Keypoint: ADHD pharmacotherapy does not reduce natural-cause mortality risk in individuals with ADHD.
Among individuals with attention-deficit/hyperactivity disorder (ADHD), initiating ADHD medication significantly decreases the risk for all-cause and unnatural-cause mortality, according to study findings published in JAMA. However, ADHD medications do not decrease natural-cause mortality risk.
It is widely established that ADHD is associated with physical and psychiatric comorbidities that increase the risk for adverse health outcomes, including premature mortality. However, it is unclear whether ADHD medication is protective or contributes to this mortality risk. To this aim, researchers examined whether the initiation of ADHD medication was associated with a decrease in mortality risk, across mortality types.
The researchers used data from multiple Swedish national registers to identify individuals aged 6 to 64 years who received a new ADHD diagnosis between 2007 and 2018 and had not previously been prescribed ADHD medication before their diagnosis. The primary outcome of interest was all-cause and cause-specific mortality during a 2-year follow-up period, confirmed using International Classification of Diseases (ICD) codes and categorized into natural (eg, physical conditions) and unnatural (eg, suicide, accidental poisoning) causes.
The researchers identified 148,578 eligible individuals with ADHD (median baseline age=17.4 years; 41.3% women). Within 3 months of their initial ADHD diagnosis, 56.7% (n=84,204) of individuals initiated ADHD medication and 43.3% (n=64,296) did not. Overall, 632 individuals died at the 2-year follow-up and 1402 individuals died during the 5-year follow-up. Unnatural causes accounted for over half of these deaths (66.7%).
At the 2-year follow-up, the researchers found individuals who initiated ADHD medication had a significantly lower risk for all-cause mortality (hazard ratio [HR], 0.79; 95% CI, 0.70-0.88) and unnatural-cause mortality (HR, 0.75; 95% CI, 0.66-0.86) relative to individuals who did not receive ADHD pharmacotherapy. However, natural-cause mortality was similar between groups (HR, 0.86; 95% CI, 0.71-1.05), regardless of ADHD medication status.
These findings were consistent for children, adolescents, young, adults, and boys/men. However, ADHD medication was only associated with a lower risk for natural-cause mortality among girls/women (HR, 0.64; 95% CI, 0.45-0.90). When stratified by type of unnatural causes of death, ADHD medication initiation was associated with a significantly lower risk for mortality due to accidental poisoning (HR, 0.47; 95% CI, 0.36-0.60).
Additionally, when the researchers extended their analyses to a 5-year follow-up, ADHD medication remained statistically significant in reducing the risk for unnatural-cause mortality (HR, 0.89; 95% CI, 0.81-0.97), relative to no ADHD pharmacotherapy.
The investigators concluded, “ADHD medication may reduce the risk of unnatural-cause mortality by alleviating the core symptoms of ADHD and its psychiatric comorbidities, leading to improved impulse control and decision-making, ultimately reducing the occurrence of fatal events, in particular among those due to accidental poisoning.”
Study limitations include a lack of data on nonpharmacological ADHD treatments and an inability to establish causal effects due to the observational design.
Note: This article originally appeared on Psychiatry Advisor