The intermediate role of impulsive personality traits between attention-deficit/hyperactivity disorder symptoms and suicidal ideation among patients with schizophrenia.

Abstract

Aim: While there is a general consensus on Attention-Deficit/Hyperactivity Disorder (ADHD) serving as a possible suicide risk factor in a broad range of populations, scant research has been dedicated to addressing ADHD and suicidality in schizophrenia. Therefore, there is a pressing need for studies that clarify these connections within the context of schizophrenia. This study was designed as one of the first to explore how impulsivity may serve as an indirect mediator of the impact of ADHD symptoms on suicidal ideation in patients with schizophrenia.

Methods: This study has a cross-sectional design and was performed between January and June 2025 among Tunisian outpatients with clinically stabilized chronic schizophrenia.

Results: 16.9% reported a lifetime personal history of suicidal attempt(s) and 11.3% a lifetime history of self-harm. Impulsivity partially mediated the association between ADHD symptoms and suicidal ideation (indirect effect: Beta = 0.127; Boot SE = 0.033; Boot CI: 0.069; 0.196). Higher ADHD symptoms were significantly associated with greater impulsivity and directly associated with higher suicidal ideation. Additionally, higher impulsivity was significantly associated with higher suicidal ideation.

Conclusion: The present results stress the importance of paying more attention to the expression of impulsive personality traits in patients with schizophrenia who exhibit prominent ADHD symptoms and suicidal ideation.