Very Early Predictors of Adolescent Depression and Suicide Attempts in Children With Attention-Deficit/Hyperactivity Disorder

Abstract

Context Major depression and dysthymia in adolescence are associated with substantial disability, need for mental health services, and risk for recurrence. Concrete suicidal ideation and attempts during adolescence are particularly associated with significant distress, morbidity, and risk for completed suicide. Objectives To test the hypothesis that young children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for depression and suicidal ideation and attempts during adolescence and to identify early predictors of which young children with ADHD are at greatest risk. Design Prospective follow-up study. Setting Chicago, Illinois, and Pittsburgh, Pennsylvania. Patients A cohort of 125 children who met DSM-IV criteria for ADHD at 4 to 6 years of age and 123 demographically matched comparison children without ADHD were prospectively followed up in 7 structured diagnostic assessments of depression and suicidal behavior in assessment years 6 through 14, spanning 9 through 18 years of age. Main Outcome Measures DSM-IV criteria for depressive disorders and suicidal behavior. Results Children with ADHD at 4 to 6 years of age were at greatly increased risk for meeting DSM-IV criteria for major depression or dysthymia (hazard ratio, 4.32) and for attempting suicide (hazard ratio,3.60) through the age of 18 years relative to comparison children. There were marked variations in risk for these outcomes among children with ADHD, however. Within the ADHD group, children with each subtype of ADHD were at risk but for different adverse outcomes. Girls were at greater risk for depression and suicide attempts. Maternal depression and concurrent child emotional and behavior problems at 4 to 6 years of age predicted depression and suicidal behavior. Conclusions All subtypes of ADHD in young children robustly predict adolescent depression and/or suicide attempts 5 to 13 years later. Furthermore, female sex, maternal depression, and concurrent symptoms at 4 to 6 years of age predict which children with ADHD are at greatest risk for these adverse outcomes. Identifying high-risk young children with ADHD sets the stage for early prevention trials to reduce risk for later depression and suicidal behavior.

Subthreshold and threshold attention deficit hyperactivity disorder symptoms in childhood: psychosocial outcomes in adolescence in boys and girls

“…With higher base‐rate levels of emotional problems among girls in the general Swedish population 74, the associations between ADHD and internalizing/emotional problems reported here could to some extent be explained by covariation. However, higher rates of internalizing and/or emotional problems among girls with ADHD have been commonly reported in both clinical and population‐ or community‐based studies 8, 16, 19, 29, 46, 75, 76, 77, 78, 79, 80, 81. Thus, ADHD symptoms seem to contribute to the total internalizing problem load in a gender‐specific manner 61.…”

How Persistent is ADHD into Adulthood? Informant Report and Diagnostic Thresholds in a Female Sample

“…Because a number of large prevalence studies have suggested that the male: female ratio of the disorder may be markedly lower than once believed, especially in adulthood (e.g., DuPaul et al, 2001;Kessler et al, 2005;Ramtekkar et al, 2010;Simon et al, 2009), research on ADHD in young women presents an urgent area of need (see also Gaub & Carlson, 1997;Gershon, 2002). Overall, girls with ADHD may be at particularly high risk for negative outcomes over time (see Babinski et al, 2011;Biederman et al, 2010Biederman et al, , 2012Chronis-Tuscano et al, 2010;Dalsgaard, Mortensen, Frydenberg, & Thomsen, 2002;Hinshaw et al, 2012).…”

Hedonic Tone: A Bridge between the Psychobiology of Depression and its Comorbidities

“…In addition, individuals with MDD and ADHD experience higher levels of substance use and psychosocial impairment than disorder in isolation [32][33][34][35], suggesting a potential variant of MDD, and therefore explaining the treatment resistance in this population when treated with traditional SSRIs.…”