ADHD-Related Symptom Dimensions and Suicidality After Hospitalization for Bipolar Disorder: A Lebanese Cross-Sectional Survey

Background: Attention-deficit/hyperactivity disorder (ADHD)-related symptoms overlap with bipolar presentations, but associations between individual ADHD-related symptom dimensions and suicidality remain uncertain. Methods: In this exploratory cross-sectional study, adults previously hospitalized for bipolar disorder at Hôtel-Dieu de France, Beirut, between 2017 and 2025 completed a post-discharge online survey. Retrospective childhood ADHD-related symptoms were screened using the Wender Utah Rating Scale-25 (WURS-25), current adult ADHD symptoms using the Adult ADHD Self-Report Scale (ASRS), and suicidality using the P4 screener and reported previous suicidal behavior. Neither the interval since discharge nor current mood state was systematically assessed. Results: Forty-nine participants completed the survey (mean age 35.9 ± 11.9 years; 71.4% women). The composite suicidality outcome was present in 73.5%; 34.7% had a positive WURS-25 screen and 22.4% a positive ASRS Part A screen. Categorical ADHD screening positivity was not significantly associated with suicidality. Participants with suicidality were younger and more frequently reported increased alcohol or substance use since hospitalization. In exploratory age-adjusted models, the associations involving inattentiveness and impulsivity varied with the included WURS-25 subdimensions: higher inattentiveness scores were associated with lower odds of suicidality, whereas higher impulsivity scores were associated with higher odds when the negative mood subdimension was excluded. Conclusions: These preliminary findings highlight the potential clinical relevance of examining individual ADHD-related symptom dimensions alongside categorical screening results when investigating suicidality in bipolar disorder. However, the observed associations between retrospective ADHD-related symptom dimensions and suicidality in this small bipolar disorder sample were exploratory and sensitive to model specification. They require replication with larger samples, diagnostic ADHD assessment, and concurrent mood-state measurement.