Zur Meital, Magnezi Racheli, Portuguese Shirley, Reuveni Inbal, Kedem Ron, Fruchter Eyal
Medical Supply Procurement Branch, Medical Services and Supply Center, Medical Corps, IDF, Israel.
Israel Defense Forces (IDF) Medical Corps, Israel.
Mil Med. 2018 Sep 1;183(9-10):e518-e524. doi: 10.1093/milmed/usy161.
Attention deficit hyperactive disorder (ADHD) is prevalent in 5.9-7.1% of children and adolescents, and 5% of adults. It results in poor academic, occupational, and social functioning. Pharmacotherapy improves core symptoms; however, average adherence levels are low and decrease at 16-17 years of age, just before the recruitment age to Israel Defense Forces (IDF). This study evaluated the effect of adherence to ADHD pharmacotherapy on occupational performance among soldiers.
Retrospective data were collected for the study cohort, which included all soldiers serving in the IDF from 2008 through 2012 (n > 500,000). Each soldier in the cohort was categorized based on adherence to treatment, as measured by prescriptions filled monthly: (1) no treatment, (2) low adherence (<2/year), (3) medium adherence (2-6/year), and (4) high adherence (>6/year). Occupational performance was evaluated by 3 indicative parameters: (1) number of sick days, (2) number of exemptions from daily activities, and (3) military profession disqualification, including sub-analysis to military profession groups.
ADHD pharmacotherapy adherence correlated inversely with occupational performance, as exhibited by more sick days and exemptions from daily activities. All soldiers pharmacologically treated for ADHD had higher professional disqualification rates compared with soldiers who did not require ADHD treatment. In contrast to the general trend, in the military drivers group, higher rates of ADHD adherence correlated with lower professional disqualification rates.
Our hypothesis that greater adherence would correlate positively with better occupational performance was refuted. We speculate that increased adherence levels are indicative of more severe ADHD and thus, accompanied by lower occupational performance. The correlation between increased adherence and improved driving ability could be attributed to the nature of driving professions, which require a high level of concentration. Due to the importance of driving in both military and civilian settings, interventions designed to enhance adherence to treatment for ADHD among drivers could have a broad effect on driving consequences, and should be considered by policymakers.
注意缺陷多动障碍（ADHD）在5.9% - 7.1%的儿童和青少年以及5%的成年人中普遍存在。它会导致学业、职业和社交功能不佳。药物治疗可改善核心症状；然而，平均依从水平较低，且在16 - 17岁时下降，恰好在以色列国防军（IDF）征兵年龄之前。本研究评估了ADHD药物治疗依从性对士兵职业表现的影响。
收集了研究队列的回顾性数据，该队列包括2008年至2012年在IDF服役的所有士兵（n > 500,000）。队列中的每名士兵根据每月处方填充量衡量的治疗依从性进行分类：（1）未治疗，（2）低依从性（<每年2次），（3）中等依从性（每年2 - 6次），以及（4）高依从性（>每年6次）。通过3个指示性参数评估职业表现：（1）病假天数，（2）日常活动豁免次数，以及（3）军事职业不合格情况，包括对军事职业组的亚分析。
ADHD药物治疗依从性与职业表现呈负相关，表现为病假天数更多和日常活动豁免次数更多。与不需要ADHD治疗的士兵相比，所有接受ADHD药物治疗的士兵职业不合格率更高。与总体趋势相反，在军事驾驶员组中，ADHD依从性较高与职业不合格率较低相关。
我们关于更高依从性将与更好职业表现呈正相关的假设被推翻。我们推测依从性增加表明ADHD更严重，因此伴随着较低的职业表现。依从性增加与驾驶能力提高之间的相关性可能归因于驾驶职业的性质，这需要高度集中注意力。由于驾驶在军事和民用环境中都很重要，旨在提高驾驶员对ADHD治疗依从性的干预措施可能会对驾驶后果产生广泛影响，政策制定者应予以考虑。
