Evaluation of Clinical and Suicidal Behavior Characteristics Among Urban, Turkish Middle-Age Depressive Patients With Comorbid Adult Attention Deficit Hyperactivity Disorder

Suicidal behavior is a serious cause of mortality and morbidity in terms of psychiatric diseases. Suicidal ideation and suicide attempts that do not result in death cause many social and emotional problems, but they are the most important risk factors for the next suicide attempt and death resulting from suicide.[1,2] It has been reported that 90% of the completed suicide attempt cases are accompanied by a psychiatric disease and depressive disorders are seen at a highest level. [3] Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with symptoms of inattention, hyperactivity and impulsivity that is seen as of childhood.[4-6] ADHD disrupts the individuals' functionality in many fields such as academic, social and business life.[7] It also increases the risk of comorbidity of many psychiatric diseases.[8-10] In the studies carried out, it has been reported that depression is seen in rates ranging from 16% to 31% in cases with adult ADHD [11] and it was accompanied by ADHD in 15% of cases with depression.[12] In depressive adults with ADHD comorbidity, resistance to depression treatment develops and the longitudinal progress of both diseases is adversely affected.[13-14] In the literature review, it has been reported that suicide risk increased in children,[15] in university students,[16] in young women,[17] in ADHD and depression comorbidity and the clinical progress of depression was adversely affected.[18] Studies examining the relationship of suicide in ADHD and depression comorbidity in adults have been mostly carried out in young adults and it has been suggested by researchers to investigate the association of ADHD and depression in older adults.[19-22] The aim of this study was to compare the suicidal behavior, the onset age of depression and the respond to the treatment of the depressive disorder inpatients in the psychiatry service who are with and without comorbid ADHD. Hypothesis of this study is that the following will be observed in the adult depression patients with ADHD comorbidity; depression starting at an earlier age, having much more suicide attempts (number of suicide attempts in the past) that are much serious (requiring medical treatment) and having more severe depression (depression scale scores) and worse self-functionality during discharge from the hospital.

Material & Methods Complying with DSM-IV criteria and Hamilton Depression Scale (HDRS) being over 16 points during hospitalization have been determined to be the criteria for inclusion in the research. In total, 96 patients were included in the study. All cases were interviewed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I).[23] Other comorbid psychiatric disorders were excluded. Adult ADHD diagnosis has been confirmed by two different researchers for each case (DHD, EE). In the retrospective investigation of ADHD diagnosis, cases who got the score of 36 and above in the Wender Utah Rating Scale (WURS) have been included in the study.

Investigators evaluated suicidal behavior in a similar manner to the methods used in some previous studies.[20,24,25] In the sociodemographic data form, suicidal ideation in the past (Have you ever thought about ending your life before? / Yes or No), suicide attempt (Have you ever attempted suicide before? / Yes or No) and number of suicide attempts have been recorded. Material

Socio-demographic data form:

Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) [26] Hamilton Depression Rating Scale (HDRS): [28] Adult ADD/ADHD DSM IV- Based Diagnostic Screening and Rating Scale (A-ADHDS) has been developed by Atilla Turgay in Canada.[29,30] Wender Utah Rating Scale (WURS): [31,32] Personal and Social Performance Scale (PSP): [33,34] Statistical analysis: SPSS Statistics Version 22.0 has been used for data analysis. The distribution characteristics of the variables have been evaluated by using the Shapiro-Wilk test. Student-t test has been used to compare normal distribution parameters and Mann-Whitney U test has been used for abnormal distribution parameters. According to the ADHD comorbidity, suicide attempt has been compared with the Pearson chi-squared test. P values below 0.05 have been considered to be statistically significant results.