Infectious Disease

ADHD medication can lower the risk of suicide in children

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Disclosure:
Barzilay reports that he serves on the scientific advisory board and owns shares in Taliaz Health. No other relevant information was given.

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A cohort study showed that children with significant externalizing symptoms who received ADHD medication had a lower risk of suicide.

Researchers wrote in JAMA Network Open that “there is a critical need to identify modifiable risk and protective factors” for suicide. Previous research, they added, has shown that psychostimulants can reduce suicidal behavior in patients with ADHD, but existing studies lack information about symptom severity and other confounding factors.

“Therefore, more data is needed on the potential relevance of the increasing use of ADHD drugs worldwide for suicide prevention,” the researchers write.
To find out more, they examined cross-sectional and 1-year longitudinal relationships of 11,878 children (mean age at the start of the study = 9.9 years; 52.2% boys; 74.1% white) from the Adolescent Brain Cognitive Development (ABCD) Study that took place from 2016 to 2019.

“Ideally, we want to test a drug effect on suicidality with a randomized prospective study.” Ran Barzilay, MD, PhD, An assistant professor at the Lifespan Brain Institute at Philadelphia Children’s Hospital said in a press release. “But given the challenges of conducting such studies, we as a society and as scientists have an obligation to derive clinical knowledge from data gathered in large-scale observational studies on children.”

Barzilay and colleagues found that 8.5% of the total study population were on ADHD medication and 8.8% reported previous or current suicidality. Externalizing symptoms (median = 1; range 0-29) were associated with suicidality, and a change in one symptom influenced the association (OR = 1.34; 95% CI 1.26-1.42), as did drug treatment of ADHD (OR = 1.32; 95% CI, 1.06-1.64). In addition, the use of ADHD drugs was associated with less suicidality in children with more externalizing symptoms (significant symptom-to-drug interaction, B = 0.25; standard error = 0.086; P = 0.004).

In children who were not administered ADHD medication, there was a correlation between more externalizing symptoms and higher chances of suicidality (for each change in a symptom OR = 1.42; 95% CI 1.33-1.52). Conversely, there was no such association in children who were administered ADHD medication (OR = 1.15; 95% CI 0.97-1.35).

The results also remained similar for covariation for confounders, including risk and protective factors for suicidality, and were duplicated in a one-year longitudinal follow-up period.

“Given the link between child suicidality and poor adult mental health, these results underscore the importance of better and more thorough screening of school-age children for the externalization of behavioral symptoms,” said Barzilay. “These symptoms are treatable and early treatment has strong potential to prevent and alleviate serious mental health problems later in life.”

The researchers also wrote that the results reinforce the idea of ​​using a “dimensional approach” to the treatment of ADHD, saying that “observing externalizing disorders along a continuum shows promise for more accurate associations with other forms of psychopathology, including suicidality, to enlighten “.

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