Demo Giulia, Xiong Yi, Ferrara Maria, Williams Jamal B
medRxiv. 2025 Aug 13:2025.08.09.25333367. doi: 10.1101/2025.08.09.25333367.
Suicide in childhood is a growing clinical concern, and Attention-Deficit/Hyperactivity Disorder (ADHD) is increasingly recognized as a potential contributor. However, the role of psychiatric comorbidities, particularly depression, anxiety, and bipolar disorders, in shaping suicide risk in children with ADHD remains insufficiently understood.
We analyzed data from 10,862 children aged 8-11 in the ABCD Study. Descriptive analyses were used to estimate the prevalence of suicidal behaviors and psychiatric comorbidities in children with and without ADHD, stratified by sex. Logistic regression models were applied to assess suicide risk associated with ADHD and comorbid psychiatric diagnoses, adjusting for age and sex.
Children with ADHD had significantly higher rates of suicidal behaviors than controls. Passive suicidal ideation was reported in 15.6 % of females and 7.6 % of males with ADHD, versus 7.0 % and 4.7 % in controls (p < 0.001). Logistic regression identified Major Depressive Disorder (OR≈10-19) and Bipolar Disorder Type 2 (OR≈7-13) as the strongest predictors across outcomes. ADHD independently increased risk for most behaviors but moderated risk when comorbid with depression or Generalized Anxiety Disorder. Sex differences showed greater Bipolar Disorder Type 2- and Generalized Anxiety Disorder-related risk in females, and greater Bipolar Disorder Type 1- and depression-related risk in males.
Children with ADHD have higher rates of suicidal thoughts and behaviors than controls, with Major Depressive Disorder and Bipolar Disorder Type 2 as the strongest independent predictors. However, ADHD moderates the risk from Major Depressive Disorder and General Anxiety Disorder, likely due to earlier recognition and intervention. Lastly, sex-specific patterns show higher BD2- and GAD-related risk in females, BD1-related risk in males.
ADHD significantly increases the risk of suicidal ideation in children. However, when present with comorbid conditions, ADHD may offer a clinical advantage by prompting earlier diagnosis and access to care. Improving ADHD recognition in pediatric settings could serve as a critical step in suicide prevention and early psychiatric intervention.
Our study looked at more than 10,000 children aged 8-11 to see how ADHD and other mental health conditions affect suicidal thoughts and behaviors. Children with ADHD were more likely to have suicidal thoughts and behaviors than those without ADHD. Depression and Bipolar Disorder Type 2 were the strongest risk factors. Interestingly, when ADHD occurred alongside depression or Generalized Anxiety Disorder, the risk was often lower, possibly because ADHD leads to earlier detection and treatment. Risk patterns also differed by sex, suggesting that suicide prevention should be tailored to each child.
儿童自杀是一个日益受到临床关注的问题，注意缺陷多动障碍（ADHD）越来越被认为是一个潜在的促成因素。然而，精神共病，特别是抑郁症、焦虑症和双相情感障碍，在塑造ADHD儿童自杀风险方面的作用仍未得到充分理解。
我们分析了ABCD研究中10862名8至11岁儿童的数据。采用描述性分析来估计患有和未患有ADHD的儿童中自杀行为和精神共病的患病率，并按性别分层。应用逻辑回归模型评估与ADHD和共病精神诊断相关的自杀风险，并对年龄和性别进行调整。
患有ADHD的儿童自杀行为发生率显著高于对照组。报告显示，患有ADHD的女性中有15.6%有被动自杀意念，男性中有7.6%有被动自杀意念，而对照组中女性为7.0%，男性为4.7%（p<0.001）。逻辑回归确定重度抑郁症（OR≈10 - 19）和2型双相情感障碍（OR≈7 - 13）是所有结果中最强的预测因素。ADHD独立增加了大多数行为的风险，但与抑郁症或广泛性焦虑症共病时风险会降低。性别差异显示，2型双相情感障碍和广泛性焦虑症相关风险在女性中更大，1型双相情感障碍和抑郁症相关风险在男性中更大。
患有ADHD的儿童自杀想法和行为发生率高于对照组，重度抑郁症和2型双相情感障碍是最强的独立预测因素。然而，ADHD会降低重度抑郁症和广泛性焦虑症带来的风险，这可能是由于更早的识别和干预。最后，特定性别的模式显示，女性中与2型双相情感障碍和广泛性焦虑症相关的风险更高，男性中与1型双相情感障碍相关的风险更高。
ADHD显著增加儿童自杀意念的风险。然而，当存在共病情况时，ADHD可能通过促使更早的诊断和获得治疗而具有临床优势。提高儿科环境中对ADHD的识别可能是预防自杀和早期精神干预的关键一步。
我们的研究观察了10000多名8至11岁的儿童，并研究了ADHD和其他心理健康状况如何影响自杀想法和行为。患有ADHD的儿童比没有ADHD的儿童更有可能产生自杀想法和行为。抑郁症和2型双相情感障碍是最强的风险因素。有趣的是，当ADHD与抑郁症或广泛性焦虑症同时出现时风险通常较低可能是因为ADHD能带来更早的发现和治疗。风险模式也因性别而异，这表明自杀预防应针对每个儿童量身定制。
