Abstract
Background: Attention deficit and hyperactivity disorder (ADHD) is one of the most common mental disorders in childhood. Recently, several studies showed the high suicide risk of patients with ADHD; however, most of these studies had a cross-sectional design.Aims: The aim of the current research is to complete a systematic review of published studies which investigate the suicide risk of ADHD patients with longitudinal design.Methods: The systematic search was made on OVID Medline, PsychInfo, PubMed, Scopus, and Web of Science. The search terms were (ADHD OR attention deficit hyperactivity disorder) AND (suicide OR suicidal OR suicidality) AND (follow-up OR longitudinal study OR prospective study). The inclusion criteria were as follows: written in English; the participants were under 18 years at baseline; longitudinal, prospective studies; ADHD population at baseline and at follow-up; and suicide behavior as a primary outcome. The exclusion criteria were as follows: the study did not contain empirical data and reviews/meta-analyses and studies which aimed to investigate the drug treatment efficacy of ADHD.Results: After the screening process, 18 papers were included in the systematic review. Ten articles were altogether published in the last 5 years. The range of follow-up periods varied between 2 and 17 years. Several different assessment tools were used to investigate the symptoms and/or the diagnosis of ADHD and the suicidal risk. Nine studies enrolled children aged under 12 at baseline, and three studies used birth cohort data, where there was no strict age-based inclusion criteria. A total of 17 studies found a positive association between ADHD diagnosis at baseline and the presence of suicidal behavior and/or attempts at the follow-up visits.Limitations: The main limitation of this review is the methodological heterogeneity of the selected studies. A further limitation is the relatively low number of studies that examined a population with balanced gender ratios. Additionally, only one study published data about the treatment of ADHD. Finally, though we carefully chose the keywords, we still may be missing some relevant papers on this topic.Conclusions: In spite of the methodological diversity of the included studies, the results of the current systematic review highlight the importance of screening suicidality in the long term in patients with ADHD. Therefore, further studies that compare the suicidal risk of treated and untreated groups of ADHD patients in the long term are needed.
Highlights
Attention deficit and hyperactivity disorder (ADHD) is one of the most common child and adolescent psychiatric disorders, with a prevalence rate of 3.4% (CI 95% 2.6–4.5) (1)
18 papers were included in the systematic review (10, 20–36) (Table 1)
The included studies differ on several characteristics, such as the study populations, e.g., the age range of the study population, the study design, e.g., the length of the follow-up period, and the measures of ADHD and suicidality
Summary
Attention deficit and hyperactivity disorder (ADHD) is one of the most common child and adolescent psychiatric disorders, with a prevalence rate of 3.4% (CI 95% 2.6–4.5) (1). In connection with the QoL aspect, ADHD is associated with social–relationship problems (3), educational problems (4), and increased risk of substance abuse (5) and criminality (6). All these can reduce the effective treatment of ADHD (7). Several studies have suggested that long-term methylphenidate treatment in ADHD could reduce depression and suicidality (8). Among the most common comorbidities in ADHD are major depression, conduct disorder, anxiety disorder, and substance use disorder (11). Attention deficit and hyperactivity disorder (ADHD) is one of the most common mental disorders in childhood. Several studies showed the high suicide risk of patients with ADHD; most of these studies had a crosssectional design
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