Machine Learning Classification of Suicidal Ideation in Adolescents with Attention-Deficit/Hyperactivity Disorder: A Random Forest Approach Incorporating Impulsivity, Emotional Dysregulation, and Family Cohesion
Keywords:
Attention-Deficit/Hyperactivity Disorder, Suicidal Ideation, Random Forest, Machine Learning, Impulsivity, Emotional Dysregulation, Family CohesionAbstract
The present study aimed to develop and evaluate a Random Forest machine learning model for classifying suicidal ideation among adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) based on impulsivity, emotional dysregulation, and family cohesion. This cross-sectional predictive modeling study was conducted among 468 Canadian adolescents aged 13–18 years with a confirmed diagnosis of ADHD. Participants were recruited from outpatient psychiatric clinics, mental health centers, and educational counseling services across multiple provinces. Suicidal ideation was assessed using the Suicidal Ideation Questionnaire-Junior (SIQ-JR), impulsivity was measured using the Barratt Impulsiveness Scale-11 (BIS-11), emotional dysregulation was evaluated using the Difficulties in Emotion Regulation Scale (DERS), and family cohesion was assessed using the Family Adaptability and Cohesion Evaluation Scales IV (FACES-IV). Data were analyzed using a Random Forest classification algorithm implemented in Python. The dataset was divided into training and testing subsets using an 80:20 ratio, and 10-fold cross-validation was employed to optimize model performance. Classification accuracy, precision, recall, specificity, F1-score, and area under the receiver operating characteristic curve (AUC-ROC) were used to evaluate predictive performance. Feature importance analyses were conducted to identify the relative contribution of each predictor. The Random Forest model demonstrated excellent classification performance, achieving an accuracy of 88.2%, precision of 86.4%, recall of 90.1%, specificity of 86.7%, F1-score of 88.2%, and an AUC-ROC of .934. Suicidal ideation was positively associated with impulsivity (r = .54, p < .01) and emotional dysregulation (r = .67, p < .01) and negatively associated with family cohesion (r = −.49, p < .01). Feature importance analysis revealed that emotional dysregulation was the strongest predictor of suicidal ideation (35.8%), followed by family cohesion (28.5%) and impulsivity (24.4%). The confusion matrix further indicated high sensitivity and low rates of classification error. The findings demonstrate that machine learning approaches can accurately classify suicidal ideation among adolescents with ADHD and highlight emotional dysregulation, family cohesion, and impulsivity as key determinants of suicide risk. These results underscore the importance of integrating psychological and family-related factors into suicide prevention efforts and support the potential clinical utility of machine learning-based screening tools for early identification of high-risk adolescents.
Downloads
References
Adachi, M., Takahashi, M., & Mori, H. (2025). Positive Childhood Experiences Reduce Suicide Risk in Japanese Youth With ASD and ADHD Traits: A Population-Based Study. Frontiers in Psychiatry, 16. https://doi.org/10.3389/fpsyt.2025.1566098
Austgulen, A., Skram, N. K. G., Haavik, J., & Lundervold, A. J. (2023). Risk Factors of Suicidal Spectrum Behaviors in Adults and Adolescents With Attention-Deficit / Hyperactivity Disorder – A Systematic Review. BMC psychiatry, 23(1). https://doi.org/10.1186/s12888-023-05099-8
Barzilay, S., & Apter, A. (2022). Recent Research Advances in Identification and Prevention of Youth Suicide Risk. Current Opinion in Psychiatry, 35(6), 395-400. https://doi.org/10.1097/yco.0000000000000816
Boylan, K., Duncan, L., Wang, L., Manion, I., Bennett, K., Colman, I., & Georgiades, K. (2025). Prevalence and Correlates of Non-Suicidal Self-Injuring Youth Who Do Not Endorse Suicidal Ideation: Prévalence Et Corrélation De L’automutilation Non Suicidaire Chez Des Jeunes Qui N’ont Pas D’idées Suicidaires. The Canadian Journal of Psychiatry, 70(7), 574-582. https://doi.org/10.1177/07067437251337609
Choi, B. S., & Kim, J. h. (2023). A Comparative Study of Anxiety, Depression, Suicidal Ideation, and Self-Esteem in Students With or Without ADHD. https://doi.org/10.20944/preprints202310.0763.v1
Demo, G., Xiong, Y., Ferrara, M., & Williams, J. B. (2025). Psychiatric Comorbidities Predict Elevated Suicidal Symptoms in Children With ADHD. https://doi.org/10.1101/2025.08.09.25333367
Duncan, M., Vogel, A. C., Ramiah, A., Tillman, R., Barch, D. M., Luby, J. L., & Hennefield, L. (2025). The Presence of Externalizing Diagnoses Increases the Risk of Suicidal Thoughts and Behaviors in Youth Enriched for Early-Onset Depression. Jaacap Open, 3(3), 516-526. https://doi.org/10.1016/j.jaacop.2025.01.004
Feibus, I., Mahiques, M. B., Costello, M. A., Potter, K., Bentley, K. H., Hoeppner, B. B., Liu, L., Evohr, B., Gilman, J. M., Evins, A. E., Kossowsky, J., & Schuster, R. M. (2025). Characterizing Proximal Risk for Depressive Symptoms and Suicidal Ideation With Acute Cannabis Use and Withdrawal Among Adolescents Using Ecological Momentary Assessment: Study Protocol. PLoS One, 20(12), e0338790. https://doi.org/10.1371/journal.pone.0338790
Gagliano, A., Costanza, C., Modica, I. D., Carucci, S., Donno, F., Germanò, E., Abbate, C. S., Roccella, M., & Vetri, L. (2024). Neurodevelopmental Disorders and Suicide: A Narrative Review. Journal of clinical medicine, 13(6), 1627. https://doi.org/10.3390/jcm13061627
Garas, P., Takács, Z. K., & Balázs, J. (2025). Longitudinal Suicide Risk in Children and Adolescents With Attention Deficit and Hyperactivity Disorder: A Systematic Review and Meta‐Analysis. Brain and Behavior, 15(6). https://doi.org/10.1002/brb3.70618
Gifuni, A. J., Spodenkiewicz, M., Laurent, G., MacNeil, S., Jollant, F., & Renaud, J. (2023). Symptoms Characteristics of Personality Disorders Associated With Suicidal Ideation and Behaviors in a Clinical Sample of Adolescents With a Depressive Disorder. Frontiers in Psychiatry, 14. https://doi.org/10.3389/fpsyt.2023.1269744
Goff, T. M., Moody, M. E., Acosta, L. L., & Joyce‐Beaulieu, D. (2022). School-Based Cognitive-Behavioral Therapy in an Inclusion Model for an Adolescent With Comorbid Major Depressive Disorder, Generalized Anxiety Disorder, and Attention Deficit Hyperactivity Disorder: A Case Study. Clinical Case Studies, 21(5), 457-473. https://doi.org/10.1177/15346501221078329
Hornor, G., & Tucker, S. (2022). Child Sexual Abuse and Suicide. Journal of Forensic Nursing, 18(4), 237-246. https://doi.org/10.1097/jfn.0000000000000394
Joo, Y. Y., Moon, S. Y., Wang, H. H., Kim, H., Lee, E., Kim, J. H., Posner, J., Ahn, W. Y., Choi, I., Kim, J.-W., & Cha, J. (2022). Association of Genome-Wide Polygenic Scores for Multiple Psychiatric and Common Traits in Preadolescent Youths at Risk of Suicide. JAMA Network Open, 5(2), e2148585. https://doi.org/10.1001/jamanetworkopen.2021.48585
Katzenmajer-Pump, L., Farkas, B. F., Varga, B., Jansma, J. M., & Balázs, J. (2021). Low Level of Perfectionism as a Possible Risk Factor for Suicide in Adolescents With Attention-Deficit/Hyperactivity Disorder. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.707831
Katzenmajer-Pump, L., Komáromy, D., & Balázs, J. (2022). The Importance of Recognizing Worthlessness for Suicide Prevention in Adolescents With Attention-Deficit/Hyperactivity Disorder. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.969164
Lawrence, H. R., Burke, T. A., Sheehan, A. E., Pastro, B., Levin, R. Y., Walsh, R. F., Bettis, A. H., & Liu, R. T. (2021). Prevalence and Correlates of Suicidal Ideation and Suicide Attempts in Preadolescent Children: A US Population-Based Study. Translational psychiatry, 11(1). https://doi.org/10.1038/s41398-021-01593-3
Liu, R. T., Walsh, R. F., Sheehan, A. E., Cheek, S. M., & Sanzari, C. M. (2022). Prevalence and Correlates of Suicide and Nonsuicidal Self-Injury in Children. JAMA Psychiatry, 79(7), 718. https://doi.org/10.1001/jamapsychiatry.2022.1256
Liu, T. L., Hsiao, R. C., Chou, W. J., & Yen, C. F. (2021). Self-Reported Depressive Symptoms and Suicidality in Adolescents With Attention-Deficit/Hyperactivity Disorder: Roles of Bullying Involvement, Frustration Intolerance, and Hostility. International journal of environmental research and public health, 18(15), 7829. https://doi.org/10.3390/ijerph18157829
Marcelo, J. A. A. B., Croci, M. S., Murray, G. E., & Choi‐Kain, L. W. (2022). The Relationship Between Self-Harm and Suicide in Adolescents and Young Adults. Psychiatric Annals, 52(8), 311-317. https://doi.org/10.3928/00485713-20220715-01
Moseley, R., Gregory, N., Smith, P., Allison, C., Cassidy, S., & Baron‐Cohen, S. (2024). Potential Mechanisms Underlying Suicidality in Autistic People With Attention Deficit/Hyperactivity Disorder: Testing Hypotheses From the Interpersonal Theory of Suicide. Autism in Adulthood, 6(1), 9-24. https://doi.org/10.1089/aut.2022.0042
Predescu, E., & Șipoș, R. (2023). Self-Harm Behaviors, Suicide Attempts, and Suicidal Ideation in a Clinical Sample of Children and Adolescents With Psychiatric Disorders. Children, 10(4), 725. https://doi.org/10.3390/children10040725
Raible, H., & D’Souza, M. S. (2023). Extended-Release Viloxazine for the Treatment of Attention-Deficit Hyperactivity Disorder in School-Age Children and Adolescents. Annals of Pharmacotherapy, 57(12), 1436-1448. https://doi.org/10.1177/10600280231163252
Rensa, V. V. (2022). One‐year Incidence, Predictors, and Accuracy of Prediction of Suicidal Thoughts and Behaviors From the First to Second Year of University. Depression and Anxiety, 39(12), 727-740. https://doi.org/10.1002/da.23278
Rother, Y., Orlando, C. M., Warren, P., & Flory, K. (2025). ADHD and Suicidality in Adolescents: A Systematic Review of Moderators and Mediators. Clinical Child and Family Psychology Review. https://doi.org/10.1007/s10567-025-00531-9
Sarkisian, K., Hulle, C. V., & Goldsmith, H. H. (2021). Persistence During Childhood Problem-Solving as a Predictor of Active Suicidal Ideation During Adolescence. Research on Child and Adolescent Psychopathology, 49(4), 533-543. https://doi.org/10.1007/s10802-020-00726-4
Shahnovsky, O., Pirogovsky, L., Toukhy, N., Hergas, D. G., Apter, A., Haruvi-Catalan, L., benaroya, n., Fennig, S., & Barzilay, S. (2022). Psychosocial Correlates of Suicidal Ideation and Behavior in Adolescents and Preadolescent Children Discharged From Emergency Department. https://doi.org/10.21203/rs.3.rs-2413093/v1
Sharkey, C., Hardy, K. K., Gioia, A., Weisman, H., & Walsh, K. S. (2021). Suicidal Ideation and Executive Functioning in Pediatric Cancer. Psycho-Oncology, 31(5), 745-752. https://doi.org/10.1002/pon.5858
Thornton, K., Wiggs, K. K., Epstein, J. N., Tamm, L., & Becker, S. P. (2024). ADHD and Cognitive Disengagement Syndrome Symptoms Related to Self-Injurious Thoughts and Behaviors in Early Adolescents. European Child & Adolescent Psychiatry, 34(3), 1195-1206. https://doi.org/10.1007/s00787-024-02556-x
Todzia-Kornaś, A., Szczegielniak, A., & Gondek, T. (2023). Suicidality and Nonsuicidal Self-Injury in Females Diagnosed With Attention-Deficit Hyperactivity Disorder - A Narrative Review. Current Opinion in Psychiatry, 37(1), 38-42. https://doi.org/10.1097/yco.0000000000000908
Trivedi, C., Nandakumar, A. L., Yousefzadehfard, Y., Goriparthi, T. S., Chaudhari, G., Vora, D., Mansuri, Z., & Jain, S. (2022). Suicide Risk Among Adolescents With ADHD. The Journal of Nervous and Mental Disease, 211(3), 216-220. https://doi.org/10.1097/nmd.0000000000001587
Upshaw, B. M., Spencer, S. D., Pinciotti, C. M., Zhyrov, V., Minhajuddin, A., Castillo, A., Abacan, A., Slater, H., Walker, R. A., Blader, J. C., Martin, S. L., Shahidullah, J. D., Soares, J. C., Harper, R. A., Goodman, L. C., Goodman, W. K., Wakefield, S., Trivedi, M. H., & Storch, E. A. (2025). ADHD in Youth With Major Depressive Disorder in the Texas Youth Depression and Suicide Research Network (TX-YDSRN): Clinical Correlates and Moderators. Journal of Attention Disorders, 29(13), 1231-1246. https://doi.org/10.1177/10870547251353392
Wiglesworth, A., Falke, C., Fiecas, M., Luciana, M., Cullen, K. R., & Klimes‐Dougan, B. (2021). Brain Signatures in Children Who Contemplate Suicide: Learning From the Large-Scale ABCD Study. Psychological medicine, 53(5), 2164-2173. https://doi.org/10.1017/s0033291721004074
