Skip to main content

Risk of suicide attempts in adolescents and young adults with attention-deficit hyperactivity disorder: a nationwide longitudinal study

  • Kai-Lin Huang (a1), Han-Ting Wei (a2), Ju-Wei Hsu (a1), Ya-Mei Bai (a1), Tung-Ping Su (a3), Cheng-Ta Li (a1), Wei-Chen Lin (a1), Shih-Jen Tsai (a1), Wen-Han Chang (a4), Tzeng-Ji Chen (a5) and Mu-Hong Chen (a6)...

Attention-deficit hyperactivity disorder (ADHD) increases the risk of suicidal behaviours through psychiatric comorbidities; however, a significant direct association has not been observed between ADHD and suicide attempts.


To evaluate the risk of suicide attempt in adolescents and young adults with ADHD.


Using a nationwide, population-based insurance claims database, this longitudinal cohort study enrolled 20 574 adolescents and young adults with ADHD and 61 722 age- and gender-matched controls between 2001 and 2009. Any suicide attempt was identified from enrolment to 31 December 2011. The association between ADHD medications and the likelihood of suicide attempt was assessed.


ADHD was an independent risk factor for any suicide attempt (hazard ratio = 3.84, 95% CI = 3.19–4.62) and repeated suicide attempts (hazard ratio = 6.52, 95% CI = 4.46–9.53). Subgroup analyses of men, women, adolescents and young adults demonstrated the same trend. Methylphenidate or atomoxetine treatment did not increase the risk of suicide attempt or repeated suicide attempts. Long-term methylphenidate treatment was associated with a significantly decreased risk of repeated suicide attempts in men (hazard ratio = 0.46, 95% CI = 0.22–0.97).


ADHD was a risk factor for suicide attempt and a stronger predictor of repeated suicide attempts, independent of comorbidities. Further investigation is warranted to explore the mechanism underlying the association between ADHD and suicidal behaviours.

Declaration of interest


Corresponding author
Correspondence: Mu-Hong Chen, MD, Department of Psychiatry, No. 201, Shih-Pai Road, Section 2, 11217, Taipei, Taiwan. Email:
Hide All

These authors contributed equally to this article.

Hide All
1 Fayyad, J, De Graaf, R, Kessler, R, Alonso, J, Angermeyer, M, Demyttenaere, K, et al. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry 2007; 190: 402–9.
2 Polanczyk, G, de Lima, MS, Horta, BL, Biederman, J, Rohde, LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 2007; 164: 942–8.
3 Willcutt, EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics 2012; 9: 490–9.
4 Furczyk, K, Thome, J. Adult ADHD and suicide. Atten Defic Hyperact Disord 2014; 6: 153–8.
5 Agosti, V, Chen, Y, Levin, FR. Does attention deficit hyperactivity disorder increase the risk of suicide attempts? J Affect Disord 2011; 133: 595–9.
6 Taylor, MR, Boden, JM, Rucklidge, JJ. The relationship between ADHD symptomatology and self-harm, suicidal ideation, and suicidal behaviours in adults: a pilot study. Atten Defic Hyperact Disord 2014; 6: 303–12.
7 Ljung, T, Chen, Q, Lichtenstein, P, Larsson, H. Common etiological factors of attention-deficit/hyperactivity disorder and suicidal behavior: a population-based study in Sweden. JAMA Psychiatry 2014; 71: 958–64.
8 McCarthy, S, Cranswick, N, Potts, L, Taylor, E, Wong, IC. Mortality associated with attention-deficit hyperactivity disorder (ADHD) drug treatment: a retrospective cohort study of children, adolescents and young adults using the general practice research database. Drug Safety 2009; 32: 1089–96.
9 Medicode (Firm). ICD-9-CM: International classification of diseases, 9th revision, clinical modification. Medicode, 2014.
10 Chen, MH, Lan, WH, Hsu, JW, Huang, KL, Su, TP, Li, CT, et al. Risk of developing type 2 diabetes in adolescents and young adults with autism spectrum disorder: a nationwide longitudinal study. Diabetes Care 2016; 39: 788–93.
11 Chen, MH, Pan, TL, Li, CT, Lin, WC, Chen, YS, Lee, YC, et al. Risk of stroke among patients with post-traumatic stress disorder: nationwide longitudinal study. Br J Psychiatry 2015; 206: 302–7.
12 Li, CT, Bai, YM, Huang, YL, Chen, YS, Chen, TJ, Cheng, JY, et al. Association between antidepressant resistance in unipolar depression and subsequent bipolar disorder: cohort study. Br J Psychiatry 2012; 200: 4551.
13 Wang, YP, Chen, YT, Tsai, CF, Li, SY, Luo, JC, Wang, SJ, et al. Short-term use of serotonin reuptake inhibitors and risk of upper gastrointestinal bleeding. Am J Psychiatry 2014; 171: 5461.
14 Liu, C-Y, Hung, Y-T, Chuang, Y-L, Chen, YJ, Weng, WS, Liu, JS. Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Health Manag 2006; 4: 122.
15 James, A, Lai, FH, Dahl, C. Attention deficit hyperactivity disorder and suicide: a review of possible associations. Acta Psychiatr Scand 2004; 110: 408–15.
16 Stickley, A, Koyanagi, A, Ruchkin, V, Kamio, Y. Attention-deficit/hyperactivity disorder symptoms and suicide ideation and attempts: findings from the Adult Psychiatric Morbidity Survey 2007. J Affect Disord 2016; 189: 321–8.
17 Dvorak, RD, Lamis, DA, Malone, PS. Alcohol use, depressive symptoms, and impulsivity as risk factors for suicide proneness among college students. J Affect Disord 2013; 149: 326–34.
18 Klonsky, ED, May, A. Rethinking impulsivity in suicide. Suicide Life Threat Behav 2010; 40: 612–9.
19 Wang, L, He, CZ, Yu, YM, Qiu, XH, Yang, XX, Qiao, ZX, et al. Associations between impulsivity, aggression, and suicide in Chinese college students. BMC Public Health 2014; 14: 551.
20 Patros, CH, Hudec, KL, Alderson, RM, Kasper, LJ, Davidson, C, Wingate, LR. Symptoms of attention-deficit/hyperactivity disorder (ADHD) moderate suicidal behaviors in college students with depressed mood. J Clin Psychol 2013; 69: 980–93.
21 Cho, SC, Kim, JW, Choi, HJ, Kim, BN, Shin, MS, Lee, JH, et al. Associations between symptoms of attention deficit hyperactivity disorder, depression, and suicide in Korean female adolescents. Depress Anxiety 2008; 25: E1426.
22 Chronis-Tuscano, A, Molina, BS, Pelham, WE, Applegate, B, Dahlke, A, Overmyer, M, et al. Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 2010; 67: 1044–51.
23 Hinshaw, SP, Owens, EB, Zalecki, C, Huggins, SP, Montenegro-Nevado, AJ, Swanson, EN, et al. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol 2012; 80: 1041–51.
24 Bangs, ME, Wietecha, LA, Wang, S, Buchanan, AS, Kelsey, DK. Meta-analysis of suicide-related behavior or ideation in child, adolescent, and adult patients treated with atomoxetine. J Child Adolesc Psychopharmacol 2014; 24: 426–34.
25 Chen, Q, Sjolander, A, Runeson, B, D'Onofrio, BM, Lichtenstein, P, Larsson, H. Drug treatment for attention-deficit/hyperactivity disorder and suicidal behaviour: register based study. BMJ 2014; 348: g3769.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
Type Description Title
Supplementary materials

Huang et al. supplementary material
Huang et al. supplementary material Table S1

 Word (29 KB)
29 KB


Altmetric attention score

Full text views

Total number of HTML views: 32
Total number of PDF views: 173 *
Loading metrics...

Abstract views

Total abstract views: 545 *
Loading metrics...

* Views captured on Cambridge Core between 4th March 2018 - 17th March 2018. This data will be updated every 24 hours.

Risk of suicide attempts in adolescents and young adults with attention-deficit hyperactivity disorder: a nationwide longitudinal study

  • Kai-Lin Huang (a1), Han-Ting Wei (a2), Ju-Wei Hsu (a1), Ya-Mei Bai (a1), Tung-Ping Su (a3), Cheng-Ta Li (a1), Wei-Chen Lin (a1), Shih-Jen Tsai (a1), Wen-Han Chang (a4), Tzeng-Ji Chen (a5) and Mu-Hong Chen (a6)...
Submit a response


No eLetters have been published for this article.


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *