Suicidal Ideation and Non-suicidal Self-injury in Early Adolescence: The Role of ADHD Symptoms, Affect, and Emotion Regulation

Abstract

Background: Suicidal ideation and non-suicidal selfinjury (NSSI) are highly prevalent during early adolescence and represent serious public health concerns. Emotional dysregulation has been identified as a transdiagnostic factor underlying various risk behaviors, particularly in youth with externalizing difficulties such as attentiondeficit/hyperactivity disorder (ADHD). While prior research has examined these factors independently, few studies have explored their joint and differential contribution to suicide-related outcomes in early adolescence. This study aimed to examine the association of ADHD-related symptoms, positive and negative affect, and emotional dysregulation with suicidal ideation and NSSI, as well as to explore whether emotional dysregulation moderates the relationship between ADHD-related symptoms and these risk behaviors.

Methods: A total of 1079 Spanish adolescents (M_age = 12.6 years, SD = 0.6) enrolled in the first year of compulsory secondary education participated in a cross-sectional study. Standardized self-report measures were used to assess ADHD-related symptoms (Strengths and Difficulties Questionnaire [SDQ]), affect (Positive and Negative Affect Schedule for Children and Adolescents [PANAS-N]), and difficulties in emotion regulation (Difficulties in Emotion Regulation Scale [DERS-18]), alongside indicators of suicidal ideation and NSSI. Data analysis included group comparisons and hierarchical logistic regression models.

Results: Suicidal ideation was reported by 10.1% of participants, and NSSI by 16.4%. Adolescents with either behavior exhibited significantly more hyperactivityinattention symptoms, greater negative affect, lower positive affect, and substantially elevated emotional dysregulation. In regression analyses, ADHD-related symptoms remained significant predictors after accounting for affect, although emotional dysregulation emerged as the strongest predictor, reducing the effects of other variables. Specific dimensions such as lack of emotional clarity and nonacceptance of emotional responses were associated with suicidal ideation, while impulse control difficulties and lack of adaptive strategies predicted NSSI. No moderation effects were found.

Conclusions: ADHD-related symptoms and emotional dysregulation both contribute independently to adolescent suicidal ideation and NSSI, with emotional dysregulation showing the most robust predictive value. Schoolbased prevention efforts should incorporate emotion regulation skill-building to reduce suicide risk and NSSI in early adolescence.