IS SUICIDAL IDEATION RISK ASSOCIATED WITH PHARMACOTHERAPY IN ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD)? A REAL-WORLD STUDY
Author(s)
Maryam Pathan, BS1, SAMUEL AYEMERE, MSc, PharmD1, Mohammad Al-Mamun, PhD2.
1West Virginia University, Morgantown, WV, USA, 2Binghamton University, Binghamton, NY, USA.
1West Virginia University, Morgantown, WV, USA, 2Binghamton University, Binghamton, NY, USA.
OBJECTIVES: Individuals with ADHD have an elevated risk of suicidal ideation (SI) than those without ADHD. This study examined the association between pharmacotherapy treatment and risk of SI among patients with ADHD.
METHODS: This retrospective longitudinal study was conducted by utilizing electronic health records from TriNetX within West Virginia healthcare organizations between 2007-2023. Patients with ADHD who had available medication information were included. Exclusion criteria were prior ADHD medication, polypharmacy, SI before or within 90 days of medication initiation, cancer, schizophrenia, or bipolar disorder within one year before or on the ADHD diagnosis, and depression or anxiety diagnosed before or within 90 days of the ADHD diagnosis. Patients were classified into three groups: stimulants only, non-stimulants only, or no pharmacotherapy. The risk of SI was estimated using Kaplan Meier and Cox-proportional hazard model. Inverse probability of treatment weighting was used to control for confounding.
RESULTS: Of the 11,906 patients included in the study, majority were male (64.60%), White (84.45%), non-Hispanic (83.87%), and between 18-45 years of age (49%).Overall, 39.65% were treated with stimulants, 6.99% with non-stimulants, and 53.36% were treated with no pharmacotherapy. Compared with no pharmacotherapy, patients treated with stimulants (HR [95%CI] = 0.75 [0.62-0.92] ; p<.01) had a lower risk of SI, whereas non-stimulants use showed a (1.0 [0.71-1.35] ; p>.05) higher risk of SI. Comorbidities such as substance use disorder (1.84 [1.19-2.82],p<.01), depression/anxiety (12.35 [8.41-18.13],p<.001), bipolar disorder (2.57 [1.97-3.35],p<0.001), and schizophrenia (1.71 [1.11-2.64],p<.05) increased the risk of SI.
CONCLUSIONS: Stimulant use was associated with a lower risk of SI in ADHD patients, while psychiatric comorbidities were associated with higher risk of SI. A non-significant increase in SI risk was observed with non-stimulants, which may be relevant to clinical monitoring considerations in patients with ADHD. Overall, these findings may inform clinical management of ADHD and related suicidal behaviors.
METHODS: This retrospective longitudinal study was conducted by utilizing electronic health records from TriNetX within West Virginia healthcare organizations between 2007-2023. Patients with ADHD who had available medication information were included. Exclusion criteria were prior ADHD medication, polypharmacy, SI before or within 90 days of medication initiation, cancer, schizophrenia, or bipolar disorder within one year before or on the ADHD diagnosis, and depression or anxiety diagnosed before or within 90 days of the ADHD diagnosis. Patients were classified into three groups: stimulants only, non-stimulants only, or no pharmacotherapy. The risk of SI was estimated using Kaplan Meier and Cox-proportional hazard model. Inverse probability of treatment weighting was used to control for confounding.
RESULTS: Of the 11,906 patients included in the study, majority were male (64.60%), White (84.45%), non-Hispanic (83.87%), and between 18-45 years of age (49%).Overall, 39.65% were treated with stimulants, 6.99% with non-stimulants, and 53.36% were treated with no pharmacotherapy. Compared with no pharmacotherapy, patients treated with stimulants (HR [95%CI] = 0.75 [0.62-0.92] ; p<.01) had a lower risk of SI, whereas non-stimulants use showed a (1.0 [0.71-1.35] ; p>.05) higher risk of SI. Comorbidities such as substance use disorder (1.84 [1.19-2.82],p<.01), depression/anxiety (12.35 [8.41-18.13],p<.001), bipolar disorder (2.57 [1.97-3.35],p<0.001), and schizophrenia (1.71 [1.11-2.64],p<.05) increased the risk of SI.
CONCLUSIONS: Stimulant use was associated with a lower risk of SI in ADHD patients, while psychiatric comorbidities were associated with higher risk of SI. A non-significant increase in SI risk was observed with non-stimulants, which may be relevant to clinical monitoring considerations in patients with ADHD. Overall, these findings may inform clinical management of ADHD and related suicidal behaviors.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
MSR159
Topic
Methodological & Statistical Research
Disease
No Additional Disease & Conditions/Specialized Treatment Areas