Drug treatment for attention-deficit/hyperactivity disorder and suicidal behaviour: register based study.
Drug treatment for attention-deficit/hyperactivity disorder and suicidal behaviour: register based study.
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DOI：
10.1136/bmj.g3769
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发表时间：
2014-06-18
期刊：
影响因子：
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通讯作者：
Larsson H
中科院分区：
文献类型：
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作者：
Chen Q;Sjölander A;Runeson B;D'Onofrio BM;Lichtenstein P;Larsson H
目的探讨注意缺陷多动障碍（ADHD）药物治疗与伴发自杀行为的关系。基于设计注册的纵向研究使用患者内设计。在瑞典建立多个国家登记册的联系。参与者37，936名出生于1960年至1996年之间的ADHD患者，从2006年到2009年，按照ADHD药物治疗和自杀相关事件（自杀未遂和自杀完成）跟踪治疗状态。主要结果测量ADHD药物治疗期间与非治疗期间自杀相关事件的发生率。结果37 936例ADHD患者在150 721人年的随访中，共发生自杀相关事件7019起。在人群水平，ADHD的药物治疗与自杀相关事件的发生率增加相关（风险比1.31，95%置信区间1.19至1.44）。然而，患者内比较显示ADHD药物治疗与自杀相关事件发生率之间存在负相关（0.89，0.79至1.00）。在兴奋剂使用者中，治疗期间自杀相关事件的患者内发生率降低（0.81，0.70至0.94）。在非兴奋剂/混合使用者中，未观察到非兴奋剂治疗期间自杀相关事件的患者内发生率显著增加（0.96，0.72至1.30）。结论：本研究没有发现ADHD患者使用药物治疗与伴随自杀行为风险之间存在正相关的证据。如果有的话，结果表明ADHD药物对自杀行为有潜在的保护作用，特别是兴奋剂药物。该研究强调了在未来的药物流行病学研究中使用患者设计来控制混杂因素的重要性。
Objective To investigate the association between drug treatment for attention-deficit/hyperactivity disorder (ADHD) and risk of concomitant suicidal behaviour among patients with ADHD. Design Register based longitudinal study using within patient design. Setting Linkage of multiple national registers in Sweden. Participants 37 936 patients with ADHD born between 1960 and 1996 and followed from 2006 to 2009 for treatment status by ADHD drug treatment and suicide related events (suicide attempt and completed suicide). Main outcome measure Incidence rate of suicide related events during ADHD drug treatment periods compared with that during non-treatment periods. Results Among 37 936 patients with ADHD, 7019 suicide related events occurred during 150 721 person years of follow-up. At the population level, drug treatment of ADHD was associated with an increased rate of suicide related events (hazard ratio 1.31, 95% confidence interval 1.19 to 1.44). However, the within patient comparison showed a reverse association between ADHD drug treatment and rate of suicide related events (0.89, 0.79 to 1.00). Among stimulant users, a reduced within patient rate of suicide related events was seen during treatment periods (0.81, 0.70 to 0.94). Among non-stimulant/mixed users, no significantly increased within patient rate of suicide related events during non-stimulant treatment periods was seen (0.96, 0.72 to 1.30). Conclusions This study found no evidence for a positive association between the use of drug treatments for ADHD and the risk of concomitant suicidal behaviour among patients with ADHD. If anything, the results pointed to a potential protective effect of drugs for ADHD on suicidal behaviour, particularly for stimulant drugs. The study highlights the importance of using within patient designs to control for confounding in future pharmacoepidemiological studies.