Individuals with Attention-Deficit Hyperactivity Disorder (ADHD) are at an increased risk of suicidal ideation and attempts compared to the general population. However, the mechanisms underlying suicidal behaviors in this group remain poorly understood. The role of childhood trauma, which frequently co-occurs with ADHD, and emotional dysregulation in suicidal behaviors remains unclear. This study employs a case-control design to investigate the impact of childhood trauma and emotional dysregulation on suicidal tendencies in adults with ADHD. A total of 160 adults diagnosed with ADHD who presented to the Adult Neurodevelopmental Disorders Clinic at Selçuk University, along with 107 typical controls, were included in the study. Participants were assessed using the Structured Clinical Interview for DSM-5, Adult ADHD Self-Report Scale, Suicidal Ideation Scale, Childhood Trauma Questionnaire, and the Difficulties in Emotion Regulation Scale—Short Form. Regression and mediation models were conducted to examine factors influencing suicidal tendencies, controlling for sociodemographic and clinical variables. Compared to controls, individuals with ADHD exhibited significantly higher levels of suicidal ideation, childhood trauma, and emotional dysregulation. Regression analysis revealed a positive association between childhood trauma, emotional dysregulation, and suicidal ideation. However, ADHD symptoms did not directly contribute to increased suicidal ideation; rather, their effect was mediated through childhood trauma and emotional dysregulation. Additionally, the presence of depression was significantly associated with both suicide attempts and suicidal ideation. These findings suggest that childhood trauma and difficulties in emotion regulation play critical roles in suicidal ideation among individuals with ADHD. In addition to depression treatment, comprehensive interventions targeting childhood trauma and emotional dysregulation may serve as promising strategies for reducing suicidal behaviors.
AdamouM.ArifM.AshersonP.CubbinS.LeaverL.Sedgwick-MüllerJ.Müller-SedgwickU.Van RensburgK.KustowJ. (2024). The adult ADHD assessment quality assurance standard. Frontiers in Psychiatry, 15, 1380410. https://doi.org/10.3389/fpsyt.2024.1380410
2.
AgostiV.ChenY.LevinF. R. (2011). Does attention deficit hyperactivity disorder increase the risk of suicide attempts?Journal of Affective Disorders, 133(3), 595–599. https://doi.org/10.1016/j.jad.2011.05.008
3.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (Vol. 5).
4.
AslanI. H.DoreyL.GrantJ. E.ChamberlainS. R. (2024). Emotion regulation across psychiatric disorders. CNS Spectrums, 29(3), 215–220. https://doi.org/10.1017/S1092852924000270
5.
BalazsJ.KeresztenyA. (2017). Attention-deficit/hyperactivity disorder and suicide: A systematic review. World Journal of Psychiatry, 7(1), 44. https://doi.org/10.5498/wjp.v7.i1.44
6.
BernsteinD. P.FinkL.HandelsmanL.FooteJ.LovejoyM.WenzelK.SaparetoE.RuggieroJ. (1994). Initial reliability and validity of a new retrospective measure of child abuse and neglect. The American Journal of Psychiatry, 151(8), 1132–1136. https://doi.org/10.1176/ajp.151.8.1132
7.
BiedermanJ.BallS. W.MonuteauxM. C.MickE.SpencerT. J.McCrearyM.CoteM.FaraoneS. V. (2008). New insights into the comorbidity between ADHD and major depression in adolescent and young adult females. Journal of the American Academy of Child & Adolescent Psychiatry, 47(4), 426–434. https://doi.org/10.1097/CHI.0b013e31816429d3
8.
CarrC. P.MartinsC. M. S.StingelA. M.LemgruberV. B.JuruenaM. F. (2013). The role of early life stress in adult psychiatric disorders: A systematic review according to childhood trauma subtypes. The Journal of Nervous and Mental Disease, 201(12), 1007–1020. https://doi.org/10.1097/NMD.0000000000000049
9.
ChristiansenH.HirschO.AlbrechtB.ChavanonM.-L. (2019). Attention-deficit/hyperactivity disorder (ADHD) and emotion regulation over the life span. Current Psychiatry Reports, 21, 1–11. https://doi.org/10.1007/s11920-019-1003-6
10.
CludiusB.MenninD.EhringT. (2020). Emotion regulation as a transdiagnostic process. Emotion, 20(1), 37. https://doi.org/10.1037/emo0000646
11.
CohenJ. (2013). Statistical power analysis for the behavioral sciences. Routledge.
12.
Colmenero-NavarreteL.García-SanchoE.SalgueroJ. M. (2022). Relationship between emotion regulation and suicide ideation and attempt in adults and adolescents: A systematic review. Archives of Suicide Research, 26(4), 1702–1735. https://doi.org/10.1080/13811118.2021.1999872
13.
CraigS. G.BondiB. C.O’DonnellK. A.PeplerD. J.WeissM. D. (2020). ADHD and exposure to maltreatment in children and youth: A systematic review of the past 10 years. Current Psychiatry Reports, 22, 1–14. https://doi.org/10.1007/s11920-020-01193-w
14.
DahmenB.PützV.Herpertz-DahlmannB.KonradK. (2012). Early pathogenic care and the development of ADHD-like symptoms. Journal of Neural Transmission, 119, 1023–1036. https://doi.org/10.1007/s00702-012-0809-8
15.
De BellisM. D.ZiskA. (2014). The biological effects of childhood trauma. Child and Adolescent Psychiatric Clinics, 23(2), 185–222. https://doi.org/10.1016/j.chc.2014.01.002
16.
Di SalvoG.PerottiC.FilippoL.GarroneC.RossoG.MainaG. (2024). Assessing suicidality in adult ADHD patients: Prevalence and related factors. Annals of General Psychiatry, 23(1), 1–14. https://doi.org/10.1186/s12991-024-00528-8
17.
DilbazN.HolatH.BayamG.TüzerT.BitlisV. (1995). İntihar düşüncesi ölçeğinin geçerlilik ve güvenirliği. 31. Ulusal Psikiyatri Bilimler Kongresi Bilimsel Çalışma Kitabı, 40–41.
18.
DinklerL.LundströmS.GajwaniR.LichtensteinP.GillbergC.MinnisH. (2017). Maltreatment-associated neurodevelopmental disorders: A co-twin control analysis. Journal of Child Psychology and Psychiatry, 58(6), 691–701. https://doi.org/10.1111/jcpp.12682
19.
DoğanS.ÖncüB.Saraçoğlu VarolG.KucukgoncuS. (2009). Validity and reliability of the Turkish version of the Adult ADHD Self-Report Scale (ASRS-v1. 1). Anadolu Psikiyatri Dergisi-Anatolian Journal of Psychiatry, 10(2), 77–87.
20.
du Prel CarrollX.YiH.LiangY.PangK.Leeper-WoodfordS.RiccardiP.LiangX. (2012). Family-environmental factors associated with attention deficit hyperactivity disorder in Chinese children: A case-control study. PLoS One, 7(11), e50543. https://doi.org/10.1371/journal.pone.0050543
21.
ElbirM.Alp TopbaşÖ.BayadS.KocabaşT.TopakO. Z.ÇetinŞ.ÖzdelO.AteşçiF.AydemirÖ. (2019). DSM-5 bozuklukları için yapılandırılmış klinik görüşmenin klinisyen versiyonunun türkçeye uyarlanması ve güvenilirlik çalışması. Turk Psikiyatri Derg, 30(1), 51–56. https://doi.org/10.5080/u23431
22.
EvrenC.UmutG.BozkurtM.UnalG. T.AgachanliR.EvrenB. (2016). Psychometric properties of the Turkish version of the Adult ADHD Self-Report Scale (ASRS-v1. 1) in a sample of Inpatients with alcohol use disorder. Dusunen Adam Journal of Psychiatry and Neurological Sciences, 29(2), 109. https://doi.org/10.5350/DAJPN2016290202
23.
FaraoneS. V.BiedermanJ.MickE. (2006). The age-dependent decline of attention deficit hyperactivity disorder: A meta-analysis of follow-up studies. Psychological Medicine, 36(2), 159–165. https://doi.org/10.1017/S003329170500471X
24.
FitzgeraldC.DalsgaardS.NordentoftM.ErlangsenA. (2019). Suicidal behaviour among persons with attention-deficit hyperactivity disorder. The British Journal of Psychiatry, 215(4), 615–620. https://doi.org/10.1192/bjp.2019.128
25.
GeorgeD. (2011). SPSS for windows step by step: A simple study guide and reference, 17.0 update, 10/e. Pearson Education India.
26.
HayesA. F. (2017). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford publications.
27.
HustedJ. A.CookR. J.FarewellV. T.GladmanD. D. (2000). Methods for assessing responsiveness: A critical review and recommendations. Journal of Clinical Epidemiology, 53(5), 459–468. https://doi.org/10.1016/S0895-4356(99)00206-1
28.
JoinerT. E. (2005). Why people die by suicide. Harvard University Press.
29.
KatzmanM. A.BilkeyT. S.ChokkaP. R.FalluA.KlassenL. J. (2017). Adult ADHD and comorbid disorders: Clinical implications of a dimensional approach. BMC Psychiatry, 17, 1–15. https://doi.org/10.1186/s12888-017-1463-3
30.
KaufmanE. A.XiaM.FoscoG.YaptangcoM.SkidmoreC. R.CrowellS. E. (2016). The Difficulties in Emotion Regulation Scale Short Form (DERS-SF): Validation and replication in adolescent and adult samples. Journal of Psychopathology and Behavioral Assessment, 38, 443–455. https://doi.org/10.1007/s10862-015-9529-3
31.
KesslerR. C.AdlerL.AmesM.DemlerO.FaraoneS.HiripiE.HowesM. J.JinR.SecnikK.SpencerT. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256. https://doi.org/10.1017/S0033291704002892
32.
KesslerR. C.BerglundP.BorgesG.NockM.WangP. S. (2005). Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990-1992 to 2001-2003. JAMA, 293(20), 2487–2495. https://doi.org/10.1001/jama.293.20.2487
33.
KlonskyE. D.MayA. M. (2015). The three-step theory (3ST): A new theory of suicide rooted in the “ideation-to-action” framework. International Journal of Cognitive Therapy, 8(2), 114–129. https://doi.org/10.1521/ijct.2015.8.2.114
34.
KooijJ.BijlengaD.SalernoL.JaeschkeR.BitterI.BalazsJ.ThomeJ.DomG.KasperS.FilipeC. N. (2019). Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry, 56(1), 14–34. https://doi.org/10.1016/j.eurpsy.2018.11.001
35.
LinehanM. M.NielsenS. L. (1981). Assessment of suicide ideation and parasuicide: Hopelessness and social desirability. Journal of Consulting and Clinical Psychology, 49(5), 773. https://doi.org/10.1037/0022-006X.49.5.773
36.
LjungT.ChenQ.LichtensteinP.LarssonH. (2014). Common etiological factors of attention-deficit/hyperactivity disorder and suicidal behavior: A population-based study in Sweden. JAMA Psychiatry, 71(8), 958–964. https://doi.org/10.1001/jamapsychiatry.2014.363
37.
Mallorquí-BaguéN.Mena-MorenoT.GraneroR.Vintró-AlcarazC.Sánchez-GonzálezJ.Fernández-ArandaF.Pino-GutiérrezA. D.Mestre-BachG.AymamíN.Gómez-PeñaM. (2018). Suicidal ideation and history of suicide attempts in treatment-seeking patients with gambling disorder: The role of emotion dysregulation and high trait impulsivity. Journal of Behavioral Addictions, 7(4), 1112–1121. https://doi.org/10.1556/2006.7.2018.132
38.
MandelliL.PetrelliC.SerrettiA. (2015). The role of specific early trauma in adult depression: A meta-analysis of published literature. Childhood trauma and adult depression. European Psychiatry, 30(6), 665–680. https://doi.org/10.1016/j.eurpsy.2015.04.007
39.
McKayM. T.CannonM.ChambersD.ConroyR. M.CoughlanH.DoddP.HealyC.O’DonnellL.ClarkeM. C. (2021). Childhood trauma and adult mental disorder: A systematic review and meta-analysis of longitudinal cohort studies. Acta Psychiatrica Scandinavica, 143(3), 189–205. https://doi.org/10.1111/acps.13268
40.
McLaughlinK. A.ColichN. L.RodmanA. M.WeissmanD. G. (2020). Mechanisms linking childhood trauma exposure and psychopathology: A transdiagnostic model of risk and resilience. BMC Medicine, 18, 1–11. https://doi.org/10.1186/s12916-020-01561-6
41.
NockM. K.BorgesG.BrometE. J.AlonsoJ.AngermeyerM.BeautraisA.BruffaertsR.ChiuW. T.De GirolamoG.GluzmanS. (2008). Cross-national prevalence and risk factors for suicidal ideation, plans and attempts. The British Journal of Psychiatry, 192(2), 98–105. https://doi.org/10.1192/bjp.bp.107.040113
O’ConnorR. C. (2011). Towards an integrated motivational–volitional model of suicidal behaviour. In O’ConnorR. C.PlattS.GordonJ. (Eds.), International Handbook of Suicide Prevention: Research, Policy and Practice, (pp.181–198). Wiley Blackwell.
44.
OhY.KimY.RyuV. (2024). Heightened suicidal risk in ADHD and subthreshold ADHD: Understanding the role of psychiatric comorbidities. Asian Journal of Psychiatry, 102, 104277. https://doi.org/10.1016/j.ajp.2024.104277
45.
ÖzbaranB.KalyoncuT.KöseS. (2018). Theory of mind and emotion regulation difficulties in children with ADHD. Psychiatry Research, 270, 117–122. https://doi.org/10.1016/j.psychres.2018.09.034
46.
PerryB. D.PollardR. (1998). Homeostasis, stress, trauma, and adaptation: A neurodevelopmental view of childhood trauma. Child and Adolescent Psychiatric Clinics, 7(1), 33–51. https://doi.org/10.1016/S1056-4993(18)30258-X
47.
PompiliM.InnamoratiM.VenturiniP.SerafiniG.LesterD.GirardiP. (2011). Child abuse as a risk factor for suicide in life: A selective overview. Minerva Psichiatrica, 52, 61–69.
48.
PreacherK. J.HayesA. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891. https://doi.org/10.3758/BRM.40.3.879
49.
RaudalesA. M.CarosaC. L.WeissN. H.SchattenH. T.ArmeyM. F. (2023). Emotion dysregulation as a mechanism linking posttraumatic stress disorder to subsequent suicidal thoughts and behaviors following inpatient psychiatric discharge. Journal of Psychiatric Research, 161, 34–39. https://doi.org/10.1016/j.jpsychires.2023.03.002
50.
RoganteE.CifrodelliM.SarubbiS.CostanzaA.ErbutoD.BerardelliI.PompiliM. (2024). The role of emotion dysregulation in understanding suicide risk: A systematic review of the literature. Healthcare, 12(2), 169. https://doi.org/10.3390/healthcare12020169
RuddM. D. (2006). Fluid vulnerability theory: A cognitive approach to understanding the process of acute and chronic suicide risk. In EllisT. E. (Ed.), Cognitive and Suicide: Theory, Research, and Therapy (pp. 355–368). American Psychological Association. https://doi.org/10.1037/11377-016
53.
San TooL.SpittalM. J.BugejaL.ReifelsL.ButterworthP.PirkisJ. (2019). The association between mental disorders and suicide: A systematic review and meta-analysis of record linkage studies. Journal of Affective Disorders, 259, 302–313. https://doi.org/10.1016/j.jad.2019.08.054
54.
SarV.OzturkE.IkikardesE. (2012). Validity and reliability of the Turkish version of Childhood Trauma Questionnaire. Turkiye Klinikleri Tip Bilimleri Dergisi, 32(4), 1054–1063. https://doi.org/10.5336/medsci.2011-26947
55.
SeptierM.StordeurC.ZhangJ.DelormeR.CorteseS. (2019). Association between suicidal spectrum behaviors and attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 103, 109–118. https://doi.org/10.1016/j.neubiorev.2019.05.022
SimonV.CzoborP.BálintS.MészárosA.BitterI. (2009). Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. The British Journal of Psychiatry, 194(3), 204–211. https://doi.org/10.1192/bjp.bp.107.048827
58.
SteinbergE. A.DrabickD. A. (2015). A developmental psychopathology perspective on ADHD and comorbid conditions: The role of emotion regulation. Child Psychiatry & Human Development, 46, 951–966. https://doi.org/10.1007/s10578-015-0534-2
59.
ThompsonR. A. (2019). Emotion dysregulation: A theme in search of definition. Development and Psychopathology, 31(3), 805–815. https://doi.org/10.1017/S0954579419000282
60.
WeinsteinD.StaffelbachD.BiaggioM. (2000). Attention-deficit hyperactivity disorder and posttraumatic stress disorder: Differential diagnosis in childhood sexual abuse. Clinical Psychology Review, 20(3), 359–378. https://doi.org/10.1016/S0272-7358(98)00107-X
61.
WilliamsJ. M. G.BarnhoferT.CraneC.DugganD. S. (2006). The role of overgeneral memory in suicidality. In EllisT. E. (Ed.), Cognition and suicide: Theory, research, and therapy (pp. 173–192). American Psychological Association.
62.
Yiğitİ.Guzey YiğitM. (2019). Psychometric properties of Turkish version of difficulties in emotion regulation scale-brief form (DERS-16). Current Psychology, 38, 1503–1511. https://doi.org/10.1007/s12144-017-9712-7
