Medication for Attention-Deficit/Hyperactivity Disorder and Risk for Suicide Attempts
Medication for Attention-Deficit/Hyperactivity Disorder and Risk for Suicide Attempts
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DOI：
10.1016/j.biopsych.2019.12.003
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发表时间：
2020-09-15
影响因子：
10.6
通讯作者：
D'Onofrio, Brian M.
中科院分区：
文献类型：
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作者：
Chang, Zheng;Quinn, Patrick D.;D'Onofrio, Brian M.
背景：注意缺陷多动障碍(ADHD)是自杀行为的危险因素，但ADHD药物对自杀行为的影响尚不清楚。这项研究旨在检验ADHD的药物治疗与自杀未遂风险之间的关系。方法：我们利用2005年至2014年美国商业医疗索赔的数据确定了大量ADHD患者(N=3874,728，47.8%的女性患者)。我们使用人群水平和个人内部分析来比较接受处方兴奋剂或非兴奋剂药物治疗的个人与没有接受药物治疗的月份的自杀企图的风险。结果：在人群水平和个人内部的分析中，ADHD药物与较低的自杀企图几率相关(优势比[OR]，0.69；95%可信区间[CI]，0.66-0.73；和OR，0.61；95%CI，0.57-0.66)。在儿童到中年成年人以及临床相关的亚组中也发现了类似的减少，包括患有既往抑郁症或药物使用障碍的ADHD患者。减少主要表现在服用兴奋剂(OR，0.72；95%CI，0.66-0.77)；非兴奋剂药物与自杀企图的风险变化没有统计学意义(OR，0.94；95%CI，0.74-1.19)。敏感性分析评估了不同的暴露定义、不同的结果定义、队列的子集和不同的分析方法的影响，提供了可比较的结果。结论：刺激性药物与ADHD患者自杀企图的降低相关，而非兴奋剂药物不太可能增加自杀企图的风险。
BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for suicidal behavior, but the effect of ADHD medication on suicidal behavior remains unclear. This study aimed to examine the associations between medication treatment for ADHD and risk of suicide attempts.METHODS: We identified a large cohort of patients with ADHD (N = 3,874,728, 47.8% female patients) using data from commercial health care claims from 2005 to 2014 in the United States. We used population-level and within-individual analyses to compare risk of suicide attempts during months when individuals received prescribed stimulant or nonstimulant medication relative to months when they did not receive medication.RESULTS: In both population-level and within-individual analyses, ADHD medication was associated with lower odds of suicide attempts (odds ratio [OR], 0.69; 95% confidence interval [CI], 0.66-0.73; and OR, 0.61; 95% CI, 0.57-0.66, respectively). Similar reductions were found in children to middle-aged adults and in clinically relevant subgroups, including patients with ADHD with preexisting depression or substance use disorder. The reduction was mainly seen for stimulant medication (OR, 0.72; 95% CI, 0.66-0.77); nonstimulant medication was not associated with statistically significant changes in risk of suicide attempts (OR, 0.94; 95% CI, 0.74-1.19). Sensitivity analyses assessing the influence of different exposure definitions, different outcome definitions, subsets of the cohort, and different analytic approaches provided comparable results.CONCLUSIONS: Stimulant medication was associated with a reduced risk of suicide attempts in patients with ADHD, and nonstimulant medication is unlikely to increase the risk of suicide attempts.