Attention-deficit hyperactivity disorder and nonsuicidal self-injury in a clinical sample of adolescents: the role of comorbidities and gender

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Abstract

Background

The aim of the present study was to investigate the possible association between attention-deficit hyperactivity disorder (ADHD) and non-suicidal self-injury (NSSI) with special focus on the role of comorbidities and gender in a clinical sample of adolescents with both a dimensional and a categorical approach to psychopathology.

Methods

Using a structured interview, the Mini International Neuropsychiatric Interview Kid and a self-rated questionnaire, the Deliberate Self-Harm Inventory, the authors examined 202 inpatient adolescents (aged: 13–18 years) in the Vadaskert Child and Adolescent Psychiatric Hospital and Outpatient Clinic, Budapest, Hungary. Descriptive statistics, Mann–Whitney U test, chi-square test and mediator model were used.

Results

Fifty-two adolescents met full criteria for ADHD and a further 77 showed symptoms of ADHD at the subthreshold level. From the 52 adolescents diagnosed with ADHD, 35 (67.30%) had NSSI, of whom there were significantly more girls than boys, boys: n = 10 (28.60%), girls: n = 25 (71.40%) ((χ ²(1) = 10.643 p < .001 ϕ = .452). Multiple mediation analyses resulted in a moderated mediation model in which the relationship between symptoms of ADHD and the prevalence of current NSSI was fully mediated by the symptoms of comorbid conditions in both sex. Significant mediators were the symptoms of affective and psychotic disorders and suicidality in both sexes and the symptoms of alcohol abuse/dependence disorders in girls.

Conclusions

ADHD symptoms are associated with an increased risk of NSSI in adolescents, especially in the case of girls. Our findings suggest that clinicians should routinely screen for the symptoms of ADHD and comorbidity, with a special focus on the symptoms of affective disorders and alcohol abuse/dependence psychotic symptoms to prevent NSSI.

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Most cited references 51

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The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies.

Stephen V Faraone, Joseph Biederman, Eric Mick (2006)

This study examined the persistence of attention deficit hyperactivity disorder (ADHD) into adulthood. We analyzed data from published follow-up studies of ADHD. To be included in the analysis, these additional studies had to meet the following criteria: the study included a control group and it was clear from the methods if the diagnosis of ADHD included subjects who did not meet full criteria but showed residual and impairing signs of the disorder. We used a meta-analysis regression model to separately assess the syndromatic and symptomatic persistence of ADHD. When we define only those meeting full criteria for ADHD as having 'persistent ADHD', the rate of persistence is low, approximately 15% at age 25 years. But when we include cases consistent with DSM-IV's definition of ADHD in partial remission, the rate of persistence is much higher, approximately 65%. Our results show that estimates of ADHD's persistence rely heavily on how one defines persistence. Yet, regardless of definition, our analyses show that evidence for ADHD lessens with age. More work is needed to determine if this reflects true remission of ADHD symptoms or is due to the developmental insensitivity of diagnostic criteria for the disorder.

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Self-injury.

Matthew Nock (2010)

People have engaged in self-injury-defined as direct and deliberate bodily harm in the absence of suicidal intent-for thousands of years; however, systematic research on this behavior has been lacking. Recent theoretical and empirical work on self-injury has significantly advanced the understanding of this perplexing behavior. Self-injury is most prevalent among adolescents and young adults, typically involves cutting or carving the skin, and has a consistent presentation cross-nationally. Behavioral, physiological, and self-report data suggest that the behavior serves both an intrapersonal function (i.e., decreases aversive affective/cognitive states or increases desired states) and an interpersonal function (i.e., increases social support or removes undesired social demands). There currently are no evidence-based psychological or pharmacological treatments for self-injury. This review presents an integrated theoretical model of the development and maintenance of self-injury that synthesizes prior empirical findings and proposes several testable hypotheses for future research.

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Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts.

M. Nock, T JOINERJR, K. Gordon … (2006)

Non-suicidal self-injury (NSSI) is a prevalent behavioral problem, yet many fundamental aspects of NSSI remain unknown. This case series study reports on the diagnostic correlates of adolescents with a recent history of NSSI and examines the relation between NSSI and suicide attempts. Data are from clinical interviews with 89 adolescents admitted to an adolescent psychiatric inpatient unit who engaged in NSSI in the previous 12 months. Results revealed that 87.6% of adolescents engaging in NSSI met criteria for a DSM-IV Axis I diagnosis (M=3.0, S.D.=2.2, range=0 to 8 diagnoses), including externalizing (62.9%), internalizing (51.7%), and substance use (59.6%) disorders. Most adolescents assessed also met criteria for an Axis II personality disorder (67.3%). Overall, 70% of adolescents engaging in NSSI reported a lifetime suicide attempt and 55% reported multiple attempts. Characteristics of NSSI associated with making suicide attempts included a longer history of NSSI, use of a greater number of methods, and absence of physical pain during NSSI. These findings demonstrate the diagnostic heterogeneity of adolescents engaging in NSSI, highlight the significant overlap between NSSI and suicide attempts, and provide a point of departure for future research aimed at elucidating the relations between non-suicidal and suicidal self-injury.

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Author and article information

Contributors

Judit Balázs: 36 1 461450 , balazs.judit@ppk.elte.hu , judit.agnes.balazs@gmail.com

Dóra Győri: gyorido@gmail.com

Lili Olga Horváth: lilio.horvath@gmail.com

Gergely Mészáros: meszaros.gergely.83@gmail.com

Dóra Szentiványi: szentivanyidori@gmail.com

Journal

Journal ID (nlm-ta): BMC Psychiatry

Journal ID (iso-abbrev): BMC Psychiatry

Title: BMC Psychiatry

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-244X

Publication date (Electronic): 6 February 2018

Publication date PMC-release: 6 February 2018

Publication date Collection: 2018

Volume: 18

Electronic Location Identifier: 34

Affiliations

[1 ]ISNI 0000 0001 2294 6276, GRID grid.5591.8, Institute of Psychology, , Eötvös Loránd University, ; Izabella str. 46, Budapest, 1064 Hungary

[2 ]Vadaskert Child and Adolescent Psychiatry Hospital, Budapest, Hungary

[3 ]ISNI 0000 0001 2294 6276, GRID grid.5591.8, Doctoral School of Psychology, , Eötvös Loránd University, ; Budapest, Hungary

[4 ]ISNI 0000 0001 0942 9821, GRID grid.11804.3c, Semmelweis University, School of Ph.D. Studies, ; Budapest, Hungary

Article

Publisher ID: 1620

DOI: 10.1186/s12888-018-1620-3

PMC ID: 5801900

PubMed ID: 29409473

SO-VID: 5c9e5825-bdff-4632-a077-3e36e401f166

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 24 October 2017

Date accepted : 28 January 2018

Funding

Funded by: OTKA

Award ID: K108336

Funded by: FundRef http://dx.doi.org/10.13039/501100006363, Bolyai Foundation;

Custom metadata

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: attention-deficit hyperactivity disorder,adhd,non-suicidal self-injury,nssi,comorbidities,gender,clinical sample,adolescents,dimensional,categorical approach

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ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: attention-deficit hyperactivity disorder, adhd, non-suicidal self-injury, nssi, comorbidities, gender, clinical sample, adolescents, dimensional, categorical approach

Attention-deficit hyperactivity disorder and nonsuicidal self-injury in a clinical sample of adolescents: the role of comorbidities and gender

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Abstract

Background

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Most cited references 51

The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies.

Self-injury.

Non-suicidal self-injury among adolescents: diagnostic correlates and relation to suicide attempts.

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