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SO446

ADHD pharmacotherapy and the risk of mortality and adverse outcomes

ADHD PHARMACOTHERAPY AND RISK OF MORTALITY AND ADVERSE OUTCOMES

In people newly diagnosed with ADHD, initiating medication within the first three months after diagnosis is associated with a lower risk of all-cause and unnatural-cause mortality, suicidal behavior, substance misuse, transport accidents, and criminal offending.

The study aimed to evaluate the effect of initiating medication after an ADHD diagnosis on mortality and adverse psychiatric, behavioral, and social outcomes. Swedish health and population registers were linked using a target trial emulation framework; cloning, censoring, and weighting were applied to follow approximately 148,600 people aged 6 to 64 years who were newly diagnosed with ADHD between 2007 and 2020 for up to two years (median age 17.4 years, 41% female); 56.7% of participants had initiated ADHD medication within three months of diagnosis. Over two years, the risk of all-cause mortality per 10,000 people was 39.1 (33.8 to 45.4) among those who initiated medication and 48.1 (42.5 to 54.5) among those who did not; the risk difference was -8.9 (-17.3 to -0.6) per 10,000 people, and the adjusted hazard ratio was 0.79 (0.70 to 0.88). This reduction was largely attributable to deaths from unnatural causes (25.9 versus 33.3; risk difference -7.4, -14.2 to -0.5; adjusted HR 0.75, 0.66 to 0.85), whereas no clear association was found for deaths from natural causes (adjusted HR 0.86; 0.71 to 1.05); the HR was 0.88 (0.74 to 1.04) for suicide, 0.47 (0.36 to 0.60) for accidental poisoning, and 1.34 (0.85 to 2.14) for accidental injury. For first events, medication initiation was associated with lower risks of suicidal behavior, 0.83 (0.78 to 0.88); substance misuse, 0.85 (0.83 to 0.87); transport accidents, 0.88 (0.82 to 0.94); and criminal offending, 0.87 (0.83 to 0.90); there was no significant difference in accidental injuries (0.98; 0.96 to 1.01). When recurrent events were considered, the reductions were more consistent: suicidal behavior, 0.85 (0.77 to 0.93); substance misuse, 0.75 (0.72 to 0.78); accidental injuries, 0.96 (0.92 to 0.99); transport accidents, 0.84 (0.76 to 0.91); and criminal offending, 0.75 (0.71 to 0.79). In conclusion, initiating ADHD pharmacotherapy is associated with reductions in mortality and numerous adverse psychiatric and behavioral outcomes; the findings indicate that the evidence for ADHD pharmacotherapy extends beyond symptom control to encompass health outcomes important to patients and broader societal outcomes, highlighting the importance of early clinical intervention after diagnosis.

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