The Mediating Roles of Mental Health and Substance Use on Suicidal Behavior Among Undergraduate Students With ADHD

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To evaluate the prevalence of suicidal ideation (SI), plans and attempts, and non-suicidal self-injury (NSSI) among students with attention deficit hyperactivity disorder (ADHD). Furthermore, we explored the mediating effects of depression, anxiety, alcohol and substance use on the association between ADHD and suicidal behaviors and NSSI.
Participants were first-year undergraduate students (n = 1,829) recruited as part of the World Mental Health International College Student Initiative. Participants completed validated clinical measures online.
The prevalence of suicide behaviors and NSSI were significantly higher among students with ADHD than those without. Mediation analyses indicated that ADHD directly and indirectly increased suicidal behaviors and NSSI. While ADHD increased suicidal behaviors and NSSI through depression, ADHD and the co-variates age and gender also had indirect effects on suicidal behaviors via substance use.
Specific predictors of risk were identified for students with ADHD which may inform the development of more targeted mental health and suicide prevention strategies across campuses.
Original languageEnglish
Article number10870547221075844
Pages (from-to)1-15
Number of pages15
JournalJournal of Attention Disorders
Early online date4 Feb 2022
Publication statusE-pub ahead of print - 4 Feb 2022

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by Cross-border Healthcare Intervention Trials In Ireland Network (CHITIN). CHITIN has received €10.6 m (or million) funding from the European Union’s INTERREG VA Programme, managed by the Special EU Programmes Body (SEUPB) with match funding from the Departments of Health in NI and ROI. The views and opinions expressed in this research paper do not necessarily reflect those of the European Commission or the Special EU Programmes Body (SEUPB). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Publisher Copyright:
© ©The Author(s) 2022.


  • ADHD
  • College Studetns
  • Depression
  • Substance use
  • Suicide
  • substance use
  • college students
  • suicide
  • depression


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