Associations of ADHD and Borderline Personality Disorder with Suicidality in Adolescents: Additive and Interactive Effects.

Background/

Objectives

Suicidal behaviors are a major clinical concern in adolescents, particularly among those with disorders marked by emotion dysregulation and impulsivity. Although attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) each heighten suicide risk, little is known about whether their occurrence confers additive or interactive effects in youth. This study examined whether ADHD and BPD diagnoses show additive or interactive associations with the suicide risk in adolescents.

Methods

In this cross-sectional observational clinical study, the sample included 108 Polish adolescents (66.7% female; aged 13-17 years) recruited from inpatient and outpatient psychiatric settings (Independent Public Healthcare Facility, Children and Youth Treatment Center in Zabór, the Youth Sociotherapy Center No. 2 in Wrocław, and the District Educational Center in Jerzmanice-Zdrój (Poland)). The data collection for our study was conducted between May 2024 and July 2025. Diagnoses and suicide risk were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID 7.02). Associations of ADHD and BPD with suicide risk were tested using linear and logistic regression models while accounting for age, sex, the current depressive episode, and the use of psychiatric medications.

Results

Unadjusted analyses revealed significant main, but not interactive, associations of BPD and ADHD with suicide risk. When covariates were included in the model, BPD remained strongly associated with suicidality severity and with the presence of any suicide risk (adjusted OR = 7.00, 95% CI [1.55-31.57]), whereas the association between ADHD and suicidality was attenuated and did not reach conventional levels of statistical significance (adjusted OR = 3.48, 95% CI [0.93-13.08]). No statistically detectable ADHD × BPD interaction was observed. Estimates for ADHD were directionally consistent across models but characterized by wide confidence intervals.

Conclusions

Adolescents with BPD appear to be at particularly high risk of suicide and should receive focused assessment, safety planning, and early intervention as part of routine care. In contrast, suicidality among adolescents with ADHD appears to be influenced by co-occurring clinical conditions, and its independent association with suicide risk remains statistically uncertain after adjustment. Clinicians should therefore remain alert to suicidality in youth with ADHD, while paying particular attention to accompanying symptoms and comorbid diagnoses that may further increase risk.