ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials

作者：Le Zhang, Nanbo Zhu, Arvid Sjölander, Mikaïl Nourredine, Lin Li, Miguel Garcia‐Argibay, Ralf Kuja‐Halkola, Isabell Brikell, Paul Lichtenstein, Brian M. D’Onofrio, Henrik Larsson, Samuele Cortese, Zheng Chang · 发表于：BMJ · 年份：2025 · DOI：10.1136/bmj-2024-083658 · 被引用次数：44 · 研究领域：Attention Deficit Hyperactivity Disorder、Traumatic Brain Injury Research、Neuroethics, Human Enhancement, Biomedical Innovations

Abstract Objective To examine the effects of drug treatment for attention deficit/hyperactivity disorder (ADHD) on suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality. Design Emulation of target trials. Setting Linkage of national registers in Sweden, 2007-20. Participants 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. Main outcome measures First and recurrent events of five outcomes over two years after ADHD diagnosis: suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality. Results 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 v 69.1 per 1000 person years; 0.85, 0.83 to 0.87), transport accidents (24.0 v 27.5 per 1000 person years; 0.88, 0.82 to 0.94), and criminality (65.1 v 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 v 90.1 per...