Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Eur Child Adolesc Psychiatry. 2024 Jun;33(6):1987-1996. doi: 10.1007/s00787-023-02294-6. Epub 2023 Sep 24.
ADHD is associated with an increased risk of injury. Causal evidence for effects of pharmacological treatment on injuries is scarce. We estimated effects of ADHD medication on injuries using variation in provider preference as an instrumental variable (IV). Using Norwegian registry data, we followed 8051 patients who were diagnosed with ADHD aged 5 to 18 between 2009 and 2011 and recorded their ADHD medication and injuries treated in emergency rooms and emergency wards up to 4 years after diagnosis. Persons with ADHD had an increased risk of injuries compared to the general population (RR 1.35; 95% CI: 1.30-1.39), with higher risk in females (RR 1.47; 95% CI: 1.38-1.56) than males (RR 1.23; 95% CI: 1.18-1.28). The between-clinics variation in provider preference for ADHD medication was large and had a considerable impact on patients' treatment status. There was no causal evidence for protective effects of pharmacological treatment on injuries overall for young individuals with ADHD characterized by milder or atypical symptoms. However, there was an apparent effect of pharmacological treatment over time on the risk of injuries treated at emergency wards in this patient group.
注意缺陷多动障碍（ADHD）与受伤风险增加有关。药物治疗对伤害影响的因果证据很少。我们使用提供者偏好的差异作为工具变量（IV）来估计 ADHD 药物治疗对伤害的影响。利用挪威登记数据，我们对 2009 年至 2011 年间被诊断为 ADHD 的 8051 名年龄在 5 至 18 岁的患者进行了随访，记录了他们在诊断后 4 年内接受 ADHD 药物治疗和在急诊室和急诊病房接受的伤害治疗情况。与普通人群相比，ADHD 患者受伤的风险增加（RR 1.35；95%CI：1.30-1.39），女性（RR 1.47；95%CI：1.38-1.56）的风险高于男性（RR 1.23；95%CI：1.18-1.28）。提供者对 ADHD 药物治疗的偏好存在较大的诊所间差异，对患者的治疗状况有重大影响。对于以轻度或非典型症状为特征的年轻 ADHD 个体，药物治疗总体上对伤害没有保护作用的因果证据。然而，在该患者群体中，药物治疗在时间上对急诊病房治疗的伤害风险有明显影响。
