School of Medical Sciences, Örebro University, Örebro, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
JAMA Netw Open. 2022 Apr 1;5(4):e226815. doi: 10.1001/jamanetworkopen.2022.6815.
Adults with attention-deficit/hyperactivity disorder (ADHD) are at greater risk for unemployment. Pharmacological treatment is effective in reducing the core symptoms of ADHD, but whether it helps to reduce the unemployment rate among adult patients remains unclear.
To investigate the association between use of ADHD medication and long-term unemployment in working-age adults with ADHD.
DESIGN, SETTING, AND PARTICIPANTS: Data for this population-based cohort study were extracted from Swedish national registers. Among 25 358 individuals with ADHD born from 1958 to 1978, 12 875 middle-aged adults among the workforce were included. The longitudinal cohort was followed up from January 1, 2008, to December 31, 2013. Data were analyzed from March 1, 2020, through May 31, 2021.
Use of medication for ADHD during the previous 2 years was the main exposure, as both categorical and continuous variables.
Yearly accumulated unemployed days were derived from the Public Employment Service, and long-term unemployment was defined as 90 or more days of unemployment per year. Overall and sex-specific relative risks (RRs) with 95% CIs were estimated using generalized estimating equations.
Among 12 875 individuals with ADHD (5343 women [41.50%] and 7532 men [58.50%]; mean [SD] age, 37.9 [5.6] years), the use of ADHD medications during the previous 2 years was associated with a 10% lower risk of long-term unemployment in the following year (adjusted RR, 0.90 [95% CI, 0.87-0.95]). An association between use of ADHD medications and long-term unemployment was found among women (RR, 0.82 [95% CI, 0.76-0.89]) but not men (RR, 0.96 [95% CI, 0.91-1.01]). Longer treatment duration was associated with a lower risk of subsequent long-term unemployment among women (RR for use of 1-6 months, 0.86 [95% CI, 0.78-0.95]; RR for use of 18-24 months, 0.72 [95% CI, 0.58-0.90]; P < .001 for trend). Within-individual comparisons showed that the long-term unemployment rate was lower during periods of ADHD medication treatment compared with nontreatment periods (RR, 0.89; 95% CI, 0.85-0.94).
The findings of this cohort study suggest that the use of ADHD medication is associated with a lower risk of subsequent long-term unemployment for middle-aged women. These findings should be considered together with the existing knowledge of risks and benefits of ADHD medication when developing treatment plans for working-age adults.
患有注意力缺陷/多动障碍 (ADHD) 的成年人失业风险更高。药物治疗在减少 ADHD 的核心症状方面是有效的，但它是否有助于降低成年患者的失业率仍不清楚。
研究 ADHD 药物的使用与工作年龄 ADHD 患者的长期失业之间的关联。
设计、地点和参与者：本基于人群的队列研究的数据从瑞典国家登记处提取。在 1958 年至 1978 年出生的 25358 名 ADHD 患者中，纳入了 12875 名在职的中年成年人。该纵向队列从 2008 年 1 月 1 日随访至 2013 年 12 月 31 日。数据分析于 2020 年 3 月 1 日至 2021 年 5 月 31 日进行。
过去 2 年中使用 ADHD 药物治疗是主要暴露因素，包括分类和连续变量。
从公共就业服务机构获得每年累积失业天数，将每年失业 90 天或以上定义为长期失业。使用广义估计方程估计总体和性别特异性相对风险 (RR) 及其 95%置信区间。
在 12875 名患有 ADHD 的个体中（女性 5343 名[41.50%]，男性 7532 名[58.50%]；平均[标准差]年龄 37.9[5.6]岁），在接下来的一年中，使用 ADHD 药物治疗与长期失业的风险降低 10%相关（校正 RR，0.90 [95% CI，0.87-0.95]）。在女性中发现使用 ADHD 药物治疗与长期失业之间存在关联（RR，0.82 [95% CI，0.76-0.89]），但在男性中未发现关联（RR，0.96 [95% CI，0.91-1.01]）。女性治疗持续时间较长与随后长期失业的风险降低相关（使用 1-6 个月的 RR，0.86 [95% CI，0.78-0.95]；使用 18-24 个月的 RR，0.72 [95% CI，0.58-0.90]；趋势 P <.001）。个体内比较显示，在 ADHD 药物治疗期间的长期失业率低于非治疗期间（RR，0.89；95% CI，0.85-0.94）。
这项队列研究的结果表明，ADHD 药物的使用与中年女性随后长期失业的风险降低相关。在为工作年龄的成年人制定治疗计划时，应将这些发现与 ADHD 药物的现有风险和益处一起考虑。
