This is our last session. It's a really big deal. It's very very very important and this is about ADHD and suicide and it's being done by I'll bring her in it's being done by once I can find the correct screen It's been done by Shanae Cleare who's at the University of Glasgow. And this is an overview of the research working being done at the University of Glasgow. Its title is sponsored by ADHD UK. The reality is there's an incredible woman called Jane Roberts. It's all her money went through the charity, but it's her and she is supporting the charity. She has become a trustee, she's an incredibly important person to us and her drive for change is something else and it comes from an absolute tragedy that her son Ben Roberts.

Took his own life and it's a, he had ADHD and consequences of that and he was undiagnosed for a very long time and the consequences of that, led to that awful result. It's Ben Jane Roberts's son and yeah, so she's sponsored this research through the charity. And, Shonaid, shall I just hand over to you to, and open up the presentation? And the University of Oslo is a specialist centre for research into suicide. It's an incredibly, incredibly important area of expertise.

Right, over to you. Thank you very much. So yeah, as Henry says, this is a massively important area of research, and I'm delighted to be along at such an incredible event to tell you a bit about it. So, yeah, this project is funded by ADHD UK, and as Henry said, particularly by Jane Roberts, who unfortunately lost her son to suicide. So obviously suicide is a very sensitive, very personal issue, and I just wanted to take a wee second to point out that in the bottom of my slides there's a rocket ship. And this is a link to a website which has international.

Resources and things, so if there's anything today that comes up that anybody feels they would like to talk about further or discuss with other people then please, please, please use those resources. So today what I thought I would do is basically that my two main aims for this presentation are to give you a little bit of the overview of kind of ADHD and suicide risk, then to talk about the kind of scale and challenges that suicide research or that faces suicide research. So could we go into the first slide please? Thank you. So I know everybody here knows a lot more about ADHD than I do, in all honesty, but just for completeness, thought I would just give a wee overview of it. So basically, as we are aware, ADHD is a neurodevelopmental.

Condition that the symptoms commonly appear during childhood, and a diagnosis is based on the presence and of persistent and impairing levels of hyperactivity, inattention, and impulsivity. And they obviously can appear in kind of to varying degrees, sorry, train going mass. And so the graph, the line graph that's there just gives an overview of prevalence of ADHD in children, and it's data from 2003 to 2011, but I thought it was a very nice indication of how the diagnosis of ADHD has increased in childhood. And as you can see, this represents a forty three percent increase from between 2003 and 2011, and as we are aware, estimates across the globe are between two to seven percent currently. In adults.

There was a recent World Health Organization survey, was conducted across 20 countries, and this indicated that rates of ADHD range from about point six percent to a seven point three percent across the globe, and this averaged out at a two point eight percent. So the numbers that are under the bar chart, so a lot of the stuff I'm talking about today is research into the area, and obviously the numbers and the rates that were seen in research can vary quite a bit. And I thought this was a really good example because, the statistics that are there, the percentage, the three and a half percent is the results from a recent, study looking at prevalence of ADHD in medical students in China.

And then the prevalence of over a quarter was recently found in a study that was conducted in Ireland by Brown and colleagues, and that looked at kind of multiple university institutions, and the data was weighted to be more representative of population. But just in terms of the numbers that I'm going to be discussing today, a lot of them can vary depending on how conditions have been measured, the population has been assessed and that sort of thing. So I thought I would just clarify that before we move on. So if we could go on to the next slide please. Thank you. So regardless of the studies, regardless of population, and regardless of measurement of assessment measures.

The one continuous thing we do see is that there is an association between people having ADHD and suicidal ideation. And a lot of studies do have this as coming in roundabout, and people with ADHD are maybe twice as likely to experience suicidal ideation. And again that study from Ireland by Brown and colleagues found that forty eight forty four point eight percent of individuals who had ADHD, who scored on ADHD measures had experienced suicidal ideation in their lifetime, and this was compared to round about twenty percent people who didn't have who didn't score for having ADHD. So there's a similar pattern seen for suicide attempts. The literature around suicide plans is a bit more varied. But in terms of suicide attempts.

There are people with ADHD symptoms or diagnosed with ADHD have been are more likely in some research to report having experienced a kind of suicidal behaviors. And in a study in 2019 that was conducted in a Danish registry sample, this so this study looked at research that had been or sorry, hospital attendances for suicidal behavior over a twenty year period, and what they found was that over the twenty years, overall people with ADHD were more likely to have attended or to have had medical support for a suicidal behaviour, and this was roundabout four times more prevalent in people with ADHD than it was with people who didn't have ADHD. And in this study, they found quite a gender difference. So in men with ADHD.

The prevalence of attending for a suicidal behaviour was around about four times more likely for them to attend than it was without a history of ADHD. And for women, the increase was around about nine times more, they were nine times more likely to have sought help for suicide behaviour. Again, that's over twenty years. And one of the things as well that makes this really difficult, and I will discuss it a bit more later, is it's really challenging because we know that people will experience suicidal thoughts, suicidal behaviours, and they might never ever seek treatment. So again, the hospital data is really interesting, it doesn't quite give us the full picture. Another thing that adds to this really complex relationship is obviously.

In terms of ADHD, there's a high rate of other conditions occurring alongside it, So a lot of studies indicate that people who have ADHD also have a kind of mood disorders, anxiety disorders, and a lot of the literature suggests that if in people who don't have a diagnosis of a mood disorder, they maybe have higher rates of depressive or anxiety symptoms. And this just really adds another layer of complexity to understanding this relationship, because it's not clear it it is not clear the nature of this relationship a lot of the time, and a lot of the data that is existing at the moment is cross sectional. So it's we can tell it's associated with kind of thoughts about suicide, that sort thing, but we don't actually understand how.

These how the relationship actually works. And it is really important for me to point out as well that most people with ADHD won't experience suicidal behaviours. And so this is something we see quite a lot in other kind of areas for suicide research, in that I think roundabout one of the most common statistics is that ninety percent of people who die by suicide have, say, a mood disorder or other kind of diagnosable psychiatric condition at that point. However, when you look at the kind of population overall, this actually equates to roundabout five percent of people who have, for instance, depression. So I know the numbers are they are big and it is a major problem, a really big concern that obviously.

Highly important to look into and kind of understand more of, but just I'm aware that I don't want to come across as very like too alarmist. And like I say, we really need to understand the relationship more. So again, a further complexity is that the research into the different kind of subtypes and the symptomology of ADHD is a bit sparse, but there there is some indication that there are different relationships between inattention symptoms suicidal ideation or hyperactivity and suicidal ideation as well. And sometimes these can be, looks so these, the relationship might be communicated through different factors, so multivariate models and mediation models have shown that in some situations inattention.

Might be associated with suicidal ideation through daydreaming or impairments that are brought on by rumination, that sort of thing as well. So again, it's at this point, it's very early, and we really need to understand this relationship more fully. And basically, there's there's a dearth of research in this really important area. So if we can move on to the next slide, please. Thank you very much. So I thought now we would just take a wee step back and look at the scale and the challenge that's presented by suicide research across the world. So as we know, suicide affects people across the globe to varying degrees, and the graph that you can see in front of you, the world map, and the different colors represent the.

Rates of suicide across the globe. And as you can see, there's only there's a couple of areas where we can't get data from, like I a global problem. And in 2019, it was estimated that seven hundred and three thousand died by suicide. And if we can move on to next slide, please. Thank you. And what that equates to is that every one in a hundred deaths is from suicide, which means that more people die from suicide than die from HIV, malaria, breast cancer, war, or homicide. And one of the things we currently don't know is how many of those deaths involve people with ADHD, and further complexity is obviously that the identification of ADHD in adulthood remains incredibly poor, unfortunately. So if we could go to the next slide, please. Okay.

So obviously, again, thinking about the burden of suicide, as I already said, hospital presentations and actually suicide deaths, they don't represent the extent of the burden of suicidal behaviour. So for those seven hundred and three thousand deaths from suicide, those individual tragedies, there's a potential, it's estimated like a potential one hundred and thirty five people could be impacted from each one of those deaths, which makes the impact of suicide around about ninety five million people potentially affected every year from suicide. And I always think what the most startling statistics is that every forty second one person dies by suicide, and in that time a further twenty people will make a suicide attempt.

And again, just to go back to that the paradox around, sorry, the gender paradox around suicide, as we know, there are more men die by suicide than women, but women are more likely to make a suicide attempt than men. And in UK, seventy five percent of suicides are by men, and suicide is the leading cause of death among men aged 35 to 49, and for men and women aged twenty to thirty four. There's also data from the National Centre of Health Statistics in America, which indicated a fifty six percent increase in suicides in young people, so aged ten to twenty four between 02/2007 2017. And again, at this point we don't, we can't, we are unable to answer the question that how many families of people with ADHD are affected by suicide.

Next slide, please. Thank you. So as I said, suicide is an incredibly complex phenomenon that occurs from a range and an interaction between various factors. And I think this model, the it's a biopsychosocial model of suicide risk, and I think this just really gives a kind of a glimpse into just how complicated, and complex this, phenomena is. So this model obviously, emphasizes the biological sorry, the my computer's trying to restart. So it's trying to yeah. Emphasizes the biological, psychological, and social factors and their complex interactions. So things like and it also gives quite a holistic approach in that we can't consider these factors in isolation. We have to look at them as a kind of integrated model for how these impact.

Individuals. And we have to take them into consideration, and so in the top box is the kind of social context of which suicidal thoughts and behaviours may develop, and we cannot even begin to consider these factors for individuals without taking social context into their lives. So things like economic turmoil or social isolation, these sorts of things, And then obviously, we have to look at this in a lifespan approach, and the early life events can increase or change somebody's vulnerability to stress. And then obviously, the impact that these factors have on somebody's suicide risk will vary between individuals and the interplay is affected by all the factors you can see in this model. And sorry, I'm trying to think of it bigger.

And obviously like down in the proximal factors that we've got, this really emphasizes the importance of psychological factors, especially in the development of dysregulated mood, and it highlights the importance of entrapment, which I'll talk about more. In my next slide, please. Again, so this is the integrated motivational relational model of suicidal behaviour, and it was basically created by Rory O'Connor to basically help us figure out how the kind of common pathway from in the emergence of suicidal ideation and suicidal behavior. So basically, I know this is a really complicated model to look at, it's actually not it's not as complicated as it looks at first sight. But essentially in this model, it kind of the pre motivational phase.

Just gives factors which might increase somebody's vulnerability to stress. The motivational phase talks about factors which are pertinent and potentially pertinent in developing suicidal ideation, and then into the volitional phase we have factors which may be implicated in the transition from suicidal thoughts to suicidal acts. And the two things I'm going to focus on really today are basically just to explain a little bit about how we think suicidal ideation develops, so the motivational phase. And then I'll say a bit more about the factors that differentiate between people who have thoughts about suicide and people who go on to engage in suicidal behaviour. So the main drivers of this model in the motivational phase are in.

The presence are our defeat and entrapment. So this model says that in the when somebody encounters an experience that might make them feel defeated, it's the emergence of feelings of entrapment that will lead to potentially them feeling more suicide or having thoughts about suicide. So when they feel they can't escape from the situation, and they that is more likely to lead to thoughts about suicide. And then in the emergence of suicidal behaviors, it's a different set of factors. And what is really nice about this model is the fact that it gives us testable pathways to look at the emergence of suicidal thoughts and then suicidal behaviors, and.

The motivational phase to feet and entrapment have repeatedly been linked with suicidal thoughts, and the volitional factors, we'll go into in the next slide please, have been more associated, thank you, with the transition to from thoughts to behaviours. So when somebody is feeling having thoughts about suicide, it would stand to potentially if they've got access to means that it might meet the likelihood of them engaging in suicidal behaviour more likely. And the same in terms of one of the ones that might be incredibly important to look at in terms of ADHD is if somebody's feeling suicidal and they are impulsive, you know, basically, like, that could lead somebody to be at increased risk to suicide.

So this is one of the things we're going to look at. If we go into the next slide, please. Thank you. So basically we're obviously we understand that ADHD is associated with increased risk of suicidal thoughts and behaviours, but currently we don't know why, and we're not 100% sure what factors increase risk and when. So IMV factors have been found to be useful in highlighting indicators of potential early risk, one of the things we're really keen to look at are which might be better to help us understand why some people with ADHD are in increased risk with suicide. And we're going to use the IMV to kind of map out our hypothesis and test these. If we go on to the next slide, please. Thank you. So basically the program of research we have.

Like I say, which is just getting started, is looking at it's a program that's going to run for about eighteen months, and there's three phases to it. The first phase, we are looking at just to find out what the current literature says about the relationship between ADHD and suicide risk, and this is mostly so as we can try to identify gaps in our knowledge, and then we will figure yeah. We can extend on the research to kind of really address these gaps. So in terms of the current literature, there was a review published in 2018, and we are using the same methodology as that to just really kind of hone in the most recent research, and so far we've found 50 papers that we're going to really go into depth with.

And if we can go on to the next slide please. So that will help us inform and figure out where to go for phase two, and in phase two we are going to conduct an online survey of people who have ADHD, people without ADHD, and this will be really to test components of the IMV and see which, like I said, if there's any factors, could be most pertinent for identifying people who may be at increased risk of suicide. And then the third and probably most important part of the study is going to be carrying out interviews with people with a history of ADHD and suicidal thoughts behaviors, and just really exploring the model in-depth in this. And, yeah, if we could move on to the, next slide, please. Thank you. So hopefully in eighteen months.

We will have a better understanding of the ADHD and suicide relationship. And yeah, thank you very much. Thank you for any questions.

Thank you very much. And we do have some questions that have been popped in. And that's this should have it should just work. What was that? Jump around cameras. Thank you for putting the QR code into your presentation. People would have seen I also put it up in a slightly larger format. For people in The UK also you can go to ADHD UK if you go to the bottom and there's a link Need Help Now which will direct you care within The UK. So it's clearly absolutely important to get help if you're in that situation or or you know someone who is the same agencies will will talk to people who have someone, you know, have someone to to give you advice if there's someone you think is at risk of of suicide. And obviously, if you think it's.

A clear and present danger right now, then you call 999 or your emergency service where wherever you are. Thank you for that. It's obviously incredibly the numbers you presented were stark and the impact that you showed was absolutely stark. The Yeah, it's obviously extremely sobering. Know from some of the evidence that you talked about that people with ADHD are at higher risk and trying to understand that. And I think some of that understanding of what are the sort of co conditions that make someone at higher risk, there's the potential to yield very, very important information to help target support and also to be able to recognize more dangerous situations that are significantly more dangerous.

When we talked a long time ago, I, well not so long, but a little while, it feels like a long time ago. It's been twenty four hours. Everything feels a long time ago right now. The I think one of the things that I was struck by was that which you intuitively knew which I like hadn't recognized was the difference between the fact that a lot of ADHD people, you know, we know are really, really struggling. We know how difficult it is to have ADHD. We know the impacts of that. The piece that I think you're particularly looking into is what's the difference between someone who's having a really, really tough time and someone who has, you know, is at high risk of suicide. And I was just confirming that is that, that is correct. In other.

Mental health conditions, what have you seen can be some of the factors that play a significant impact?

To go back to the IMD model, one of the things we do see really coming through quite strongly in the literature are entrapment. So when somebody is in a situation that they don't feel they can escape from for whatever reason, whether it's impaired kind of, like, goal adjustment or impaired memory recollection and problem solving to get out of it. If they start to feel trapped and stuck in the situation, then that can that's quite often associated with, you know, increased suicidal thoughts and things like that. But it's a very, very good question because obviously it's unfortunately as well, it's not if there was one factor, everything is so much easier, but it's just such a complex interplay. Yeah.

I thought that and that's quite it's particularly it's just very it's very emotional, very sad. Like, this that point on it on on feeling trapped, but but your point, it's not about physical entrapment, about being not able to think out of out of the thing and out of your position and situation.

Absolutely.

You know, people with ADHD will often talk about overwhelm where they're locked out, like it just can't, yeah and how that aspect people will have had some familiarity with and yeah it is it is and it's very important research you're doing. Think we're excited that you're doing it and excited for the donation that's made that made that be able to happen. We probably should do some nuts and bolts in terms of like what should people do, like if if they themselves have feeling suicidal, like what would your recommendation be? And what would your recommendation be to people who feel that they know someone who might be?

I think always a go to is if possible speak to people and it can be really difficult obviously for in terms of sometimes we find people find it really difficult to speak to somebody they know about how they've been feeling because they don't sometimes there's a perception of that feeling putting on somebody, and I would always recommend like, that's why I think that the link the website and stuff that's linked, I find incredibly useful because there's a ream of resources out there for people who are feeling distress, and they are these people are you know, people at the resources are trained to discuss these things. And it gives people a safe place with trained professionals to have a conversation with.

And I think it's really important as well if people do think that they do suspect that somebody they know is struggling, then I think it is really important to ask the person directly and just try to have an open dialogue about to find out how they've been feeling. Obviously, if you if you are concerned, like you said, Henry, contact emergency services. If you are really concerned that somebody cannot keep themselves safe or you feel you can't keep yourself safe, please contact emergency services, and please don't suffer in silence.

Yeah. And the you you in case that isn't working for people and for the global audience, so it's findahelpline.com that you've directed people to. The other, so we've had some questions come in, so if I'll go through those. One is someone offering themselves up recruitment for research as someone with lived experience of ADHD and suicidal ideation in previous attempts, can I participate in your research?

We are currently not at the point recruiting but I really appreciate the offer. If you can get my email, which is on the slides, please feel free to pop me an email. And that that goes for absolutely anybody. We actually we have a phenomenal a lot of people have contacted us for other research. We're really keen to be kept on board for learning about future things as well. So we do have oh, thank you. We have a database of people, and if anybody would like to be added to it, we can certainly we'd be delighted to link people in with our future research. Yeah. So sometimes the research doesn't want coming to Glasgow, so know that might not be practical, but certainly, I can let people.

Know about research or something coming. So please feel free to drop me an email or find me on Twitter.

Yeah. And and rather than attempt to after twenty four hours, attempt to to spell everything out correctly, it's at Shonaid Cleare, and it's Seonaid Cleare Glasgow dot a c dot u k. I'm gonna go for seonaid.cleare@Glasgow.aac.uk. Did I get it right wrong? It's actually quite that we're golden. You did better than I do most days, so thank you. Okay. I got it right though. That's the joke. Okay. Good. And otherwise, it's actually need Cleare on Twitter. Do get in touch. We will at the point to which that happens, we obviously, as a charity, will also be putting it on our newsletter. So do you like, if you subscribe to that, that's another way you'll you'll find out about it. If you don't do look to look to email now. Certainly, we will.

Obviously try and try and direct you or direct people on. So that's great. So they'll do I'll send her an email and and if you're watching this later, so not live, and they're completely different from when you know those TV competitions. If you're watching this on catch up or like a late date, please do not so this is actually for a future list and looking to have your interviews in what sort of time scale again?

We.

Haven't got that far but hopefully next year. Okay. So sometime next year. Do so you can still so get in touch if you're watching this later as well. That's going to be We've had someone ask and I think I think it's an important question because there's some misconceptions around that around this. What are the what are these the signs of suicidal tendencies? What should people look out for? And that's in in in other people.

I well, obviously, anything that if you suddenly start noticing behavior changes, maybe somebody withdrawing from situations or somebody seeming particularly distressed about future, I always think it's really helpful to to ask people as well, especially if I could have how they are feeling about the future more generally. I'm And distracted by my face.

You at my can face as well if that helps at all. Much better.

But yeah, essentially, like people withdrawing from situations or if they are feeling if they're talking about things that they maybe seem just distressed or depressed, hopeless. Again, sometimes it can be really, really difficult to pick up on these things, and I do think if you have any concerns about people asking them. Yeah. Just asking them how they currently feel about the future, how they're they're feeling more generally, if there's been anything that's happened recently. Again, going back to the entrapment thing, asking if there's any you know, just basically trying to get a sense, like, do people feel? Do they.

Are they thinking about the future? Are they, you know, able to see past things? Are they are they are they feeling stuck? Are they feeling trapped? There's again, there's some really good resources, like the Samaritan's website and NHS.

Yeah. And the the you can those are both directed from our need help now page on the bottom of ADHD UK, so we've got some resources to direct to people. And I think something important, because I think a lot of people are very concerned that if they speak to someone individually about suicide and ask them that that is in some way a bad thing? Think do you want to clarify that?

Absolutely not. Mean it's always scary. I personally would say that like it's yeah, it's not an easy thing to ask somebody if they are having thoughts about ending their life and it's not an easy thing to back talking to have a conversation about. But a lot of the time it's it can be a massive relief for people to be asked directly and I know there is a myth around that, you know, if you ask somebody about suicide, you're you're there's a potential that you're putting it into their the forefront of their mind, that sort of thing, but it's there's no evidence to support that. The evidence is that yeah. It's uh-huh. Ask Yeah. We'd recommend asking.

And I think the it's the I think we're no. And and that's I think that's important. And I think that it's a good thing to say and I think we, it's discussion in groups is I think not so recommended except within very structured environments because then that doesn't Yeah. Caring caring.

One of the one of the ways that I do find quite useful for asking is that sort of, you know, if if you're not comfortable act asking directly or the person you don't think might react that way, but sometimes saying, like, you know, if somebody in your situation, I'm aware that other people might experience, like, thoughts around suicide, and I just wanted to check. Is this something that's been around for you at moment, that sort of thing. And just instead of, I don't know, opening it more that I am instead of, I suppose, focusing in on somebody and making me feel like they already might feel quite isolated, and this might feel like a further isolation whereas kind of.

Including the the kind of perspective of other people can be really helpful I find.

That's a that's a really interesting approach and thank you. And I just want I want to get your your advice on groups, like what's your recommendations for talking within a wider group?

Think that depends on the individuals. So there's some for me, I find group settings quite difficult. Sometimes if I'm in that sort of situation, I might find that I withdraw more than maybe engaging more people. So sorry, know that's a bit of a kind of a.

Waffle answer but I certainly I think it's it's I just wanted it was important to cover. The the only the other side I just wanted to touch on is for individuals who themselves are having suicidal thoughts, is there a level of normal and what point should they be going, you know what I think I need to go and talk to someone?

Again it's all individual. One So of the things we do know about suicidal thoughts is that they can increase and they also come back down. Have it, it depends on again on the individual and I would always recommend talking to people. I would always recommend, it's amazing like the more conversations I have with people, the more I have realised that there's just the number of people who experience thoughts about suicide are it's, you know, because I know it's a very isolating thing to have and in that experience you feel alone in that moment, whereas actually just having conversation about how you've been feeling, like just being open with people maybe especially earlier, it might help stop things escalate.

And obviously, if you're feeling that the thoughts have escalated, speaking to somebody can be good for reducing the thoughts as well. So just the entire time talk to people. But again it's a really hard thing to answer because it does all depend on the individual circumstances, the individual's tolerances and what other kind of, I suppose protective factors people have around them and things like that.

Thank you. I think that wraps us up the conference. Have to do, I'll just do the wrap up. I want to thank you so much for coming and talking now with such great information, deep thoughts. It's obviously a very difficult topic and I'm very grateful for you to being here to talk about it. I'm very grateful for the work you're doing. Clearly it's incredibly important that link between ADHD and suicide that we need to know more. We need to so that we can we can help people and we can reduce that number. That's the that's the aim is to understand to save lives and so I thank you very much for Thank you and congratulations on such an amazing event. Thank you. Thank you. Happily pivots us into the into the celebration and thank you stage. And.

Don't know if we all go. So I'll say goodbye to you now. Thank you so much. Bye bye. And thank you. Have a great rest of your day. And oh, it was exciting.