ADHD mortality driven by unnatural causes, especially accidents
Attention deficit hyperactivity disorder (ADHD) is a common mental disorder associated with factors that are likely to increase mortality, such as oppositional defiant disorder or conduct disorder, criminality, accidents, and substance misuse. However, whether ADHD itself is associated with increased mortality remains unknown. With that in mind researchers set out to determine ADHD-related mortality in a large cohort of Danish individuals.
Dr. Søren Dalsgaard, PhD, visiting researcher, senior researcher from Aarhus University in Denmark, and lead author of this study along with colleagues in this large nationwide cohort researchers used the Danish national registers and followed 1·92 million individuals, including 32 061 with ADHD, from their first birthday through to 2013. The team adjusted for calendar year, age, sex, family history of psychiatric disorders, maternal and paternal age and parental educational and employment status, by Poisson regression, o compare individuals with and without ADHD.
During follow-up 5580 cohort members died. The mortality rate per 10 000 person-years was 5·85 among individuals with ADHD compared with 2·21 in those without
This increased risk of premature death in people with ADHD was mainly driven by deaths from unnatural causes, especially accidents (42 deaths among 79 people for whom the cause of death was known).
The risk of premature death increased with age at time of diagnosis. Individuals diagnosed at younger than six years had almost double the risk (1.86) compared to their healthy counterparts. Being diagnosed at six to 17 years had around one and half times the risk (1.58) compared to their healthy counterparts. For those diagnosed at age 18 years and older at time of diagnosis were more than four times (4.25) the risk for premature death compared to their healthy counterparts.
Previous research has shown that individuals with ADHD are more likely to have a range of co-existing disorders.. Previous research has shown that individuals with ADHD are more likely to have a range of co-existing disorders including oppositional defiant disorder, conduct disorder, and substance use disorders. People with ADHD who also had all three of these disorders were more than eight times as likely to die early than individuals without ADHD or any of these co-existing disorders.
Around two-thirds of children with ADHD have at least one co-existing disorder such as Disruptive behavior disorders anxiety and learning disabilities. Evidence has shown adults that meet the criteria of ADHD also have major depressive disorder (9.4%) and 22.6% with dysthymic disorder.
According to Dr. Dalsgaard, “Our findings emphasize the importance diagnosing ADHD early, especially in girls and women, and treating any co-existing antisocial and substance use disorders. It is however important to emphasize that although the relative risk of premature death is increased in ADHD, the absolute risk is low.”
Dr. Stephen Faraone, PhD, Professor of Psychiatry and Director of Child and Adolescent Psychiatry Research at SUNY Upstate Medical University in New York, USA, said in a written linked comment “For too long, the validity of ADHD as a medical disorder has been challenged. Policy makers should take heed of these data and allocate a fair share of health care and research resources to people with ADHD. For clinicians, early identification and treatment should become the rule rather than the exception.”
Dr. Faraone cautions, “Although talk of premature death will worry parents and patients, they can seek solace in the knowledge that the absolute risk for premature death is low and that this and other risks can be greatly reduced with evidenced-based treatments for the disorder.”
CHADD; Children and Adults with Attention Deficit/ Hyperactivity Disorder
Cleveland Clinic; Recognizing & Treating ADHD in Adults with Comorbid Depression
Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. The Lancet, 2015; DOI: 10.1016/S0140-6736(14)61684-6
News Release The Lancet