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Attention deficit hyperactivity disorder and suicide: a review of possible associations

Authors


Dr Anthony James, Highfield Adolescent Unit, Warneford Hospital, Oxford OX3 7JX, UK.

E-mail: anthony.james@psych.ox.ac.uk

Abstract

Objective:  To review the evidence of a possible association between attention deficit hyperactivity disorder (ADHD) and suicide.

Design:  We searched the electronic data bases: Medline, Psych LIT, between 1966 and March 2003 looking for articles on ADHD, attention deficit disorder, hyperactivity and suicide.

Results:  An association of ADHD and completed suicide was found, especially for younger males. However, the evidence for any direct or independent link was modest with an overall suicide rate from long-term follow-up studies of ADHD of 0.63–0.78%. The estimated relative risk ratio, compared with US national suicide rates (males 5–24 years) is 2.91 (95% confidence interval 1.47–5.7, χ2 = 9.3, d.f. = 1, P = 0.002). ADHD appears to increase the risk of suicide in males via increasing severity of comorbid conditions, particularly conduct disorder (CD) and depression.

Conclusion:  Identification of those at risk, particularly males with comorbid ADHD, depression and CD, may represent a useful clinical means of reducing completed suicide.

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