Sophie Hsin-Yi Liang1, Yao-Hsu Yang2, Ting-Yu Kuo3, Yin-To Liao4, Tzu-Chin Lin4, Yena Lee5, Roger S McIntyre6, Brent A Kelsen7, Tsu-Nai Wang8, Vincent Chin-Hung Chen9. 1. Department of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC; Department of Child Psychiatry, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan, ROC. 2. Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC; Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC. 3. Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC. 4. Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC; Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC. 5. Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada. 6. Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Department of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada. 7. Language Center, National Taipei University, New Taipei City, Taiwan, ROC. 8. Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC. 9. Department of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC; Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC. Electronic address: hjcch@yahoo.com.tw.
Abstract
BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) youths have increased suicide risk. Nevertheless, the beneficial effects of methylphenidate (MPH) on suicide attempt have received relatively little attention. AIMS: To investigate the MPH usage and the risk of suicide attempt among ADHD youths. METHODS: We identified 84,898 youths less than 18 years old with ADHD diagnosis between 1997 and 2013 from National Health Insurance, and examined whether MPH use affected suicide attempt risk using Cox proportional-hazards models. OUTCOME AND RESULTS: Among ADHD youths, reduction of suicide risk was found in patients prescribed 90-180days of MPH after adjusting for confounding factors (hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.19-0.90) and a greater reduction in those prescribed more than 180days of MPH (HR: 0.28, 95% CI: 0.17-0.48). CONCLUSIONS AND IMPLICATIONS: We observed a 59% suicide attempt risk reduction among ADHD youths prescribed between 90 and 180days and a 72% risk reduction in those prescribed more than 180days of MPH. The protective benefit observed by the group prescribed MPH for longer duration underscores the importance of psychoeducation and compliance enhancement as part of ADHD management. Indication bias is identified as a limitation of this study, and future self-case control study to investigate the association between suicide attempt and ADHD medication is suggested. WHAT THIS PAPER ADDS: This nationwide population-based cohort study showed that among ADHD youths, reduction of suicide risk was observed in patients prescribed MPH for duration 90days and longer, underscoring the importance of appropriate ADHD pharmacotherapy and enhancing drug compliance.
BACKGROUND:Attention-deficit/hyperactivity disorder (ADHD) youths have increased suicide risk. Nevertheless, the beneficial effects of methylphenidate (MPH) on suicide attempt have received relatively little attention. AIMS: To investigate the MPH usage and the risk of suicide attempt among ADHD youths. METHODS: We identified 84,898 youths less than 18 years old with ADHD diagnosis between 1997 and 2013 from National Health Insurance, and examined whether MPH use affected suicide attempt risk using Cox proportional-hazards models. OUTCOME AND RESULTS: Among ADHD youths, reduction of suicide risk was found in patients prescribed 90-180days of MPH after adjusting for confounding factors (hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.19-0.90) and a greater reduction in those prescribed more than 180days of MPH (HR: 0.28, 95% CI: 0.17-0.48). CONCLUSIONS AND IMPLICATIONS: We observed a 59% suicide attempt risk reduction among ADHD youths prescribed between 90 and 180days and a 72% risk reduction in those prescribed more than 180days of MPH. The protective benefit observed by the group prescribed MPH for longer duration underscores the importance of psychoeducation and compliance enhancement as part of ADHD management. Indication bias is identified as a limitation of this study, and future self-case control study to investigate the association between suicide attempt and ADHD medication is suggested. WHAT THIS PAPER ADDS: This nationwide population-based cohort study showed that among ADHD youths, reduction of suicide risk was observed in patients prescribed MPH for duration 90days and longer, underscoring the importance of appropriate ADHD pharmacotherapy and enhancing drug compliance.
Authors: Zheng Chang; Patrick D Quinn; Lauren O'Reilly; Arvid Sjölander; Kwan Hur; Robert Gibbons; Henrik Larsson; Brian M D'Onofrio Journal: Biol Psychiatry Date: 2019-12-13 Impact factor: 13.382
Authors: Zheng Chang; Laura Ghirardi; Patrick D Quinn; Philip Asherson; Brian M D'Onofrio; Henrik Larsson Journal: Biol Psychiatry Date: 2019-04-17 Impact factor: 13.382
Authors: Joseph Biederman; Maura DiSalvo; Ronna Fried; K Yvonne Woodworth; Itai Biederman; Stephen V Faraone Journal: J Adolesc Health Date: 2019-07-23 Impact factor: 5.012
Authors: Louise Öhlund; Michael Ott; Robert Lundqvist; Mikael Sandlund; Ellinor Salander Renberg; Ursula Werneke Journal: Ther Adv Psychopharmacol Date: 2020-08-06
Authors: Gal Shoval; Elina Visoki; Tyler M Moore; Grace E DiDomenico; Stirling T Argabright; Nicholas J Huffnagle; Aaron F Alexander-Bloch; Rebecca Waller; Luke Keele; Tami D Benton; Raquel E Gur; Ran Barzilay Journal: JAMA Netw Open Date: 2021-06-01
Authors: Stephen V Faraone; Tobias Banaschewski; David Coghill; Yi Zheng; Joseph Biederman; Mark A Bellgrove; Jeffrey H Newcorn; Martin Gignac; Nouf M Al Saud; Iris Manor; Luis Augusto Rohde; Li Yang; Samuele Cortese; Doron Almagor; Mark A Stein; Turki H Albatti; Haya F Aljoudi; Mohammed M J Alqahtani; Philip Asherson; Lukoye Atwoli; Sven Bölte; Jan K Buitelaar; Cleo L Crunelle; David Daley; Søren Dalsgaard; Manfred Döpfner; Stacey Espinet; Michael Fitzgerald; Barbara Franke; Manfred Gerlach; Jan Haavik; Catharina A Hartman; Cynthia M Hartung; Stephen P Hinshaw; Pieter J Hoekstra; Chris Hollis; Scott H Kollins; J J Sandra Kooij; Jonna Kuntsi; Henrik Larsson; Tingyu Li; Jing Liu; Eugene Merzon; Gregory Mattingly; Paulo Mattos; Suzanne McCarthy; Amori Yee Mikami; Brooke S G Molina; Joel T Nigg; Diane Purper-Ouakil; Olayinka O Omigbodun; Guilherme V Polanczyk; Yehuda Pollak; Alison S Poulton; Ravi Philip Rajkumar; Andrew Reding; Andreas Reif; Katya Rubia; Julia Rucklidge; Marcel Romanos; J Antoni Ramos-Quiroga; Arnt Schellekens; Anouk Scheres; Renata Schoeman; Julie B Schweitzer; Henal Shah; Mary V Solanto; Edmund Sonuga-Barke; César Soutullo; Hans-Christoph Steinhausen; James M Swanson; Anita Thapar; Gail Tripp; Geurt van de Glind; Wim van den Brink; Saskia Van der Oord; Andre Venter; Benedetto Vitiello; Susanne Walitza; Yufeng Wang Journal: Neurosci Biobehav Rev Date: 2021-02-04 Impact factor: 9.052
Authors: I Conejero; I Jaussent; R Lopez; S Guillaume; E Olié; C Hebbache; R F Cohen; J P Kahn; M Leboyer; P Courtet; J Lopez-Castroman Journal: Sci Rep Date: 2019-03-14 Impact factor: 4.379
Authors: Kai Xiang Lim; Frühling Rijsdijk; Saskia P Hagenaars; Adam Socrates; Shing Wan Choi; Jonathan R I Coleman; Kylie P Glanville; Cathryn M Lewis; Jean-Baptiste Pingault Journal: PLoS Med Date: 2020-06-01 Impact factor: 11.069