Advertisement

Cognitive Therapy and Research

, Volume 42, Issue 4, pp 461–467 | Cite as

Stress Accounts for the Association Between ADHD Symptoms and Suicide Ideation When Stress-Reactive Rumination Is High

  • Carlos E. Yeguez
  • Ryan M. Hill
  • Victor Buitron
  • Jeremy W. Pettit
Original Article

Abstract

ADHD symptoms are significantly associated with suicide ideation. However, the variables that explain this association remain unknown. This study tested a theoretical model in which stress was hypothesized to account for the association between ADHD symptoms and suicide ideation among individuals high, but not low, in ruminative responding to stress. We examined this model in a sample of 432 emerging adults, who were predominantly female (72.5%) and Hispanic (70.6%), with a mean age of 19.73 years. Demographic and clinical (ADHD symptoms, stress, stress-reactive rumination, depressive symptoms) information was collected via self-reported rating scales. ADHD symptoms were significantly and positively associated with stress, stress-reactive rumination, and suicide ideation. As hypothesized, the association between ADHD symptoms and suicide ideation was accounted for by stress, and this effect was strongest at high levels of stress-reactive rumination. Conclusions did not change after controlling for depressive symptoms. These findings shed light on one explanation of the elevated levels of suicide ideation seen in emerging adults with elevated ADHD symptoms: heightened levels of stressful events and a tendency to respond to stress by ruminating. Implications for theory development and prevention efforts are discussed.

Keywords

ADHD Rumination Stress Suicide ideation 

Notes

Acknowledgements

The authors would like to thank Dr. Dana McMakin for her feedback and assistance in the preparation of this manuscript.

Compliance with Ethical Standards

Conflict of Interest

Carlos E. Yeguez, Ryan M. Hill, Victor Buitron, and Jeremy W. Pettit declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Research Involving Human and Animal Participants

This article does not contain any studies with animals performed by any of the authors.

References

  1. Adler, L. A., Spencer, T., Faraone, S. V., Kessler, R. C., Howes, M. J., Biederman, J., & Secnik, K. (2006). Validity of pilot Adult ADHD Self-Report Scale (ASRS) to rate adult ADHD symptoms. Annals of Clinical Psychiatry, 18(3), 145–148.CrossRefPubMedGoogle Scholar
  2. Altszuler, A. R., Page, T. F., Gnagy, E. M., Coxe, S., Arrieta, A., Molina, B. S., & Pelham, W. E. Jr. (2016). Financial dependence of young adults with childhood ADHD. Journal of Abnormal Child Psychology, 44(6), 1217–1229.CrossRefPubMedPubMedCentralGoogle Scholar
  3. Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through the twenties. American Psychologist, 55(5), 469–480.CrossRefPubMedGoogle Scholar
  4. Barbaresi, W. J., Colligan, R. C., Weaver, A. L., Voigt, R. G., Killian, J. M., & Katusic, S. K. (2013). Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: A prospective study. Pediatrics, 131(4), 637–644.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Barkley, R. A., & Fischer, M. (2005). Suicidality in children with ADHD, grown up (Special Issue–Focus on Assessment). The ADHD Report, 13(6), 1–6.CrossRefGoogle Scholar
  6. Barkley, R. A., & Fischer, M. (2010). The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. Journal of the American Academy of Child & Adolescent Psychiatry, 49(5), 503–513.Google Scholar
  7. Cairncross, M., & Miller, C. J. (2018). The effectiveness of mindfulness-based therapies for ADHD: A meta-analytic review. Journal of Attention Disorders.  https://doi.org/10.1177/1087054715625301.Google Scholar
  8. Canu, W. H., Hartung, C. M., Stevens, A. E., & Lefler, E. K. (2016). Psychometric properties of the Weiss functional impairment rating scale evidence for utility in research, assessment, and treatment of ADHD in emerging adults. Journal of Attention Disorders, 2016, 1087054716661421.Google Scholar
  9. Chronis-Tuscano, A., Molina, B. S., Pelham, W. E., Applegate, B., Dahlke, A., Overmyer, M., & Lahey, B. B. (2010). Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 67(10), 1044–1051.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Ciarrochi, J., Deane, F. P., & Anderson, S. (2002). Emotional intelligence moderates the relationship between stress and mental health. Personality and Individual Differences, 32(2), 197–209.CrossRefGoogle Scholar
  11. Combs, M. A., Canu, W. H., Broman-Fulks, J. J., Rocheleau, C. A., & Nieman, D. C. (2015). Perceived stress and ADHD symptoms in adults. Journal of Attention Disorders, 19(5), 425–434.CrossRefPubMedGoogle Scholar
  12. Corominas-Roso, M., Palomar, G., Ferrer, R., Real, A., Nogueira, M., Corrales, M., … Ramos-Quiroga, J. A. (2015). Cortisol response to stress in adults with attention deficit hyperactivity disorder. International Journal of Neuropsychopharmacology, 18(9), pyv027.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Drum, D. J., Brownson, C., Denmark, A. B., & Smith, S. E. (2009). New data on the nature of suicidal crises in college students: Shifting the paradigm. Professional Psychology: Research and Practice, 40(3), 213–222.CrossRefGoogle Scholar
  14. Eisenberg, D., Hunt, J., & Speer, N. (2013). Mental health in American colleges and universities: Variation across student subgroups and across campuses. The Journal of Nervous and Mental Disease, 201(1), 60–67.CrossRefPubMedGoogle Scholar
  15. Hechtman, L., Swanson, J. M., Sibley, M. H., Stehli, A., Owens, E. B., & Mitchell, J. T. & … MTA Cooperative Group (2016). Functional adult outcomes 16 years after childhood diagnosis of attention-deficit hyperactivity disorder: MTA results. Journal of the American Academy of Child and Adolescent Psychiatry, 55(11), 945–953.CrossRefPubMedPubMedCentralGoogle Scholar
  16. Hill, R. M., & Pettit, J. W. (2013). The role of autonomy needs in suicidal ideation: Integrating the interpersonal-psychological theory of suicide and self-determination theory. Archives of Suicide Research, 17(3), 288–301.CrossRefPubMedGoogle Scholar
  17. Hill, R. M., Rey, Y., Marin, C. E., Sharp, C., Green, K. L., & Pettit, J. W. (2015). Evaluating the Interpersonal Needs Questionnaire: Comparison of the reliability, factor structure, and predictive validity across five versions. Suicide and Life-Threatening Behavior, 45(3), 302–314.CrossRefPubMedGoogle Scholar
  18. Joiner, T. E., Walker, R. L., Pettit, J. W., Perez, M., & Cukrowicz, K. C. (2005). Evidence-based assessment of depression in adults. Psychological Assessment, 17(3), 267.CrossRefPubMedGoogle Scholar
  19. Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E. V. A., … Ustun, T. B. (2005b). The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256.CrossRefPubMedGoogle Scholar
  20. Kessler, R. C., Berglund, P., Borges, G., Nock, M., & Wang, P. S. (2005a). Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA, 293(20), 2487–2495.CrossRefPubMedGoogle Scholar
  21. Knouse, L. E., Teller, J., & Brooks, M. A. (2017). Meta-analysis of cognitive–behavioral treatments for adult ADHD. Journal of Consulting and Clinical Psychology, 85(7), 737–750.CrossRefPubMedGoogle Scholar
  22. Kuriyan, A. B., Pelham, W. E., Molina, B. S., Waschbusch, D. A., Gnagy, E. M., Sibley, M. H., … Kent, K. M. (2013). Young adult educational and vocational outcomes of children diagnosed with ADHD. Journal of Abnormal Child Psychology, 41(1), 27–41.CrossRefPubMedPubMedCentralGoogle Scholar
  23. Lackschewitz, H., Hüther, G., & Kröner-Herwig, B. (2008). Physiological and psychological stress responses in adults with attention-deficit/hyperactivity disorder (ADHD). Psychoneuroendocrinology, 33(5), 612–624.CrossRefPubMedGoogle Scholar
  24. Lewinsohn, P. M., Mermelstein, R. M., Alexander, C., & MacPhillamy, D. J. (1985). The unpleasant events schedule: A scale for the measurement of aversive events. Journal of Clinical Psychology, 41(4), 483–498.CrossRefPubMedGoogle Scholar
  25. Liu, R. T., & Miller, I. (2014). Life events and suicidal ideation and behavior: A systematic review. Clinical Psychology Review, 34(3), 181–192.CrossRefPubMedGoogle Scholar
  26. Meinzer, M. C., Pettit, J. W., Waxmonsky, J. G., Gnagy, E., Molina, B. S., & Pelham, W. E. (2016). Does childhood attention-deficit/hyperactivity disorder (ADHD) predict levels of depressive symptoms during emerging adulthood? Journal of Abnormal Child Psychology, 44(4), 787–797.CrossRefPubMedPubMedCentralGoogle Scholar
  27. Mitchell, J. T., Benson, J. W., Knouse, L. E., Kimbrel, N. A., & Anastopoulos, A. D. (2013). Are negative automatic thoughts associated with ADHD in adulthood? Cognitive Therapy and Research, 37(4), 851–859.CrossRefGoogle Scholar
  28. Morrison, R., & O’Connor, R. C. (2008). A systematic review of the relationship between rumination and suicidality. Suicide and Life-Threatening Behavior, 38(5), 523–538.CrossRefPubMedGoogle Scholar
  29. Mowlem, F. D., Skirrow, C., Reid, P., Maltezos, S., Nijjar, S. K., Merwood, A., … Asherson, P. (2016). Validation of the mind excessively wandering scale and the relationship of mind wandering to impairment in adult ADHD. Journal of Attention Disorders, 2016, 1087054716651927Google Scholar
  30. Nock, M. K., Hwang, I., Sampson, N. A., & Kessler, R. C. (2010). Mental disorders, comorbidity and suicidal behavior: Results from the National Comorbidity Survey Replication. Molecular Psychiatry, 15(8), 868–876.CrossRefPubMedGoogle Scholar
  31. Osman, A., Kopper, B. A., Linehan, M. M., Barrios, F. X., Gutierrez, P. M., & Bagge, C. L. (1999). Validation of the Adult Suicidal Ideation Questionnaire and the reasons for living inventory in an adult psychiatric inpatient sample. Psychological Assessment, 11(2), 115–123.CrossRefGoogle Scholar
  32. Patros, C. H., Hudec, K. L., Alderson, R. M., Kasper, L. J., Davidson, C., & Wingate, L. R. (2013). Symptoms of attention-deficit/hyperactivity disorder (ADHD) moderate suicidal behaviors in college students with depressed mood. Journal of Clinical Psychology, 69(9), 980–993.CrossRefPubMedGoogle Scholar
  33. Pettit, J. W., Roberts, R. E., Lewinsohn, P. M., Seeley, J. R., & Yaroslavsky, I. (2011). Developmental relations between perceived social support and depressive symptoms through emerging adulthood: Blood is thicker than water. Journal of Family Psychology, 25(1), 127.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891.CrossRefPubMedGoogle Scholar
  35. Querstret, D., & Cropley, M. (2013). Assessing treatments used to reduce rumination and/or worry: A systematic review. Clinical Psychology Review, 33(8), 996–1009.CrossRefPubMedGoogle Scholar
  36. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.CrossRefGoogle Scholar
  37. Reynolds, W. M. (1991a). ASIQ, Adult Suicidal Ideation Questionnaire: Professional manual. Lutz: Psychological Assessment Resources.Google Scholar
  38. Reynolds, W. M. (1991b). Psychometric characteristics of the Adult Suicidal Ideation Questionnaire in college students. Journal of Personality Assessment, 56(2), 289–307.CrossRefPubMedGoogle Scholar
  39. Robinson, M. S., & Alloy, L. B. (2003). Negative cognitive styles and stress-reactive rumination interact to predict depression: A prospective study. Cognitive Therapy and Research, 27(3), 275–291.CrossRefGoogle Scholar
  40. Rogers, M. L., Stanley, I. H., Hom, M. A., Chiurliza, B., Podlogar, M. C., & Joiner, T. E. (2016). Conceptual and empirical scrutiny of covarying depression out of suicidal ideation. Assessment, 2016, 1073191116645907.Google Scholar
  41. Sibley, M. H., & Yeguez, C. E. (2018). Managing ADHD at the post-secondary transition: A qualitative study of parent and young adult perspectives. Manuscript submitted for publication.Google Scholar
  42. Smallwood, J. (2013). Distinguishing how from why the mind wanders: A process–occurrence framework for self-generated mental activity. Psychological Bulletin, 139(3), 519–535.CrossRefPubMedGoogle Scholar
  43. Stickley, A., Koyanagi, A., Ruchkin, V., & Kamio, Y. (2016). Attention-deficit/hyperactivity disorder symptoms and suicide ideation and attempts: Findings from the Adult Psychiatric Morbidity Survey 2007. Journal of Affective Disorders, 189, 321–328.CrossRefPubMedGoogle Scholar
  44. Swanson, E. N., Owens, E. B., & Hinshaw, S. P. (2014). Pathways to self-harmful behaviors in young women with and without ADHD: A longitudinal examination of mediating factors. Journal of Child Psychology and Psychiatry, 55(5), 505–515.CrossRefPubMedGoogle Scholar
  45. Van Eck, K., Ballard, E., Hart, S., Newcomer, A., Musci, R., & Flory, K. (2015). ADHD and suicidal ideation: The roles of emotion regulation and depressive symptoms among college students. Journal of Attention Disorders, 19(8), 703–714.CrossRefPubMedGoogle Scholar
  46. Wolf, L. E. (2001). College students with ADHD and other hidden disabilities. Annals of the New York Academy of Sciences, 931(1), 385–395.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PsychologyFlorida International UniversityMiamiUSA
  2. 2.Department of PediatricsBaylor College of MedicineHoustonUSA
  3. 3.Florida International UniversityMiamiUSA

Personalised recommendations