In this podcast, Esme Fuller-Thomson, PhD, of the University of Toronto, Ontario, Canada, discusses her recent research which showed significantly higher rates of suicide attempt and ideation among people with attention-deficit/hyperactivity disorder (ADHD), particularly women, and her other work illustrating the mental health problems that co-occur with ADHD.
Read the transcript:
Hello, my name is Esme Fuller‑Thomson. I'm a Professor at the Factor‑Inwentash Faculty of Social Work at the University of Toronto. I'm cross‑appointed to the faculties of medicine and nursing here at University of Toronto. I'm also Director of the Institute for Life Course and Aging.
Today, I've been asked to speak about my research on women and ADHD. In December 2020, we published an article in the Archives of Suicide Research, looking at suicide attempts among women and men with ADHD.
We were very distressed to find that 24 percent of women with ADHD had attempted suicide. This compares to about 3 percent of women without ADHD. Among men, 9 percent of men with ADHD had attempted suicide, compared to about 2 percent of men without ADHD.
Basically, we found that ADHD casts a very long shadow, and even when we took into account history of mental illness and the higher levels of poverty and early adversity that adults with ADHD often experience, those with ADHD still had 56 percent higher odds of having attempted suicide than their peers without ADHD.
Because ADHD is much more common among boys than girls, little attention has even focused on young women and even less on older women, but what our research has found is that, with respect to suicide attempts, women are much more vulnerable, compared to men.
I'll reflect on some of our earlier research suggesting it's not just suicide attempts, but the whole gamut of mental health consequences seem to be more acute for women with ADHD. We certainly would like to emphasize that there is an urgency for healthcare providers to be paying attention to their patients with ADHD with respect to both their mental health and suicidality.
My co‑authors on that paper were Lauren Carrique, who is a recent graduate of University of Toronto's Master’s of Social Work program, and she is a social worker at the Toronto General Hospital, and also Raphaël Nahar Rivière, he was a graduate of University of Toronto, and is a medical resident in anesthesiology at the University of Toronto, currently.
Senyo Agbeyaka, who is a another Master’s of Social Work graduate from U of T, who is a social worker in Toronto at the University Health Network. Our sample had over 21,000 Canadians, of whom 529 had been diagnosed with ADHD.
An earlier paper that we published in 2016, in Child: Care, Health and Development, had focused solely on the women in this dataset.
We've already discussed the suicide attempts, but we also found in that analysis that almost half—46 percent— had seriously considered suicide, 36 percent of the women with ADHD had generalized anxiety disorder, 31 percent had major depressive disorders, and 39 percent had substance abuse problems at some point in their life.
Compared to women without ADHD, this is 4 times the odds of suicidal thoughts and generalized anxiety disorders, and more than twice the odds of major depressive disorders and substance abuse.
That study was focused on those 20 to 39, of whom there were 3908 women in that study, of whom 107 reported that they've been diagnosed with ADHD. All the research I'm talking about is nationally representative of community‑dwelling adults.
That means people not in institutions, these are people living in the community, and it's a representative sample. It was gathered in 2012 from the Statistics Canada Survey called the Canadian Community Health Survey ‑ Mental Health.
My co‑author on the women study was Danielle Lewis, who was also a recent Master’s of Social Work graduate from our university. Now what's interesting is in addition to mental health concerns, the women had a high level of physical health problems.
These are young women 20 to 39, and more than 1 in 4, that was 28 percent said that physical pain prohibited some of their activities. This compares to about 9 percent of their peers without ADHD. Insomnia was also extremely high. Forty-four percent of the women with ADHD had insomnia versus 12 percent of women without ADHD, and smoking rates were also high—41 percent vs 22 percent.
Unfortunately, our study does not provide insight into why women with ADHD are so vulnerable. It's possible that some of the mental health problems may be caused by and/or contributing to financial distress. We found that 1 in 3 of the women, 37 percent, had difficulty meeting basic expenses such as food, shelter, and clothing.
If you looked at their peers without ADHD, that was only about 13 percent, so this was 3 times as high. It seems that we need to be vigilant about monitoring and treating the female patients with ADHD.
Our earlier work, this was in 2015, published in Child Abuse & Neglect, we looked at both women and men and their history of early adversities. We found that one‑third of women with ADHD reported that they had been sexually abused during their childhood. Thirty-four percent had been sexually abused before they turned 18. Fourteen percent of the women without ADHD reported sexual abuse, so the women with ADHD were at a much higher level, and twice as many women with ADHD reported that they had been physically abused during their childhood, compared to women without ADHD.
That would be 44 percent versus 21 percent. These findings suggest that there is a silent epidemic of abuse among people and particularly women with ADHD.
My research also notes that there is a greater percentage of men with ADHD than men who report being sexually abused. In fact, 11 percent of the young men with ADHD in this study reported sexual abuse compared to 6 percent of their peers without ADHD. Physical abuse was also higher—41 percent vs 31 percent. This is physical abuse and sexual abuse before the age of 18.
Now, we don't know who committed the abuse, so it may have been family members, but it might also be that those with ADHD are more vulnerable because of peer group vulnerability. You had to be abused by somebody 5 years older than yourself, but if you're in a rougher crowd, potentially, you could have been abused in those contexts.
No matter who is the perpetrator, however, it's very important that health professionals working with children with ADHD screen for sexual abuse and physical abuse because they are at such high risk.
Overall, these 3 papers do underline greater vulnerability for mental health problems for those with ADHD, with particular attention to women with ADHD.
Women tend to be under the radar screen because they may present differently in childhood with ADHD, but it does appear that those who have been diagnosed with ADHD—those women who have been diagnosed with ADHD—are particularly vulnerable. Thank you very much for your attention.
Fuller-Thomson E, Rivière RN, Carrique L, Agbeyaka S. The dark side of ADHD: factors associated with suicide attempts among those with ADHD in a national representative Canadian sample. Archives of Suicide Research. 2020 December 21;[Epub ahead of print].
Professor Esme Fuller-Thomson, PhD, is cross-appointed to the Faculties of Social Work, Medicine and Nursing at the University of Toronto. She is also Director of the Institute for Life Course & Aging. She has published more than 150 articles in peer-reviewed journals including the New England Journal of Medicine, The Lancet, and Cancer. Her research examines ADHD and mental health, the association between early adversities and adult physical and health outcomes, and disparities in health. Her work has widely cited in the media including The New York Times, Wall Street Journal, Time Magazine and CNN.