近日，瑞典卡罗林斯卡学院Zheng Chang团队研究了ADHD药物治疗与药物滥用、意外伤害、交通事故和犯罪风险的关联。相关论文发表在2025年8月13日出版的《英国医学杂志》上。

为了研究注意缺陷/多动障碍（ADHD）药物治疗对自杀行为、药物滥用、意外伤害、交通事故和犯罪的影响，研究组进行了一项目标试验的模拟。他们在瑞典国家登记册中分析2007-2020年6-64岁新诊断为ADHD的患者，在诊断后三个月内开始或未开始ADHD药物治疗。主要结局为测量诊断为ADHD后两年内五项结果的首次和复发事件：自杀行为、药物滥用、意外伤害、交通事故和犯罪。

在148581名ADHD患者中（中位年龄17.4岁；41.3%为女性），84282人（56.7%）开始接受ADHD药物治疗，其中哌醋甲酯是最常见的处方药（74515人；88.4%）。ADHD的药物治疗与自杀行为首次发生率的降低有关（初次吸毒组的加权发病率为14.5‰，非初次吸毒组为16.9‰；调整后的发病率比为0.83，95%置信区间为0.78至0.88），药物滥用（58.7比69.1‰；0.85，0.83至0.87），交通事故（24.0比27.5‰；0.88，0.82至0.94）和犯罪率（65.1比76.1‰；0.87，0.83到0.90），而意外伤害的减少在统计学上并不显著（88.5比90.1‰；发病率比0.98 0.96至1.01）。

在有既往事件的个体中，降低的发生率更为明显，自杀行为的发生率比率为0.79（0.72至0.86），意外伤害的发生率比为0.97（0.93至1.00）。对于复发性事件，ADHD的药物治疗与所有五种结局的发生率降低显著相关，自杀行为的发生率比为0.85（0.77至0.93），药物滥用的发生率比率为0.75（0.72至0.78），意外伤害的发生率为0.96（0.92至0.99），交通事故的发生率率比率为0.84（0.76至0.91），犯罪的发生率比值为0.75（0.751至0.79）。

研究结果表明，ADHD的药物治疗与降低自杀行为、药物滥用、交通事故和犯罪的风险有关，但考虑到首次事件发生率时，意外伤害的风险则无关。复发事件的风险降低更为明显，所有五种结果的发生率都降低了。这项目标试验模拟研究使用国家登记数据提供的证据是在常规临床患者的代表性。

附：英文原文

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

Author: Le Zhang, Nanbo Zhu, Arvid Sjlander, Mikail Nourredine, Lin Li, Miguel Garcia-Argibay, Ralf Kuja-Halkola, Isabell Brikell, Paul Lichtenstein, Brian M D’Onofrio, Henrik Larsson, Samuele Cortese, Zheng Chang

Issue&Volume: 2025/08/13

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 148581 individuals with ADHD (median age 17.4 years; 41.3% female), 84282 (56.7%) started drug treatment for ADHD, with methylphenidate being the most commonly prescribed at initiation (74515; 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 1000 person years; incidence rate ratio 0.98, 0.96 to 1.01). The reduced rates were more pronounced among individuals with previous events, with incidence rate ratios ranging from 0.79 (0.72 to 0.86) for suicidal behaviours to 0.97 (0.93 to 1.00) for accidental injuries. For recurrent events, drug treatment for ADHD was significantly associated with reduced rates of all five outcomes, with incidence rate ratios of 0.85 (0.77 to 0.93) for suicidal behaviours, 0.75 (0.72 to 0.78) for substance misuse, 0.96 (0.92 to 0.99) for accidental injuries, 0.84 (0.76 to 0.91) for transport accidents, and 0.75 (0.71 to 0.79) for criminality.

Conclusions Drug treatment for ADHD was associated with beneficial effects in reducing the risks of suicidal behaviours, substance misuse, transport accidents, and criminality but not accidental injuries when considering first event rate. The risk reductions were more pronounced for recurrent events, with reduced rates for all five outcomes. This target trial emulation study using national register data provides evidence that is representative of patients in routine clinical settings.

DOI: 10.1136/bmj-2024-083658

Source: https://www.bmj.com/content/390/bmj-2024-083658