Di Salvo Gabriele, Perotti Camilla, Filippo Lorenzo, Garrone Camilla, Rosso Gianluca, Maina Giuseppe
Department of Neurosciences "Rita Levi Montalcini", University of Turin, Turin, Italy.
Psychiatric Unit, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy.
Ann Gen Psychiatry. 2024 Nov 1;23(1):42. doi: 10.1186/s12991-024-00528-8.
The association between Attention-deficit hyperactivity disorder (ADHD) and suicidality has been subject of growing interest for research in the latest years. Suicidality was generally assessed categorically and without the use of validated instruments, leading to heterogeneous or even conflicting evidence. The prevalence of both suicidal ideation and attempts varies considerably, and the associated risk factors remain unclear. Our study investigated suicidality in ADHD using a dimensional approach and a validated and internationally recognized instrument. Our primary aim was to evaluate the prevalence of suicidal ideation (SI), severe suicidal ideation (SSI), suicidal behavior (SB) and non suicidal self-injury behavior (NSSIB) in a sample of adult patients with ADHD. The second objective was to identify sociodemographic and clinical features associated with increased risk of suicidality in these patients.
The sample included 74 adult patients with clinical diagnosis of ADHD. Suicidality was assessed by administering the Columbia-Suicide Severity Rating Scale. Logistic regressions were used to examine predictors of SI, SSI, SB and NSSIB.
The lifetime prevalence of SI and SSI were 59.5% and 16.2%, respectively. The 9.5% of patients showed lifetime SB, while NSSIB was found in 10.8% of the subjects. Lifetime SI was associated with severity of inattentive symptoms during adulthood, low self-esteem and impairment in social functioning. Lifetime SSI appeared related to severity of inattentive symptoms during childhood, attentional impulsiveness and number of hospitalizations, while physical activity appeared to be protective. The prevalence of lifetime SB and NSSIB did not appear significantly related to any socio-demographic or clinical feature.
Adults with ADHD should be considered at risk of suicide and it is important to determine which patients are at higher risk, in order to guide preventive interventions. The association between ADHD and suicidal ideation did not appear to be influenced by psychiatric comorbidities, but rather by inattention itself, which represents the core symptom of ADHD.
近年来，注意缺陷多动障碍（ADHD）与自杀倾向之间的关联一直是研究日益关注的主题。自杀倾向的评估通常采用分类法，且未使用经过验证的工具，这导致了证据的异质性甚至相互矛盾。自杀意念和自杀未遂的患病率差异很大，相关的风险因素仍不明确。我们的研究采用维度方法和经过验证且国际认可的工具，对ADHD患者的自杀倾向进行了调查。我们的主要目的是评估成年ADHD患者样本中自杀意念（SI）、严重自杀意念（SSI）、自杀行为（SB）和非自杀性自伤行为（NSSIB）的患病率。第二个目标是确定与这些患者自杀倾向风险增加相关的社会人口统计学和临床特征。
样本包括74名临床诊断为ADHD的成年患者。通过使用哥伦比亚自杀严重程度评定量表对自杀倾向进行评估。采用逻辑回归分析来检查SI、SSI、SB和NSSIB的预测因素。
SI和SSI的终生患病率分别为59.5%和16.2%。9.5%的患者有终生SB，而10.8%的受试者存在NSSIB。终生SI与成年期注意力不集中症状的严重程度、低自尊和社交功能受损有关。终生SSI似乎与儿童期注意力不集中症状的严重程度、注意力冲动性和住院次数有关，而体育活动似乎具有保护作用。终生SB和NSSIB的患病率似乎与任何社会人口统计学或临床特征均无显著关联。
成年ADHD患者应被视为有自杀风险，确定哪些患者风险更高很重要，以便指导预防干预措施。ADHD与自杀意念之间的关联似乎不受精神共病的影响，而是受注意力不集中本身的影响，注意力不集中是ADHD的核心症状。
