利用挪威登记数据对注意力缺陷多动障碍（ADHD）临床实践中的变异及长期结局进行因果建模：ADHD争议项目
Causal modelling of variation in clinical practice and long-term outcomes of ADHD using Norwegian registry data: the ADHD controversy project.
作者信息
Mykletun Arnstein, Widding-Havneraas Tarjei, Chaulagain Ashmita, Lyhmann Ingvild, Bjelland Ingvar, Halmøy Anne, Elwert Felix, Butterworth Peter, Markussen Simen, Zachrisson Henrik Daae, Rypdal Knut
机构信息
Department of Community Medicine, University of Tromso Faculty of Health Sciences, Tromso, Norway
Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway.
出版信息
BMJ Open. 2021 Jan 19;11(1):e041698. doi: 10.1136/bmjopen-2020-041698.
INTRODUCTION
Attention-deficit/hyperactivity disorder (ADHD) is among the most common mental disorders in children and adolescents, and it is a strong risk factor for several adverse psychosocial outcomes over the lifespan. There are large between-country and within-country variations in diagnosis and medication rates. Due to ethical and practical considerations, a few studies have examined the effects of receiving a diagnosis, and there is a lack of research on effects of medication on long-term outcomes.Our project has four aims organised in four work packages: (WP1) To examine the prognosis of ADHD (with and without medication) compared with patients with other psychiatric diagnoses, patients in contact with public sector child and adolescent psychiatric outpatient clinics (without diagnosis) and the general population; (WP2) Examine within-country variation in ADHD diagnoses and medication rates by clinics' catchment area; and(WP3) Identify causal effects of being diagnosed with ADHD and (WP4) ADHD medication on long-term outcomes.
METHOD AND ANALYSIS
Our project links several nationwide Norwegian registries. The patient sample is all persons aged 5-18 years that were in contact with public sector child and adolescent psychiatric outpatient clinics in 2009-2011. Our comparative analysis of prognosis will be based on survival analysis and mixed-effects models. Our analysis of variation will apply mixed-effects models and generalised linear models. We have two identification strategies for the effect of being diagnosed with ADHD and of receiving medication on long-term outcomes. Both strategies rely on using preference-based instrumental variables, which in our project are based on provider preferences for ADHD diagnosis and medication.
ETHICS AND DISSEMINATION
The project is approved by the Regional Ethics Committee, Norway (REC number 2017/2150/REC south-east D). All papers will be published in open-access journals and results will be presented in national and international conferences.
TRIAL REGISTRATION NUMBERS
ISRCTN11573246 and ISRCTN11891971.
引言
注意力缺陷多动障碍（ADHD）是儿童和青少年中最常见的精神障碍之一，并且是一生中多种不良心理社会后果的重要风险因素。各国之间以及国内在诊断率和用药率方面存在很大差异。由于伦理和实际考虑因素，仅有少数研究考察了获得诊断的影响，而关于药物治疗对长期结局影响的研究则较为缺乏。我们的项目有四个目标，分别组织在四个工作包中：（工作包1）与其他精神疾病诊断患者、与公共部门儿童和青少年精神科门诊有接触的患者（未确诊）以及普通人群相比，研究ADHD（无论是否用药）的预后；（工作包2）按诊所的服务区域研究国内ADHD诊断和用药率的差异；（工作包3）确定被诊断为ADHD的因果效应；（工作包4）确定ADHD药物治疗对长期结局的影响。
方法与分析
我们的项目将挪威几个全国性登记处的数据相链接。患者样本为2009年至2011年期间与公共部门儿童和青少年精神科门诊有接触的所有5至18岁的人员。我们对预后的比较分析将基于生存分析和混合效应模型。我们对差异的分析将应用混合效应模型和广义线性模型。我们有两种识别策略来确定被诊断为ADHD以及接受药物治疗对长期结局的影响。这两种策略都依赖于使用基于偏好的工具变量，在我们的项目中，这些变量基于医疗服务提供者对ADHD诊断和用药的偏好。
伦理与传播
该项目已获得挪威地区伦理委员会批准（伦理委员会编号2017/2150/REC东南部D）。所有论文将发表在开放获取期刊上，研究结果将在国内和国际会议上展示。
试验注册号
ISRCTN11573246和ISRCTN11891971。
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