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Drug treatment for attention-deficit/hyperactivity disorder and suicidal behaviour: register based study
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA.
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2014 (English)In: BMJ-BRITISH MEDICAL JOURNAL, E-ISSN 1756-1833, Vol. 348, article id g3769Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the association between drug treatment for attention-deficit/hyperactivity disorder (ADHD) and risk of concomitant suicidal behaviour among patients with ADHD.

Design: Register based longitudinal study using within patient design.

Setting: Linkage of multiple national registers in Sweden.

Participants: 37,936 patients with ADHD born between 1960 and 1996 and followed from 2006 to 2009 for treatment status by ADHD drug treatment and suicide related events (suicide attempt and completed suicide).

Main outcome measure: Incidence rate of suicide related events during ADHD drug treatment periods compared with that during non-treatment periods.

Results: Among 37,936 patients with ADHD, 7019 suicide related events occurred during 150,721 person years of follow-up. At the population level, drug treatment of ADHD was associated with an increased rate of suicide related events (hazard ratio 1.31, 95% confidence interval 1.19 to 1.44). However, the within patient comparison showed a reverse association between ADHD drug treatment and rate of suicide related events (0.89, 0.79 to 1.00). Among stimulant users, a reduced within patient rate of suicide related events was seen during treatment periods (0.81, 0.70 to 0.94). Among non-stimulant/mixed users, no significantly increased within patient rate of suicide related events during non-stimulant treatment periods was seen (0.96, 0.72 to 1.30).

Conclusions: This study found no evidence for a positive association between the use of drug treatments for ADHD and the risk of concomitant suicidal behaviour among patients with ADHD. If anything, the results pointed to a potential protective effect of drugs for ADHD on suicidal behaviour, particularly for stimulant drugs. The study highlights the importance of using within patient designs to control for confounding in future pharmacoepidemiological studies.

Place, publisher, year, edition, pages
London, United Kingdom: B M J Group , 2014. Vol. 348, article id g3769
National Category
Medical and Health Sciences General Practice
Identifiers
URN: urn:nbn:se:oru:diva-54601DOI: 10.1136/bmj.g3769ISI: 000337805600002PubMedID: 24942388Scopus ID: 2-s2.0-84902590390OAI: oai:DiVA.org:oru-54601DiVA, id: diva2:1064428
Funder
Swedish Research CouncilÅke Wiberg Foundation
Note

Funding Agencies:

Swedish Council for Working Life and Social Research 

Strategic Research Program in Epidemiology at Karolinska Institutet 

Swedish Initiative for Research on Microdata in the Social and Medical Sciences (SIMSAM) 

Available from: 2017-01-12 Created: 2017-01-12 Last updated: 2019-04-17Bibliographically approved

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Larsson, Henrik

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