Evaluation of Attention-Deficit/Hyperactivity Disorder Medications, Externalizing Symptoms, and Suicidality in Children.
Evaluation of Attention-Deficit/Hyperactivity Disorder Medications, Externalizing Symptoms, and Suicidality in Children.
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评估儿童注意力缺陷/多动障碍药物，外部化症状和自杀性。
DOI：
10.1001/jamanetworkopen.2021.11342
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发表时间：
2021-06-01
影响因子：
13.8
通讯作者：
Barzilay R
中科院分区：
文献类型：
--
作者：
Shoval G;Visoki E;Moore TM;DiDomenico GE;Argabright ST;Huffnagle NJ;Alexander-Bloch AF;Waller R;Keele L;Benton TD;Gur RE;Barzilay R
注意力缺陷/多动障碍(ADHD)药物治疗、外化症状和儿童自杀(即构思或企图)之间是否存在关联？在这项对11 878名9至10岁基线儿童的队列研究中，外在症状显示预期与自杀有关。在基线和1年随访评估中，ADHD药物治疗与有外在症状的儿童，特别是那些有实质性症状负担的儿童的自杀倾向较低有关。这些发现表明，在有明显外化症状的儿童中，ADHD药物的使用可能与较少的自杀有关，除了在治疗外化症状方面已知的临床好处。这项队列研究调查了注意力缺陷/多动障碍(ADHD)药物与外化症状和儿童自杀的关系。儿童自杀(即自杀念头或企图)的比率正在上升，注意力缺陷/多动障碍(ADHD)和外在症状是与自杀有关的常见危险因素。需要更多的数据来描述ADHD药物治疗与儿童自杀之间的联系。目的：探讨ADHD药物治疗与儿童外化症状和儿童自杀的关系。在这项队列研究中，使用青少年大脑认知发展(ABCD)研究的数据(2016-2019年收集)，对横截面和一年纵向关联进行了检验。ABCD研究是一个大型、多样化的美国样本，涵盖了9至11岁的儿童。数据分析时间为2020年11月至12月。基线评估时，外在症状(多动多动症症状、对立违抗症状和品行障碍症状)和多动症药物治疗(哌甲酯和苯丙胺衍生物、α-2激动剂和托莫西汀)之间的主要和相互作用关系。儿童报告的自杀(基线时的过去和现在；目前的纵向评估)。协变量包括年龄、性别、种族/民族、父母的教育程度、婚姻状况以及伴随的儿童精神病药物治疗(抗抑郁药物和抗精神病药物)。在基线评估的11878名儿童中(平均[SD]年龄， 9.9[0.6]岁；6 196名男孩[52.2%]；8805名白人[74.1%])，1006名(8.5%)接受ADHD药物治疗，1 040名(8.8%)报告过去或现在有自杀倾向。外化症状(中位数 [范围]，1[0~29]个症状计数)与自杀(症状变化1 SD，优势比[OR]， 1.34；95%CI，1.26~1.42；P <； .001)和药物治疗(OR， 1.32；95%CI，1.06~1.64；P = .01)有关。在有更多外在症状的儿童中，使用ADHD药物与较少的自杀有关(显著的逐个症状交互作用，B = −0.250；SE = 0.086；P = .004)，因此，对于没有接受ADHD药物治疗的儿童，更多的外在症状与自杀倾向之间存在关联(症状变化1 SD，OR， 1.42；95%CI，1.33-1.52；P <； .001)；然而，对于接受ADHD药物治疗的儿童，没有这样的关联(OR， 1.15；95%CI，0.97-1.35；P = .10)。即使多个混杂因素，包括ABCD自杀的风险和保护因素，与药物的相关性仍然存在，并在一年的纵向随访中重复出现。敏感性分析匹配了大量外在症状服用和不服用ADHD药物治疗的参与者，证实其与较少的自杀有关。这些发现表明，ADHD药物治疗与有实质性外在症状的儿童的自杀倾向较低有关，并可用于儿童自杀预防策略。
Are there associations among attention-deficit/hyperactivity disorder (ADHD) pharmacotherapy, externalizing symptoms, and childhood suicidality (ie, ideation or attempts)? In this cohort study of 11 878 children aged 9 to 10 years at baseline, externalizing symptoms showed expected associations with suicidality. ADHD pharmacotherapy was associated with less suicidality in children with externalizing symptoms, specifically among those with substantial symptoms burden, both at the baseline and 1-year follow-up assessment. These findings suggest that in children with substantial externalizing symptoms, ADHD medication use may be associated with less suicidality, in addition to its known clinical benefits in treating externalizing symptoms. This cohort study investigates the associations of attention-deficit/hyperactivity disorder (ADHD) medication with externalizing symptoms and childhood suicidality. Childhood suicidality (ie, suicidal ideation or attempts) rates are increasing, and attention-deficit/hyperactivity disorder (ADHD) and externalizing symptoms are common risk factors associated with suicidality. More data are needed to describe associations of ADHD pharmacotherapy with childhood suicidality. To investigate the associations of ADHD pharmacotherapy with externalizing symptoms and childhood suicidality. In this cohort study, cross-sectional and 1-year-longitudinal associations were examined using data (collected during 2016-2019) from the Adolescent Brain Cognitive Development (ABCD) Study, a large, diverse US sample of children aged 9 to 11 years. Data analysis was performed from November to December 2020. Main and interaction associations of externalizing symptoms (hyperactivity ADHD symptoms, oppositional defiant, and conduct disorder symptoms) and ADHD medication treatment (methylphenidate and amphetamine derivatives, α-2-agonists, and atomoxetine) at baseline assessment. Child-reported suicidality (past and present at baseline; current at longitudinal assessment). Covariates were age, sex, race/ethnicity, parents’ education, marital status, and concomitant child psychiatric pharmacotherapy (antidepressants and antipsychotics). Among 11 878 children at baseline assessment (mean [SD] age, 9.9 [0.6] years; 6196 boys [52.2%]; 8805 White [74.1%]), 1006 (8.5%) were treated with ADHD medication and 1040 (8.8%) reported past or current suicidality. Externalizing symptoms (median [range], 1 [0-29] symptom count) were associated with suicidality (for a change of 1 SD in symptoms, odds ratio [OR], 1.34; 95% CI, 1.26-1.42; P < .001), as was ADHD medication treatment (OR, 1.32; 95% CI, 1.06-1.64; P = .01). ADHD medication use was associated with less suicidality in children with more externalizing symptoms (significant symptom-by-medication interaction, B = −0.250; SE = 0.086; P = .004), such that for children who were not receiving ADHD medications, there was an association between more externalizing symptoms and suicidality (for a change of 1 SD in symptoms, OR, 1.42; 95% CI, 1.33-1.52; P < .001); however, for children who were receiving ADHD medication, there was no such association (OR, 1.15; 95% CI, 0.97-1.35; P = .10). The association with medication remained even when covarying for multiple confounders, including risk and protective factors for suicidality in ABCD, and was replicated in 1-year longitudinal follow-up. Sensitivity analyses matching participants with high numbers of externalizing symptoms taking and not taking ADHD medication treatment confirmed its association with less suicidality. These findings suggest that ADHD medication treatment is associated with less suicidality in children with substantial externalizing symptoms and may be used to inform childhood suicide prevention strategies.
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DOI：
10.1016/j.jaac.2020.07.908
发表时间：
2021-05
影响因子：
13.3
作者：
Geselowitz B;Whalen DJ;Tillman R;Barch DM;Luby JL;Vogel A
通讯作者：
Vogel A
影响因子：
3
作者：
Lambek, Rikke;Tannock, Rosemary;Thomsen, Per Hove
通讯作者：
Thomsen, Per Hove
影响因子：
3.2
作者：
Klonsky, E. David;May, Alexis
通讯作者：
May, Alexis
影响因子：
1.9
作者：
Hills, Amber L.;Afrfi, Tracie O.;Sareen, Jitender
通讯作者：
Sareen, Jitender
影响因子：
8.8
作者：
Booth, C. M.;Tannock, I. F.
通讯作者：
Tannock, I. F.