Attention-deficit hyperactivity disorder and suicidality in a treatment naive sample of children and adolescents

Background: The aim of the present study was to investigate the possible association between attention-deficit/hyperactivity disorder (ADHD) and suicidality. Methods: Using a structured interview (Mini International Neuropsychiatric Interview Kid), the authors examined 418 treatment naive children/adolescents (aged: 3-18 years). Suicidality was defined by the MINI. Kid as having any current suicidal ideations and/or suicide attempts. Results: Two hundred and eleven children/adolescents fulfilled the DSM-IV diagnosis of ADHD and a further 105 showed symptoms of ADHD in subthreshold level. Multiple mediation analyses resulted in a moderated meditational model in which the relationship between symptoms of ADHD and current suicidality was fully mediated by the symptoms of comorbid conditions, but this was moderated by age. In children under 12 years, significant mediators were the symptoms of specific anxiety disorders, while in the adolescent group symptoms of major depressive episode and dysthymia and symptoms of substance abuse/dependence approved as significant mediators. Limitations: As the study was cross-sectional, it did not reveal any causal relationship among the investigated factors. Furthermore, as the study population included a treatment naive clinical sample, we can assume that adolescents, who and/or whose family seek for help at the first time in this age belonged to the less sever end of the spectrum. Conclusions: ADHD symptoms are associated with an increased risk of suicidality in treatment naive children/adolescents. The mechanisms of this relationship can be understood only when developmental factors are considered. Our findings suggest that clinicians should screen suicidality and comorbid symptoms routinely in patients with ADHD. (C) 2013 Elsevier B.V. All rights reserved