Spodenkiewicz, Michel, Inja, Ayla, Cortese, Samuele, Galera, Cédric, Ouellet-Morin, Isabelle, Côté, Sylvana M., Boivin, Michel, Vitaro, Frank, Brengden, Mara, Dionne, Ginette, Renaud, Johanne, Tremblay, Richard E., Turecki, Gustavo, Geoffroy, Marie-Claude and Orri, Massimiliano (2025) Association of hyperactivity-impulsivity and inattention symptoms profiles with suicide attempt: a 18-year population-based cohort study. BMJ Mental Health, 28 (1), [e301725]. (doi:10.1136/bmjment-2025-301725).
Abstract
Aims: attention-deficit/hyperactivity disorder (ADHD) symptomatology in childhood is associated with a high risk of suicide attempt later in life. However, symptoms presentation in ADHD is heterogeneous, and little is known about how suicide risk varies according to different profiles of ADHD symptoms and sex. The aim was to investigate the longitudinal associations between childhood profiles of ADHD symptoms (i.e., hyperactivity-impulsivity and inattention) and youth suicide attempt in males and females, separately.
Methods: this population-based cohort study used data from three longitudinal cohorts: the Quebec Longitudinal Study of Child Development the Quebec Longitudinal Study of Kindergarten Children, and the Quebec Newborn Twin Study for a total of 4,399 participants (1490 from the QLSCD, 2134 from the QLSKC, and 775 from the QNTS; 50% females) followed up from age 6 to age 23 years. Symptoms of hyperactivity-impulsivity and inattention were assessed by teachers 5 times from ages 6 to 12 years. Suicide attempt in adolescence and young adulthood (by age 23) was self-reported. Multi-trajectory modelig was used to identify profiles of ADHD symptoms, and regression analysis was used to test their association with suicide attempt, adjusting for childhood socioeconomic and clinical characteristics.
Results: we identified four ADHD symptoms profiles with distinct associations with suicide attempt for males and females. Compared with those with persistently low symptoms, females with persistently high inattention and hyperactivity-impulsivity (OR: 2.54, CI 1.39-4.63) or high inattention and low hyperactivity-impulsivity (OR: 1.81, CI 1.21-2.70) were at higher risk of suicide attempt, while, among males, only those with decreasing hyperactivity-impulsivity and inattention over time (OR: 2.23, CI 1.20-4.13) were at higher risk of suicide attempt.
Conclusions: suicide risk in children with ADHD symptoms varies according to both symptoms profile and sex, the highest risk being for females with high inattention symptoms (with or without hyperactivity), and males with decreasing symptoms. Accounting for these differences may be relevant to more accurately identify and manage suicide risk in individuals with ADHD.
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