Association of risk of suicide attempts with methylphenidate treatment
IMPORTANCE Patients with attention-deficit/hyperactivity disorder (ADHD) are at an increased risk of attempting suicide. Stimulants, such as methylphenidate hydrochloride, are the most common treatment for ADHD, but the association between their therapeutic use and suicide is unclear. OBJECTIVE T...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Published: |
American Medical Association
2017
|
| Online Access: | https://eprints.nottingham.ac.uk/44306/ |
| _version_ | 1848796885941223424 |
|---|---|
| author | Man, Kenneth K.C. Coghill, David Chan, Esther W. Lau, Wallis C.Y. Hollis, Chris Liddle, Elizabeth Banaschewski, Tobias McCarthy, Suzanne Neubert, Antje Sayal, Kapil Ip, Patrick Schuemie, Martijn J. Sturkenboom, Miriam Sonuga-Barke, Edmund Buitelaar, Jan Carucci, Sara Zuddas, Alessandro Kovshoff, Hanna Garas, Peter Nagy, Peter Inglis, Sarah K. Konrad, Kerstin Häge, Alexander Rosenthal, Eric Wong, Ian C.K. |
| author_facet | Man, Kenneth K.C. Coghill, David Chan, Esther W. Lau, Wallis C.Y. Hollis, Chris Liddle, Elizabeth Banaschewski, Tobias McCarthy, Suzanne Neubert, Antje Sayal, Kapil Ip, Patrick Schuemie, Martijn J. Sturkenboom, Miriam Sonuga-Barke, Edmund Buitelaar, Jan Carucci, Sara Zuddas, Alessandro Kovshoff, Hanna Garas, Peter Nagy, Peter Inglis, Sarah K. Konrad, Kerstin Häge, Alexander Rosenthal, Eric Wong, Ian C.K. |
| author_sort | Man, Kenneth K.C. |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | IMPORTANCE Patients with attention-deficit/hyperactivity disorder (ADHD) are at an increased risk of attempting suicide. Stimulants, such as methylphenidate hydrochloride, are the most common treatment for ADHD, but the association between their therapeutic use and suicide is unclear.
OBJECTIVE To investigate the association between methylphenidate and the risk of suicide attempts.
DESIGN, SETTING, AND PARTICIPANTS A population-based, electronic medical records database from the Hong Kong Clinical Data Analysis & Reporting System was used to identify 25 629 individuals aged 6 to 25 years who were treated with methylphenidate between January 1, 2001, and December 31, 2015. Those who had attempted suicide were included in the analysis. A self-controlled case series design was used to control for time-invariant characteristics of the patients.
MAIN OUTCOMES AND MEASURES Relative incidence of suicide attempt during periods when patients were exposed to methylphenidate compared with nonexposed periods.
RESULTS Among 25 629 patients with methylphenidate prescriptions, 154 had their first recorded suicide attempt within the study period; of these individuals, 111 (72.1%) were male; mean (SD) age at baseline was 7.15 (2.19) years. The overall incidence of suicide attempts duringmethylphenidate treatment was 9.27 per 10 000 patient-years. An increased risk of suicide attempts was detected during the 90-day period before methylphenidate was initiated, with an incidence rate ratio (IRR) of 6.55 (95%CI, 3.37-12.72). The IRR remained elevated during the first 90 days of treatment (IRR, 3.91; 95%CI, 1.62-9.42) before returning to baseline levels during ongoing treatment (IRR, 1.35; 95%CI, 0.77-2.38). When the risk during the first 90 days of treatment was compared with the 90 days preceding first treatment, the incidence of suicide attempts was not elevated (IRR, 0.78; 95%CI, 0.26-2.35).
CONCLUSIONS AND RELEVANCE The incidence of suicide attempts was higher in the period immediately before the start ofmethylphenidate treatment. The risk remained elevated immediately after the start ofmethylphenidate treatment and returned to baseline levels during continuation of methylphenidate treatment. The observed higher risk of suicide attempts before treatment may reflect emerging psychiatric symptoms that trigger medical consultations that result in a decision to begin ADHD treatment. Therefore, this study’s results do not support a causal association between methylphenidate treatment and suicide attempts. |
| first_indexed | 2025-11-14T19:55:06Z |
| format | Article |
| id | nottingham-44306 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:55:06Z |
| publishDate | 2017 |
| publisher | American Medical Association |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-443062020-05-04T18:57:15Z https://eprints.nottingham.ac.uk/44306/ Association of risk of suicide attempts with methylphenidate treatment Man, Kenneth K.C. Coghill, David Chan, Esther W. Lau, Wallis C.Y. Hollis, Chris Liddle, Elizabeth Banaschewski, Tobias McCarthy, Suzanne Neubert, Antje Sayal, Kapil Ip, Patrick Schuemie, Martijn J. Sturkenboom, Miriam Sonuga-Barke, Edmund Buitelaar, Jan Carucci, Sara Zuddas, Alessandro Kovshoff, Hanna Garas, Peter Nagy, Peter Inglis, Sarah K. Konrad, Kerstin Häge, Alexander Rosenthal, Eric Wong, Ian C.K. IMPORTANCE Patients with attention-deficit/hyperactivity disorder (ADHD) are at an increased risk of attempting suicide. Stimulants, such as methylphenidate hydrochloride, are the most common treatment for ADHD, but the association between their therapeutic use and suicide is unclear. OBJECTIVE To investigate the association between methylphenidate and the risk of suicide attempts. DESIGN, SETTING, AND PARTICIPANTS A population-based, electronic medical records database from the Hong Kong Clinical Data Analysis & Reporting System was used to identify 25 629 individuals aged 6 to 25 years who were treated with methylphenidate between January 1, 2001, and December 31, 2015. Those who had attempted suicide were included in the analysis. A self-controlled case series design was used to control for time-invariant characteristics of the patients. MAIN OUTCOMES AND MEASURES Relative incidence of suicide attempt during periods when patients were exposed to methylphenidate compared with nonexposed periods. RESULTS Among 25 629 patients with methylphenidate prescriptions, 154 had their first recorded suicide attempt within the study period; of these individuals, 111 (72.1%) were male; mean (SD) age at baseline was 7.15 (2.19) years. The overall incidence of suicide attempts duringmethylphenidate treatment was 9.27 per 10 000 patient-years. An increased risk of suicide attempts was detected during the 90-day period before methylphenidate was initiated, with an incidence rate ratio (IRR) of 6.55 (95%CI, 3.37-12.72). The IRR remained elevated during the first 90 days of treatment (IRR, 3.91; 95%CI, 1.62-9.42) before returning to baseline levels during ongoing treatment (IRR, 1.35; 95%CI, 0.77-2.38). When the risk during the first 90 days of treatment was compared with the 90 days preceding first treatment, the incidence of suicide attempts was not elevated (IRR, 0.78; 95%CI, 0.26-2.35). CONCLUSIONS AND RELEVANCE The incidence of suicide attempts was higher in the period immediately before the start ofmethylphenidate treatment. The risk remained elevated immediately after the start ofmethylphenidate treatment and returned to baseline levels during continuation of methylphenidate treatment. The observed higher risk of suicide attempts before treatment may reflect emerging psychiatric symptoms that trigger medical consultations that result in a decision to begin ADHD treatment. Therefore, this study’s results do not support a causal association between methylphenidate treatment and suicide attempts. American Medical Association 2017-07-26 Article PeerReviewed Man, Kenneth K.C., Coghill, David, Chan, Esther W., Lau, Wallis C.Y., Hollis, Chris, Liddle, Elizabeth, Banaschewski, Tobias, McCarthy, Suzanne, Neubert, Antje, Sayal, Kapil, Ip, Patrick, Schuemie, Martijn J., Sturkenboom, Miriam, Sonuga-Barke, Edmund, Buitelaar, Jan, Carucci, Sara, Zuddas, Alessandro, Kovshoff, Hanna, Garas, Peter, Nagy, Peter, Inglis, Sarah K., Konrad, Kerstin, Häge, Alexander, Rosenthal, Eric and Wong, Ian C.K. (2017) Association of risk of suicide attempts with methylphenidate treatment. JAMA Psychiatry, 74 (10). pp. 1048-1055. ISSN 2168-6238 http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2645499 doi:10.1001/jamapsychiatry.2017.2183 doi:10.1001/jamapsychiatry.2017.2183 |
| spellingShingle | Man, Kenneth K.C. Coghill, David Chan, Esther W. Lau, Wallis C.Y. Hollis, Chris Liddle, Elizabeth Banaschewski, Tobias McCarthy, Suzanne Neubert, Antje Sayal, Kapil Ip, Patrick Schuemie, Martijn J. Sturkenboom, Miriam Sonuga-Barke, Edmund Buitelaar, Jan Carucci, Sara Zuddas, Alessandro Kovshoff, Hanna Garas, Peter Nagy, Peter Inglis, Sarah K. Konrad, Kerstin Häge, Alexander Rosenthal, Eric Wong, Ian C.K. Association of risk of suicide attempts with methylphenidate treatment |
| title | Association of risk of suicide attempts with methylphenidate treatment |
| title_full | Association of risk of suicide attempts with methylphenidate treatment |
| title_fullStr | Association of risk of suicide attempts with methylphenidate treatment |
| title_full_unstemmed | Association of risk of suicide attempts with methylphenidate treatment |
| title_short | Association of risk of suicide attempts with methylphenidate treatment |
| title_sort | association of risk of suicide attempts with methylphenidate treatment |
| url | https://eprints.nottingham.ac.uk/44306/ https://eprints.nottingham.ac.uk/44306/ https://eprints.nottingham.ac.uk/44306/ |