Study: Nearly One in Four Women with ADHD Has Attempted Suicide

January 5, 2021

Nearly one in four women with attention deficit hyperactivity disorder (ADHD or ADD) has attempted suicide, according to Canada’s Archives of Suicide Research study^1, which found that adults with ADHD in general are five times more likely to attempt suicide than are their neurotypical peers (14% vs. 2.7%). The correlation between ADHD and suicidality, the researchers say, is largely explained by chronic comorbid depression or anxiety — the strongest risk factors.

“That anxiety and depression account for the bulk of suicidality does not invalidate the importance in women with ADHD, as anxiety and depression frequently co-occur with ADHD,” said Timothy E. Wilens, M.D., of Massachusetts General Hospital and Harvard Medical School, upon review of the Canadian study. “Hence, the frequent comorbid presentation of ADHD continues to be shown to increase the risk of suicidality.”

Notably, the study did not investigate the relationship between ADHD treatment and self-harm, however it did note that “studies have suggested that medication may be a protective factor against suicide-related behavior among those with ADHD.” “There have been a number of large, registry, international studies that have shown that pharmacotherapy of ADHD with stimulants, for example, reduces the risk for the development of major depression; and of suicidality,” Wilens added.

“It is possible that misdiagnosis and undertreatment and/or delayed treatment, due to referral bias favoring males and differences in clinical presentation of females with ADHD, are also contributing to the observed gender discrepancy,” wrote the researchers, suggesting that women with ADHD face significantly worse mental health outcomes due to misdiagnosis and late treatment — both the results of long-standing ADHD misconceptions.

For this study, researchers reviewed data from a Canadian Mental Health Survey of 21,744 adults, 529 of whom had reported an ADHD diagnosis for ADHD. All participants were asked to report suicide attempts; strong positive correlations were found between self-harm and ADHD, as well as Adverse Childhood Experiences (ACEs) such as chronic parental domestic violence, comorbid mood and anxiety disorders, substance use disorders, learning disabilities, chronic pain, and low education levels. “Anxiety disorders show… a prevalence of 47% in adults with ADHD, in comparison to 20% among adults without ADHD,” wrote the study authors. “Both anxiety and depressive disorders are strongly associated with an elevated risk of suicide attempts across genders and age cohorts.”

One in 7 Canadian adults with ADHD was found to have attempted suicide, compared to just one in 37 adults without ADHD. This disparity was even more stark among women with ADHD, 23.5% of whom said they had attempted suicide compared to 3.3% of women without ADHD. Only 8.5% of men with ADHD said they had attempted suicide, compared to 2.1% of men without ADHD.

Roughly 60% of the association between ADHD and attempted suicide was reduced when researchers factored in a lifetime history of depression and anxiety disorders: “Some of the strongest correlates of suicidality were mental health factors such as history of depression with sevenfold higher odds and history of substance abuse with more than double the odds of suicide attempts.” Another significant correlate of suicide attempts in participants with ADHD was chronic parental domestic violence during childhood, a finding that has not been previously documented.

Though this research fails to investigate the impact of ADHD treatment on suicidality, its findings can help inform suicide prevention strategies and targeted clinical interventions for more vulnerable adults with ADHD. It also shines a light on the real, demonstrable mental health risks facing girls and women whose ADHD symptoms are misdiagnosed or dismissed by clinicians who fail to acknowledge or factor in gender disparities.

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