Association of psychiatric comorbidity with the risk of premature death among children and adults with attention-deficit/hyperactivity disorder
JAMA Aug 14, 2019
Sun S, Kuja-Halkola R, Faraone SV, et al. - Through a cohort study of 86,670 individuals with attention-deficit/hyperactivity disorder (ADHD) from a Swedish register, researchers examined the all-cause and cause-specific mortality risks in ADHD and investigated the potential role of psychiatric comorbidities. A total of 424 individuals with ADHD and 6,231 without ADHD died during follow-up, leading to mortality rates of 11.57 and 2.16 per 10,000 person-years, respectively. The correlation was more powerful in adulthood vs childhood, and grew substantially with the number of psychiatric comorbidities with ADHD. The relation between ADHD and the risk of death due to natural causes was weakened substantially and was not, any longer, statistically important in adulthood while adjusting for early-onset psychiatric comorbidity. The correlation was reduced to statistical non-significance for death because of suicide, but remained statistically significant for death caused by unintentional injury or other external conditions, while adjusting for later-onset psychiatric disorders. A vital role is played by psychiatric comorbidity in all-cause and cause-specific mortality risks in ADHD. Early-onset psychiatric comorbidity contributed mainly to the relationship with death because of natural events in adulthood, while later-onset psychiatric comorbidity mainly impacted death because of unnatural reasons, including suicide and unintentional injury. Moreover, in individuals with ADHD, healthcare professionals should closely observe specific psychiatric comorbidities in order to recognize high-risk groups for prevention efforts.
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