Missed opportunities for suicide prevention in teens with ADHD

Background: Epidemiological evidence links Attention Deficit Hyperactivity Disorder (ADHD) to increased risk of suicide. The research aimed to describe awareness among primary care pediatricians (PCPs) of ADHD as a  risk factor for suicide and PCPs’ practices of suicide risk assessment (SRA) and firearms safety assessment (FSA) in teens with ADHD. Method: An online survey was conducted among residents and attendings (N =68, response rate 72%) at an academic medical center. An open-ended question asking respondents to list up to 10 suicide risk factors was followed by Likert-scale items measuring knowledge, attitudes and self-reported practice. Analysis of variance and Pearson correlations were used to assess relationships between physicians’ personal and practice  parameters and their SRA and FSA practices. Results: Unprompted, only two doctors mentioned ADHD as a risk factor for suicide. Respondents rated ADHD  significantly lower than depression as a factor that would motivate them to perform a clinical assessment of suicide risk and firearm safety; 4.07 (1.62) v 6.49 (0.97), p<0.001 and 4.01 (1.87) v 6.19 (1.22), p<0.001, respectively. Limitations: Study data set is limited to a single institution and the sample size is small. Conclusion: PCPs are unlikely to recognize ADHD as a risk factor for suicide, and are therefore unlikely to thoroughly assess and intervene to prevent suicide in teens with ADHD.