People with Attention Deficit Hyperactive Disorder are far more likely to attempt suicide than those without ADHD, with women being particularly vulnerable to suicidal ideation, according to a large-scale national study out of Canada.

A nationally representative Canadian study of more than 21,000 adults reported that the prevalence of suicide attempts among women with ADHD stood at 24% but at just 3% for those without. Men with ADHD were also about four and a half times more likely to have attempted suicide than their peers without ADHD. The study, published in December in the Archives of Suicide Research, found that overall, 14% of adults with ADHD had attempted suicide, compared to just 2.7% of those without.

“I was dismayed by the magnitude of the difficulties that those with ADHD in general, and women in particular, are experiencing,” said lead author Esme Fuller-Thomson, professor at the University of Toronto’s Factor-Inwentash Faculty of Social Work. “These levels of suicide attempts are shocking, worrying, and clearly in need of attention.”

Part of the underlying issue when it comes to the connection between ADHD and suicide is the societal belief that ADHD is something that only exists during childhood, Fuller-Thomson said. This belief might make it less likely for adults to get the support they need.

“Most people just assume ADHD disappears at your 18th birthday. Unfortunately, it does not,” Fuller-Thomson said. “Many people do manage, develop coping strategies, and can function well. But there are some who continue to live with levels of symptomatology that would indicate that they still have ADHD in adulthood.”

Certain comorbidities for other kinds of disorders could also be playing a role in the comparatively high levels of suicide attempts for those with ADHD. For example, 47% of adults with ADHD have a comorbid anxiety disorder, while 44% reported that they had insomnia. Individuals with ADHD also showed higher rates of substance use disorders, depression or other mood disorders, learning disabilities and chronic pain issues. All of these factors have been shown to be strongly associated with suicidal thoughts and suicide attempts, Fuller-Thomson said.

“We’ve got this perfect storm of stressors,” Fuller-Thompson said.

For women in particular, 44% of those with ADHD had also reported having experienced physical abuse of some kind during their childhood, another factor that can lead to suicidal thoughts. Previous research into this topic showed that 46% of women with ADHD had seriously considered suicide at some point, Fuller-Thomson said, further highlighting the gender discrepancies.

A large part of the issue for women with ADHD is that, especially during childhood, they may have been “under the radar” for a diagnosis, Fuller-Thomson noted.

“They may not present with the hyperactive component, so as long as they’re fine academically, they muddle through and may not even be noticed,” Fuller-Thompson said. “It may be that women with ADHD are actually more severe than the men with ADHD. The men might have had the hyperactive component, so we see the whole spectrum of ADHD in those diagnoses, but we might only see the most acute among women, just because it’s less common to be diagnosed among women.”

ADHD manifesting as a lack of impulse control or organizational ability can lead to financial hardship during adulthood, which too can often lead to suicidal ideation, Fuller-Thomson said. An even larger part of the problem is how, “ADHD tends to run amok with your social relations,” Fuller-Thomson added, which can result in a lack of a support system during adulthood.

“If you have impulse control issues, it can impact social belonging, and make it more difficult from childhood on up to have close and supportive relationships,” Fuller-Thomson said.

However, there are some simple interventions that can be taken in order to stave off the onset of comorbid disorders for those who have ADHD. Fuller-Thomson recommended that people look into cognitive behavioral therapy, which is a form of psychological treatment that has been shown to help individuals with a variety of disorders work through dysfunctional thoughts. Other kinds of coaching and behavioral modification for organizational skills have also proven to be effective.

“There [was] a fabulous intervention in Scandinavia where they just did some training with people about using a calendar, and it was very, very effective in reducing symptoms,” Fuller-Thomson noted. “If you can’t get to work on time, if you can’t get to your appointment on time, you end up missing out on things – all of these can be managed … or certainly be improved with coaching.”

Fuller-Thomson said that she hopes the study will bring a greater awareness of the connection between ADHD and suicide, given that the ADHD population is especially vulnerable to suicidal thoughts.

“Health care providers need to be particularly attentive to their patients with ADHD and helping monitor and screen and address mental health concerns,” Fuller-Thomson added.

The article, “The Dark Side of ADHD: Factors Associated With Suicide Attempts Among Those With ADHD in a National Representative Canadian Sample,” was published Dec. 21, 2020 in the Archives of Suicide Research. It was authored by Esme-Fuller Thomson, Raphaël Nahar Rivière and Lauren Carrique, all of the University of Toronto, and Senyo Agbeyaka of Toronto General Hospital.