Zhang Le, Zhu Nanbo, Sjölander Arvid, Nourredine Mikail, Li Lin, Garcia-Argibay Miguel, Kuja-Halkola Ralf, Brikell Isabell, Lichtenstein Paul, D'Onofrio Brian M, Larsson Henrik, Cortese Samuele, Chang Zheng
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
BMJ. 2025 Aug 13;390:e083658. doi: 10.1136/bmj-2024-083658.
To examine the effects of drug treatment for attention deficit/hyperactivity disorder (ADHD) on suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality.
Emulation of target trials.
Linkage of national registers in Sweden, 2007-20.
People aged 6-64 years with a new diagnosis of ADHD, who either started or did not start drug treatment for ADHD within three months of diagnosis.
First and recurrent events of five outcomes over two years after ADHD diagnosis: suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality.
Of 148 581 individuals with ADHD (median age 17.4 years; 41.3% female), 84 282 (56.7%) started drug treatment for ADHD, with methylphenidate being the most commonly prescribed at initiation (74 515; 88.4%). Drug treatment for ADHD was associated with reduced rates of the first occurrence of suicidal behaviours (weighted incidence rates 14.5 per 1000 person years in the initiation group versus 16.9 in the non-initiation group; adjusted incidence rate ratio 0.83, 95% confidence interval 0.78 to 0.88), substance misuse (58.7 69.1 per 1000 person years; 0.85, 0.83 to 0.87), transport accidents (24.0 27.5 per 1000 person years; 0.88, 0.82 to 0.94), and criminality (65.1 76.1 per 1000 person years; 0.87, 0.83 to 0.90), whereas the reduction was not statistically significant for accidental injuries (88.5 90.1 per 1000 person years; incidence rate ratio 0.98, 0.96 to 1.01). The reduced rates were more pronounced among individuals with previous events, with incidence rate ratios ranging from 0.79 (0.72 to 0.86) for suicidal behaviours to 0.97 (0.93 to 1.00) for accidental injuries. For recurrent events, drug treatment for ADHD was significantly associated with reduced rates of all five outcomes, with incidence rate ratios of 0.85 (0.77 to 0.93) for suicidal behaviours, 0.75 (0.72 to 0.78) for substance misuse, 0.96 (0.92 to 0.99) for accidental injuries, 0.84 (0.76 to 0.91) for transport accidents, and 0.75 (0.71 to 0.79) for criminality.
Drug treatment for ADHD was associated with beneficial effects in reducing the risks of suicidal behaviours, substance misuse, transport accidents, and criminality but not accidental injuries when considering first event rate. The risk reductions were more pronounced for recurrent events, with reduced rates for all five outcomes. This target trial emulation study using national register data provides evidence that is representative of patients in routine clinical settings.
研究注意力缺陷多动障碍（ADHD）药物治疗对自杀行为、药物滥用、意外伤害、交通事故和犯罪行为的影响。
模拟目标试验。
瑞典国家登记处2007年至2020年的数据链接。
年龄在6至64岁之间，新诊断为ADHD的患者，在诊断后三个月内开始或未开始ADHD药物治疗。
ADHD诊断后两年内五种结局的首次和复发事件：自杀行为、药物滥用、意外伤害、交通事故和犯罪行为。
在148581名ADHD患者中（中位年龄17.4岁；41.3%为女性），84282名（56.7%）开始了ADHD药物治疗，其中哌甲酯是开始治疗时最常用的药物（74515名；88.4%）。ADHD药物治疗与首次出现自杀行为的发生率降低相关（开始治疗组的加权发病率为每1000人年14.5例，未开始治疗组为16.9例；调整后的发病率比为0.83，95%置信区间为0.78至0.88）、药物滥用（每1000人年58.7对69.1例；0.85，0.83至0.87）、交通事故（每1000人年24.0对27.5例；0.88，0.82至0.94）和犯罪行为（每1000人年65.1对76.1例；0.87，0.83至0.90），而意外伤害的降低无统计学意义（每1000人年88.5对90.1例；发病率比为0.98，0.96至1.01）。在有既往事件的个体中，降低的发生率更为明显，自杀行为的发病率比为0.79（0.72至0.
