量 ADHD、抑郁、易怒和焦虑症状以及自杀（包括自杀意念、尝试或自残）。分别为家长和教师报告构建了调整年龄、性别和心理社会逆境的多中介模型。
家长报告的自杀率高于教师（12.1%和 3.8%，p<0.001）。自杀与父母（OR=1.10，95%CI：1.07-1.14）和教师（OR=1.08，95%CI：1.03-1.15）报告的 ADHD 症状相关。ADHD 症状与自杀之间的关联通过父母（分别为总效应的 39.1%和 45.3%）和教师（分别为总效应的 36.8%和 38.4%）报告的抑郁和易怒症状而中介。ADHD 与自杀之间的焦虑症状通过父母报告（总效应的 19.0%）起中介作用，但通过教师报告不起中介作用。一旦控制了抑郁、易怒和焦虑，就没有发现 ADHD 症状的直接影响。
横断面设计限制了在中介和结果之间确定因果顺序的能力。
我们的研究结果证实了 ADHD 症状与自杀之间的关联。然而，这种关联是间接的，完全由抑郁、易怒和焦虑症状介导。评估这些症状可以估计自杀倾向并有助于管理 ADHD 患者的自杀风险。
