Further ado, let's bring in Shinaid.

Hello. Hi, Henry. How are you? I'm great. Thank you. How are you? I'm good. Thanks. I just had to say I I what an incredible conference. I've only kinda dipped in and out, but we organize a really small conference of about 80 people with a couple of online things. I do not know how you guys have done it. So hats off to you. Been amazing.

There's there's thank you so much. There's a lot of people who are gonna get some thank yous at the end at the end of this who've been working, you know, through the night, a lot of hours up to this. It is a labor of love, right? We're doing it to make a difference. Everyone who's speaking, yourself including, gets absolutely zero fees. You're also doing it for love and wanting to change the world. And it's hugely appreciated. We're all doing this together. Right, I'm handing over to you. So this is research on ADHD and suicide. This is something that we fund, but it's through donation of an individual whose son lost his life to ADHD and the consequence of ADHD and took his own life. And it's it's an incredibly important work.

I'll share your slides now over to you. Thank you.

Yeah. So, again, just to say thank you so much for having me along. And I saw somebody put in the comments there that, absolutely, this is I'm going to talk quite a bit about suicide. And what you can see in the corner, a little rocket ship, that is a QR code that will take you to a a global kinda hosting page for resources and things. So, just to make you aware that that's there. Okey doke. So yep. My name is Seonaid. I'm a researcher at the Suicide Behavior Research Lab at Glasgow. And as Henry said, we have been doing this work with ADHD and funded by Jane Roberts looking at trying to understand the relationship between ADHD, mental health, and suicide risk.

So this I I came around last year and presented a little bit on this, and this is just kind of more of an update on, what's been going on. So, just a bit of background. ADHD, you guys probably know more than I do, is a quite commonly detected condition during childhood. It's characterized by varying levels of, attention or a hyperactivity symptoms, and they don't obviously occur in equal measures. And they can impact people across different domains of functioning, such as interpersonal or academic functioning. And very much, I was thinking of that there during the last presentation, about oh, sorry. I just saw that the video was over the QR code. Sorry. Yeah. I was thinking about that during the last presentation that the.

This thing about, like, trying to mask and trying to wear suits and stuff and, obviously, having things that are more open and accepting and people can dip in and out of may very well be useful for, engaging people more. So sorry. That was my wee tangent. So, yeah, ADHD can impact across, different domains. Obviously, the detection of ADHD in childhood, well, at all, is quite challenging because, as I say, not everybody presents with the same symptoms, and a lot of, the detection is based on externalizing symptoms and hyperactivity. So my little graph, like, graph to the side, just kinda emphasizes that there has been an increase in, detection, of, ADHD over the last few years, which could represent a change in the diagnostic procedures.

Maybe people are becoming a bit more aware of how, these things present and differences between genders. In fact, one study, looked at ADHD in young people who had a major depressive disorder. So what they actually found this is between 2012 and 2014. What they saw was an increase of about ten percent in diagnosis of ADHD for young people sorry, for young females, whereas there was a a ten percent decrease, in diagnosis for, young males during that time period as well. So the global estimates in 2018 of ADHD in children was between two and seven percent. And, obviously, as we know, there's a greater range across countries, and we are maybe not getting particularly representative data. And in adulthood so I think my word of today is complex.

Because ADHD is an incredibly complex condition. And I think the diagnosis of ADHD is incredibly complex as well, particularly in terms of identifying it and responding to it in adulthood. So I'll tell you a bit about it in a while, but one of the studies that we're doing is interviews. And the the real sense I'm getting from people is that the there's been a kind of misconception that ADHD, for some people, they have not realized it existed in, adulthood. They all thought it was a kind of childhood condition, that sort of thing. So it never occurred to them that, ADHD, could be a possibility for them. Excuse me. So, obviously, in adulthood, again, further complexity, it presents slightly differently to, younger ages. And it's often quite.

It happens quite a lot with other conditions. So it can be, masked or happen at the same time as somatic conditions, behavioral impairments, other kind of mental health concerns. And it can be then makes a challenge of trying to identify this and respond to it properly, particularly challenging. So ADHD and suicide risk. We the literature has said that there is an association between ADHD symptoms and suicidal thoughts. This can sometimes be as high as double as what people without ADHD experience. There can also be associations with suicide plans and suicide attempts. As I said about ADHD, conditions that occur at the same time, there's a lot of research that suggests that ADHD occurs with conditions alongside.

Such as quite commonly depression, that sort of thing. And there's been some research conducted into how ADHD and the difference, the varying symptoms, might present. So things like, the risk associated with, predominantly inattentive or predominantly high productivity, or the combined, and how this might interact to increase risk of suicide. But the thing is we have a really large gap in most of our knowledge and our understanding of how ADHD might increase an individual's risk of suicide. And we don't under yes. A lot of the research we do looks at trying to understand what factors increase individual risk and when, under what circumstances, because it's really important to highlight that a lot of the majority of people with ADHD.

Will never be suicidal. And that's something that's really important for me just to point out about all the research I'm going to talk about. A lot of these are not prevalent studies, or they're not, you know, general population. They're not representative of the wider ADHD. Research does often, and it's it's not to diminish any of the research, but it's just something to be aware of that sometimes it's quite people choose to take part in research for, other reasons and things. Eternally grateful for that. So, just to kind of discuss a bit about, the problem of suicide. So in 2019, around about seven hundred thousand people died by suicide, and it's a global concern as we all. And it affects all genders, all ages.

And, like I say, across the globe. So what this equates to is that round about every one in a hundred deaths is from suicide, which means that more people die from suicide than HIV, malaria, breast cancer, war, or homicide. And, again, just to highlight one of the gaps we have is we are not aware how many of those deaths involve people with ADHD. And suicide doesn't affect only the person who's experiencing the crisis. It also for every one of the seven hundred and three adults that dies by suicide sorry, death, there's the ripples are extensive, so it's potentially affecting ninety odd million. Because.

For every one person that dies by suicide, it's estimated that around about twenty people will attempt suicide as well. And that equates to about one every forty seconds. And there's a a gender imbalance in a or a gender paradox, sorry, I should say, in suicides where women are more likely to make a suicide attempt, whereas the majority of suicide deaths are by men. And suicide is the leading cause of death for men aged 35 to 49 and for young women at the moment. And, again, we're still not quite sure how many of the families of of people with ADHD are affected by suicide. So it's just really to emphasize the the the global scale of the problem. And, again, once again, suicide is also an incredibly complex situation. And.

The slide that you've got in front of you is the just got a bit wrong there. The slide that you've got in front of the you there is the biopsychosocial model of suicide risk. So, again, this I'm not gonna go into this in too much depth, but this slide just really emphasizes the impact of or the importance of looking at a the kind of context, the social context, more kind of distal factors such as early life experiences, genetic factors, family history, and then works through more recent events and things to proximal factors, so things that have recently happened, life events, psychopathology, substance abuse, and then how the but then, of course, it it emphasizes the need to keep in mind the dysregulated mood, depressive symptoms, things.

Possibility or increasing the vulnerability that somebody might experience thoughts about suicide or want to make a suicide attempt. Oh, excuse me. And this just this is the integrated motivational volitional model of suicide behavior. Name just rolls up tongue. So this is just really it's very similar to the model before, but it has a real focus on trying to draw out the kind of psychological factors. And the other thing that's really important about this model is that it looks at the factors that might be associated with suicidal ideation as being different from the factors that might be associated with suicidal behavior. And, again, so on the the left hand side of the the model, it just emphasizes.

The need to keep in mind people's context and stresses from, environmental factors, that sort of thing, previous life events. The second part of the model is the motivational phase. And in this phase, it just emphasizes factors which may be associated with the development of a kind of suicidal thoughts. And then this one, it particularly emphasizes the presence of a defeat as basically, if a defeating event happens in the presence of, you know, the threat to self moderators, then an individual could be more likely to experience feelings of entrapment, feeling trapped. And then the presence of motivational moderators, like including kind of interpersonal factors such as feeling like a burden, feeling like they don't belong.

It could increase an individual's risk of experiencing suicidal ideation and developing suicidal intent. But, again, the yeah. So the model kind of really emphasizes the interaction between psychological, biological, and environment factors. But it also is really helpful because it gives us an idea of things we can look at, particularly in terms of trying to detect, you know, early warning factors or signals and things. So it also it not only shows a pathway, but it also shows multiple potential intervention points. So and then in the third phase of the model, the volitional phase, the volitional moderators, are factors that in the presence of, could increase an individual's risk of making a a suicide attempt. And these include things like.

Physical pain sensitivity, fearless mental imagery, and previous history of, suicidal experiences. And, again, if anybody's there's a lot more in-depth information on it by on our website, and I've got the link at the the end of our, at the end of the presentation. So as I say, we understand that some groups, including people with ADHD, are at increased risk of suicidal behavior. But we are there's so many gaps in our knowledge, that we really the first stage of this program of research was to go and have a look at the latest literature. So, yeah, last year, I came along and presented on the fact that we were, conducting this review. So in phase one, we carried out a literature search.

The original plan had been to look at the last decade of research, around ADHD and suicide risk. However, when we went and had a look, there were three reviews that were conducted, which took us up between 2018, sorry, and 2020. There were three reviews conducted looking at this the association between suicidal thoughts and behaviors and ADHD. So informed by the literature previous searches, we conducted a review to update this. So it spanned from 2020 to 2023. And we were looking for studies that reported on ADHD, either suicidal ideation, suicide plans, suicide attempts and deaths, and they had to look at the relationship between ADHD and the suicide related outcome. So in that three year gap, there were 89.

Studies that were potentially eligible and 49 that fitted our criteria to include, which I think is a fantastic volume of research for three years. And this was obviously, like, this was going on quite the criteria were quite fixed and things because it was extending the research from one of other reviews. So it's quite a focused review. So we ended up including 49 studies, but there were actually there were 52 published articles that that, that were relevant. However, three of them reported on kind of, used the same dataset. So we just focused on including ones that, reported on that were unique studies. And so this is my little summary of, the populations and the outcome measures that were included in these 14 studies.

So as you can probably see, the research varied between populations. So it was it was reasonably balanced in that there was 25 with adult populations and 24 with young people. However, within that, they all focused on quite different outcomes, and they were also associated they also looked at a variety of different populations. So within the suicidal thoughts and behaviors, although there's, like, ten and eighteen papers that are included, these changed between focused populations such as military populations, forensic populations. A lot of them were in student populations, so it was incredibly varied, which means it was really difficult to kind of synthesize this into something rather than just describing they said this, they said this.

So, essentially, what they found was that ADHD, in line with the previous research, was associated with higher risk of suicidal thoughts and behaviors when controlled compared to control groups. And this was across all the populations. So, again, ended up with this this very succinct report of 50 odd pages, But I've just picked out some of the the findings I found particularly relevant. So in line with previous literature, we found that ADHD people with ADHD were more likely to have other mental health concerns at the same time compared to control groups or people without ADHD. Sorry. And in the presence of other conditions, ADHD was associated with increased suicide risk. However, there was some research that found that when ADHD occurred.

By itself without a a comorbid mental health condition, there was no increased risk of suicidal thoughts and behaviors when it was compared to other mental health diagnoses. So things like depression, bipolar disorder, that sort of thing. And there was one study that found when they controlled for, in people that had, more than one condition, when they controlled for the other conditions individually, they found that ADHD didn't remain associated with suicidality, but that actually suggests that the in that the comorbid comorbidity doesn't explain the entire relationship between ADHD and suicide risk. So, again, as the findings kind of indicate that there's something else underlying. It's it's it's potentially not the presence of ADHD.

As we kind of expected. We thought that there's probably going to be psychological factors that might be particularly relevant in these populations or any populations and might, again, give us a kind of indication of what would be a potential intervention point. So there were some studies that looked at the role of psychological factors. And one of the studies in students found that, ADHD, they can they carried out a a statistical model where they basically looked at the role of depressive symptoms in increasing an individual with ADHD, their risk of suicide. And they found that factors such as depressive symptoms or self esteem, stress, and interpersonal factors all potentially had a role, increasing an individual's risk of suicide.

Of suicide. Sorry. One of the things that was really interesting as well was that there there was a a study that found adaptive perfectionism was protective in reducing suicidal behavior in a group of young people. And, basically, for every unit increase of perfectionism, this equated to round about a ten percent reduction in the instant rate of suicidal behavior in the in the study. And even more interestingly, one of the psychological factors that's often associated with suicidal thoughts and behaviors is maladaptive perfectionism. So feeling pressure from or inter it's socially prescribed perfectionism where the individual feels that they are that other people have really high expectations, and they are striving to be perfect.

And they can't, they don't feel that they can reach that. So that's been found in a lot of previous research to be a risk factor for, suicidal thoughts and behaviors. But this study found that it wasn't related to suicidal thoughts and behaviors, which is really interesting because it could be that, again, it it could just indicate that there's a a different potential role, other psychological factors that might be more important, at identifying, people who are at increased vulnerability in these populations. The only thing is this study didn't actually control for gender. So, and that's obviously important due to differences in, perfectionism. There there tends to be quite a there's a bit of variability between.

Genders and things and how they perceive or how perfectionism may have the role may have a play. Those words in a different order. So, again, these studies are all just really they're interesting because they really can highlight the fact that there are other factors that are potential points of intervention, and a indication of potential early suicide risk. So, again, given all the the gaps we have in our our knowledge oh, excuse me. So, basically, what the review really emphasized, we are aware that ADHD is often associated with increased risk for suicidal thoughts and behaviors, but we don't know why. And, again, I keep coming back to this point, but we don't know what factors increase an individual's risk of, experiencing suicidality.

And we don't understand when these factors are particularly pertinent. So they again, the integrated motivational relational model is incredibly useful in highlighting potential indicators of early risk. So the next part of our our research was to look at what if there's any factors from the model that might be particularly pertinent in helping us understand why some people with ADHD are increased risk of suicide. So I would just like to take this opportunity to say a huge thank you. A d UK, were very, good for advertising our study. They really, we had a lot of support, and especially just making this more visible. And I have to say a huge thank you to all those that persevered and took part in the study. So earlier this year.

We carried out an online survey that was open to all adults in The UK over age 18. And, again, this was the main aim of this was to explore components of the IMV that might be particularly pertinent in identifying individuals who might be, at increased risk of suicide. And, again, I would just like to point out this is actually not a prevalent study. So this was we advertised a study for we were looking at looking to find out more about kind of, ADHD and risk of suicide and mental health concerns. So we had a really great response. We had 800 odd people take, who opened up the survey followed the link initially. And we had data from 734 participants to a park. And, obviously, one of the amazing things is that we had 734 people take part.

And, especially, academic surveys tend to be, even when we try to reduce the number of items that are in them because there were so many things we wanted to include, so many factors we felt were really important, that it was, I think, it took around twenty minutes. So I really appreciate everybody that persevered with it. This slide just kinda gives an overview of who took part in the study. So we had adults from age 18 to 73 take part, and the majority of them were female. I and we had a range of different sexual orientations to take part as well. And then on the right hand side of my screen, under the results section image, there's it just gives a breakdown of people that took part with ADHD.

So we had six hundred and twenty six people who had experienced ADHD, and this was we asked them, have you ever have you had experience of ADHD? Have you, have you had a diagnosis of ADHD? And this is just that group all in, so regardless of whether they'd had the diagnosis, or, experienced it. We had 626 people take part. I think this is probably the first study I have ever, conducted where I had to reopen recruitment to try and get people without experience of ADHD, for in in terms of the analysis and things. We were, I think, right away about 80 people at start, and it's quite good in terms of, analysis to have over a 100. So we reopened that. And I thought it was really interesting that we had about seventy percent of our sample.

Who said they'd experienced ADHD had a diagnosis of ADHD, but only three percent had been diagnosed before they were 16. So the majority of people, ninety odd percent, had been diagnosed after age 17 or 17 and older. Sorry. We also looked at, we used the World Health Organization screening questionnaire for, looking at recent ADHD, symptoms. And, again, we found a really high prevalence of people experiencing or having recent symptoms as well. And people who had felt that they had not experienced ADHD, found we about ten percent of them had they scored as possibly experiencing ADHD symptoms. And in terms of suicide attempt and suicide history and things, so what we asked.

This is just reporting. I do have a a kind of scale measure of recent ideation as well, but we asked people if they had ever experienced in their lifetime, had they experienced suicidal thoughts, had they made a suicide attempt. And as you can see, we had a really high proportion of people in both groups who had experienced thoughts about suicide. And in terms of making a suicide attempt, we had about a quarter of people who didn't have ADHD compared to forty two percent, of people who'd experienced ADHD who had made a suicide attempt in the past. And, again, high prevalence of nonsuicidal self harm thoughts and people who've injured themselves in the past as well in both groups. Just checking my time. Sorry. Okey doke. So we had.

Sorry. I'm kind of giggling because my my stars just won't stay in the right place. So the stars indicate where there were significant differences between the groups. So this is looking at the sample overall. So this is differences between people who had, experienced ADHD and had not experienced ADHD. Actually, just on that kind of, outcome measure of just asking people whether or not they'd experienced it. And people with ADHD in this study had higher levels of, depressive symptoms, anxiety symptoms, defeat, entrapment, Not surprisingly, given the high, proportion of suicidal thoughts in both group, there's no difference between, the groups and the suicidal thoughts. Interestingly, there was no difference, between the groups on stress.

There was no difference on emotional regulation, which I found quite interesting as well. And this is believe it or not, this is some of the selected measures and things that we included. There are a few other ones, which I was trying to make it succinct. So these are, some of the ones that are are kind of main measures we're looking at. So then I focused on within people who had experienced ADHD, and I looked at people who had made a suicide attempt and people who hadn't or people who told us they'd made a suicide attempt and people who hadn't. And, again, a similar pattern, where defeat, entrapment, anxiety symptoms, depression symptoms, are all significantly different between the groups. But, again, quite interestingly.

There's no difference in perfectionism. And this, again, this was focusing on socially prescribed perfectionism. There was no difference in feeling, feelings of loneliness. There were no difference in the emotional regulation. No difference on well-being. And the one at the end is benefit finding, and this was specifically for people with experience of ADHD. And we asked whether there was anything protective, or any benefits they felt were associated with their ADHD. And there was no difference in these between the groups. So, obviously, this is just kind of really, brief overview of a lot of research, and a lot more there's a lot more analysis to be done. So, my next steps are looking at, how these factors might associate with ADHD.

Or they might have a role between ADHD and suicide risk. There there was there was so much. It was really, really difficult to choose what to put in. And the other thing that we're also we have on the ongoing is we're currently carrying out interviews with people who have experience of ADHD and the history of suicidal thoughts and behaviors. And this is obviously to try and looking at psychological factors is is really, really useful. It's highly beneficial. However, we need the qualitative. We need sorry. Quant yeah. Qualitative. We need to talk to people and actually find out about their experiences because, otherwise, we don't understand the context, and we don't understand what's been around for people.

And we're only getting half a story. So that's what we've got on the go at the moment. So I I'm still looking for participants. Interviews can be conducted over Zoom, and I've put a little link there if anybody would like more information on the study. And if anybody would like more information on any of the studies, you are perfectly welcome to contact me, and that's my details all below. And that's a whistle stop tour of all the research we've got on going on at the moment.

Thank you. Thank you so much. It's obviously look, it's such important work and but obviously heartbreaking at the same time. It's really tough. You've chosen an incredibly important but tough area of research to do. We will put the link into the chat so people can see it. And I think I know the people in the back end team are just doing that right now. The yeah. Which I was just pausing whilst I pressed the button because I did I've got the link. So I need to just send it send it to them, which actually answered one of the key question that came in, which is can we get involved? Can we help?

Absolutely. Please do. Because I think on the ADHD, you had a conference schedule, I'm sure they've got the link or you've got the link for my email address maybe. So if anybody would like to get in touch, please feel free to.

That's very kind of you. Thank you. You've been amazing. We've got to wrap up. We've got to wrap up this conference. We are in our we're about to complete our twenty four hours of round the clock. We've circumnavigated the globe and had participants from around the globe and audience from here. So we need to thank you for your work. It's a big deal. You did it. I would like to do it as well. And to thank Jane Roberts, who's funding it in the name of her son, Ben. And it's there's there's there's money which comes with serious weight. And and that's definitely some of it. Like, all donations to charity carry weight, but some even more so when they're donated in the name of their, you know, their child. It's a big deal. Right.

I need to let you go and possibly to drink a lot of water before you struggle. So thank you very much. Thanks for all your Thanks for having me. And well done.