(PS9-B47) Distress Tolerance as a Mediator Between Attention-deficit/hyperactivity Disorder Diagnosis and Suicide Risk

Individuals with Attention-Deficit/Hyperactivity Disorder (ADHD) have higher rates of suicidal thoughts and behaviors than the general population, although factors linking the two are still under investigation. Prior research has indicated that low distress tolerance is associated with an increased risk for suicide. Though distress tolerance has not been widely researched in ADHD, there is evidence to suggest that individuals with ADHD may struggle with emotion regulation and frustration tolerance. Thus, examining the role of distress tolerance among individuals with ADHD is an important step toward better understanding the rates of suicidal thoughts and behaviors among this population.

The current study examined distress tolerance as a possible mediator between ADHD diagnosis and suicide risk. Participants included 1,156 undergraduate students (37% cisgender men, 61% cisgender women, 2% other genders) from a large university in the Southern United States. Although the sample consisted of primarily (75%) Caucasian/White individuals, a substantial portion identified as Black/African-American (18%), and 7% identified as another race. Eighteen percent of the sample reported that they had ADHD. Distress tolerance was measured using Distress Tolerance Scale (total score), and suicide risk was measured using the Suicide Behaviors Questionnaire-Revised (total score). A mediated linear regression model with ADHD diagnosis (yes/no) as the independent variable, suicide risk as the dependent variable, and distress tolerance as a mediator was conducted using PROCESS for SPSS. Participants with ADHD had lower distress tolerance skills than participants without ADHD. Lower distress tolerance also was associated with higher suicide risk. There was a direct effect of ADHD diagnosis on suicide risk, such that participants with ADHD tended to have higher suicide risk than participants without ADHD (partially standardized direct effect = 0.40). There was also an indirect effect of ADHD diagnosis on suicide risk, such that lower distress tolerance skills partially mediated the relation between ADHD diagnosis and suicide risk (partially standardized indirect effect = 0.06). These findings reiterate the importance of suicide risk assessment in individuals with ADHD, given the elevated risk of suicidal thoughts and behaviors in this population. In addition, results suggest that distress tolerance skills are partially responsible for the association between ADHD and elevated suicide risk. Interventions focusing on distress tolerance skills, such as the distress tolerance module of dialectical behavior therapy, could potentially reduce suicide risk in this population and warrant further investigation.