Department of Psychiatry,Taipei Veterans General Hospital and Department of Psychiatry,College of Medicine,National Yang-Ming University,Taipei,Taiwan.
Department of Psychiatry,College of Medicine,National Yang-Ming University and Linsen Chinese Medicine and Kunming Branch,Taipei City Hospital,Taiwan.
Br J Psychiatry. 2018 Apr;212(4):234-238. doi: 10.1192/bjp.2018.8. Epub 2018 Mar 4.
Attention-deficit hyperactivity disorder (ADHD) increases the risk of suicidal behaviours through psychiatric comorbidities; however, a significant direct association has not been observed between ADHD and suicide attempts. Aims To evaluate the risk of suicide attempt in adolescents and young adults with ADHD.
Using a nationwide, population-based insurance claims database, this longitudinal cohort study enrolled 20 574 adolescents and young adults with ADHD and 61 722 age- and gender-matched controls between 2001 and 2009. Any suicide attempt was identified from enrolment to 31 December 2011. The association between ADHD medications and the likelihood of suicide attempt was assessed.
ADHD was an independent risk factor for any suicide attempt (hazard ratio = 3.84, 95% CI = 3.19-4.62) and repeated suicide attempts (hazard ratio = 6.52, 95% CI = 4.46-9.53). Subgroup analyses of men, women, adolescents and young adults demonstrated the same trend. Methylphenidate or atomoxetine treatment did not increase the risk of suicide attempt or repeated suicide attempts. Long-term methylphenidate treatment was associated with a significantly decreased risk of repeated suicide attempts in men (hazard ratio = 0.46, 95% CI = 0.22-0.97).
ADHD was a risk factor for suicide attempt and a stronger predictor of repeated suicide attempts, independent of comorbidities. Further investigation is warranted to explore the mechanism underlying the association between ADHD and suicidal behaviours. Declaration of interest None.
注意力缺陷多动障碍（ADHD）会通过精神共病增加自杀行为的风险；然而，尚未观察到 ADHD 与自杀企图之间存在显著的直接关联。目的评估 ADHD 青少年和年轻成人自杀企图的风险。
本纵向队列研究使用了一个全国性的基于人群的保险索赔数据库，纳入了 2001 年至 2009 年间 20574 名 ADHD 青少年和年轻成人以及 61722 名年龄和性别匹配的对照者。从登记到 2011 年 12 月 31 日，任何自杀企图都通过保险索赔数据库识别。评估 ADHD 药物与自杀企图可能性之间的关联。
ADHD 是任何自杀企图（风险比=3.84，95%CI=3.19-4.62）和重复自杀企图（风险比=6.52，95%CI=4.46-9.53）的独立危险因素。对男性、女性、青少年和年轻成人的亚组分析显示出相同的趋势。哌醋甲酯或托莫西汀治疗并未增加自杀企图或重复自杀企图的风险。长期哌醋甲酯治疗与男性重复自杀企图风险显著降低相关（风险比=0.46，95%CI=0.22-0.97）。
ADHD 是自杀企图的危险因素，也是重复自杀企图的更强预测因素，独立于共病。需要进一步研究来探讨 ADHD 与自杀行为之间关联的机制。利益声明无。
