What psychiatric conditions can cause suicidal tendencies in individuals with a history of mood disorders, anxiety disorders, or attention deficit hyperactivity disorder (ADHD)?

Psychiatric Conditions That Cause Suicidal Tendencies

Major depressive disorder, bipolar disorder, anxiety disorders (when comorbid with depression), substance use disorders, and disruptive/conduct disorders are the primary psychiatric conditions that cause suicidal tendencies, with bipolar disorder and major depression conferring the highest risk—approximately 8.6-fold increased likelihood of death by suicide compared to the general population. 1

Primary High-Risk Mood Disorders

Major Depressive Disorder (MDD)

• MDD increases the odds of dying by suicide 8.62 times compared to the general population, with women facing 9.40 times higher odds specifically 1, 2
• The lifetime prevalence of suicide attempts in MDD is 5.6%, compared to 2.0% in non-depressed controls 1
• Major depression is the most significant risk factor for suicide in girls and young women, increasing risk up to 20-fold 1
• The first year following hospital discharge represents the period of greatest suicide risk in MDD patients 1, 2

Bipolar Disorder (BD)

• Bipolar disorder confers an 8.66 times higher risk of death by suicide compared to non-affected individuals 1, 3
• The lifetime prevalence of suicide attempts in BD is 29.2%, compared to 4.9% in non-BD controls—substantially higher than the 5.6% seen in MDD 1, 3
• 4-8% of individuals with bipolar disorder die by suicide, compared to 2-8% with MDD 1, 3
• BD poses a greater overall risk of suicidality than MDD, with bipolar type I showing especially high rates of violent suicide attempts 1
• At least 25-50% of patients with bipolar disorder attempt suicide at least once in their lifetime 4

Comorbid Conditions That Amplify Risk

Anxiety Disorders

• Comorbid anxiety disorders are more prevalent and strongly linked to suicidality specifically in MDD patients 1
• Anxiety comorbidity increases the likelihood that depressed patients will act on suicidal thoughts 1

Substance Use Disorders (SUD)

• Substance use disorders are more common and strongly linked to suicidality in bipolar disorder compared to MDD 1
• Substance abuse and alcoholism markedly increase the risk of suicidal acts during mood episodes 5
• Past substance use disorder or alcoholism is significantly more frequent in suicide attempters across all psychiatric diagnoses 6

Disruptive Disorders and ADHD

• Disruptive disorders (conduct disorder, oppositional defiant disorder) are common in male adolescents who commit suicide, with approximately one-third of male suicides showing evidence of conduct disorder 1
• Previous suicide attempts are the most potent predictor in boys with disruptive disorders, increasing risk more than 30-fold 1
• ADHD is associated with increased suicidal risk, particularly when comorbid with mood disorders 7
• The disruptive disorder is commonly comorbid with mood, anxiety, or substance abuse diagnoses, creating a synergistic risk 1

Additional High-Risk Psychiatric Conditions

Personality Disorders

• Cluster B personality disorders, particularly borderline personality disorder, markedly increase risk of suicidal acts during mood episodes 1, 5
• Borderline personality disorder is characterized by repeated suicide attempts, nonlethal self-injury, and pervasive impulsivity that remains strongly associated with suicidality even after controlling for depression and substance abuse 1
• Hypomanic personality traits are associated with recurring suicidal behavior 1

Psychotic Features

• Psychotic symptoms, including paranoid ideas and auditory/visual hallucinations, increase short-term suicide risk 1
• Mixed states (concurrent manic and depressive symptoms) or rapid cycling in bipolar disorder substantially elevate suicide risk 1, 7
• Schizophrenia increases suicide rate, though it accounts for fewer suicides in the child and adolescent age group due to its rarity 1

Critical Risk Factors Across Diagnoses

Temporal and Clinical Factors

• Suicidal acts usually occur during major depressive episodes or mixed illness episodes, with incidence 20-40 fold higher compared to euthymia 5
• Earlier onset of illness is associated with higher risk of suicidality in both MDD and BD 1
• Hospital admission, onset age ≤25 years, and mixed features are independent predictors of suicidal acts 7

Psychological and Behavioral Traits

• Higher scores on subjective depression, suicidal ideation, and fewer reasons for living distinguish suicide attempters 6
• Lifetime aggression and impulsivity rates are greater in attempters across all psychiatric diagnoses 6
• Hopelessness and impulsive-aggressive traits are major risk factors 5

Historical and Social Factors

• Family history of suicidal acts or bipolar illness increases risk 1, 7
• Childhood abuse, trauma, or head injury are more frequent in suicide attempters 6, 7
• Being divorced/unmarried, having fewer children, and unemployment are associated with suicidal acts 7
• Poor perceived social support predicts suicidal acts 5

Common Pitfalls to Avoid

• Do not underestimate impulsivity—many suicide attempts occur within minutes of the decision, particularly in patients with disruptive disorders or substance use 3
• Do not rely solely on objective severity of depression or psychosis to assess risk; subjective depression scores and suicidal ideation are better discriminators 6
• Recognize that previous suicide attempts are the most potent predictor in males, especially adolescents, increasing risk more than 30-fold 1
• In females, major depression is the dominant risk factor, increasing risk up to 20-fold 1
• Be aware that comorbidity patterns differ: anxiety disorders amplify MDD risk, while substance use disorders amplify BD risk 1