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.

中文翻译：

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治疗注意力缺陷/多动症和自杀未遂风险的药物


背景注意力缺陷/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仍不清楚。本研究旨在探讨多动症药物治疗与自杀未遂风险之间的关联。方法 我们利用 2005 年至 2014 年美国商业医疗保健索赔的数据，确定了一大群 ADHD 患者（N = 3,874,728，47.8% 女性患者）。我们使用人群水平和个体内分析来比较个人接受处方兴奋剂或非兴奋剂药物的几个月与不接受药物的几个月的自杀企图风险。结果 在人群水平和个体内分析中，ADHD 药物与较低的自杀企图几率相关（比值比 [OR]，0.69；95% 置信区间 [CI]，0.66-0.73；OR，0.61；95% CI，分别为 0.57-0.66）。在儿童到中年成年人以及临床相关亚组中也发现了类似的减少，包括患有多动症且先前存在抑郁症或药物滥用障碍的患者。这种减少主要见于兴奋剂药物（OR，0.72；95% CI，0.66-0.77）；非兴奋剂药物与自杀未遂风险的统计学显着变化无关（OR，0.94；95% CI，0.74-1.19）。评估不同暴露定义、不同结果定义、队列子集和不同分析方法的影响的敏感性分析提供了可比较的结果。结论 兴奋剂药物与 ADHD 患者自杀企图风险降低相关，而非兴奋剂药物不太可能增加自杀企图风险。