Attention-Deficit/Hyperactivity Disorder and Suicidal Risk in Major Depression: Analysis of 141,530 Adolescent Hospitalizations

Abstract

We conducted a cross-sectional study to understand the differences in demographics and psychiatric comorbidities in adolescents with major depressive disorder (MDD) and assess the risk of suicidality due to comorbid attention-deficit/hyperactivity disorder (ADHD). Methods We included 141,530 adolescents (age, 12 to 18 years) with a primary diagnosis of MDD from the nationwide inpatient sample (NIS, 2012-2014), and grouped by a comorbid diagnosis of ADHD (N = 22,665, 16%). Logistic regression analysis was used to measure the demographic predictors for ADHD in adolescents with MDD, and to measure the suicidal risk in ADHD versus non-ADHD. Results Comorbid ADHD was prevalent in whites (71.9%), and males had two times higher odds (95% CI 2.25-2.41) compared to females. The most prevalent comorbidities seen in ADHD-cohort were anxiety disorders (46.3%) and substance abuse (20.1%) with 1.3 times higher odds of substance abuse (95% CI 1.41-1.65) compared to non-ADHD. Suicidal behaviors were seen in a higher proportion of the ADHD cohort compared to the non-ADHD cohort (54.3% vs. 52.7%). ADHD and suicidal behaviors relationship was statistically significant but had a very small positive association (OR 1.04, 95% CI 1.01-1.08) after controlling for demographic confounders and comorbidities. There was a significant increase in the number of MDD hospitalization with ADHD for suicidal behaviors from 51.1% (N = 3,360) in 2012 to 58.2% (N = 5,115) in 2014. Conclusion There exists a significant but small positive association between suicidal behaviors and comorbid ADHD in MDD adolescents. The suicide rate has increased by 52.2% during the study period in depressed adolescents with ADHD. This calls for early diagnosis and management of ADHD and early-onset depression in adolescents to prevent suicide risk.

Substance Use Disorders (SUD) and Suicidal Behaviors in Adolescents: Insights From Cross-Sectional Inpatient Study

“…Past studies have found adolescents with psychiatric comorbidities like depressive disorders and attentiondeficit/hyperactivity disorder were at a higher risk of SUD, which can lead to impairment of overall functioning [12,13]. Our study focuses on identifying the demographic predictors of suicidal behaviors and assessing the relationship between the spectrum of SUD and suicidal behaviors in the adolescent population.…”

Intento de Autoeliminación en la Niñez y Adolescencia. Presentación de un modelo de prevención del intento de autoeliminación en niños y adolescentes tempranos en un Hospital Pediátrico en Montevideo

“…En esta muestra hay un importante retraso escolar, las dificultades académicas y el abandono escolar están señalados como fuertes factores de riesgo para las conductas lesivas (2,15,19,21,22,25). Si bien el 92,5 % se encuentran escolarizados, lo cual se podría considerar como un factor protector, en cuanto a su nivel de instrucción, el 35 % de los varones tienen retraso escolar (o sea repitieron un año) y lo mismo sucede con el 52 % de las mujeres.…”

“…El vínculo entre el suicidio y los trastornos mentales, no siempre evidente (4), parecería responder a la acumulación de factores de riesgo que repercute tanto en los problemas internalizados como externalizados (7) y las situaciones individuales estresantes marcadas por la impulsividad (19). En el suicidio infantil, el Trastorno Psiquiátrico presente alrededor de un 80 %, se relaciona los trastornos del estado de ánimo, de ansiedad, del comportamiento y del consumo de sustancias (3,9).…”

“…En el suicidio infantil, el Trastorno Psiquiátrico presente alrededor de un 80 %, se relaciona los trastornos del estado de ánimo, de ansiedad, del comportamiento y del consumo de sustancias (3,9). La desregulación emocional, propia de las patologías graves del humor y del comportamiento de presentación temprana, se asocian a los IAE y a las LAIs (19,20).…”

Comorbid Anxiety and Suicidal Behaviors in American Adolescents With Major Depression

“…Other major risk factors are anxiety disorders, eating disorders, alcohol and/or drug abuse, impulsive aggression, antisocial behavior, family history of suicidal behavior, and family conflict and discordance [6]. Also, two nationwide studies conducted in the United States found a significant association between suicidality and post-traumatic stress disorder, with attention-deficit/hyperactivity disorder (ADHD) increasing suicide risk in depressed adolescents by 52% [7,8].…”