2025-06-25 カロリンスカ研究所(KI)
<関連情報>
- https://news.ki.se/adhd-medication-benefits-persist-but-not-like-they-used-to
- https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2835661
注意欠陥・多動性障害治療薬の処方増加と実社会における経時的結果 Increased Prescribing of Attention-Deficit/Hyperactivity Disorder Medication and Real-World Outcomes Over Time
Lin Li, PhD; David Coghill, MD, PhD; Arvid Sjölander, PhD; et al
JAMA Psychiatry Published:June 25, 2025
DOI:10.1001/jamapsychiatry.2025.1281
Key Points
Question Do the real-world benefits of attention-deficit/hyperactivity disorder (ADHD) medications in reducing adverse outcomes change as prescription rates increase in the population?
Findings In this nationwide study of 247 420 ADHD medication users in Sweden from 2006 to 2020, ADHD medication use was consistently associated with lower risks of self-harm, unintentional injury, traffic crashes, and crime, while some of these associations weakened as prescriptions rates increased.
Meaning These results demonstrated that ADHD medications were consistently associated with reduced risks of several serious real-world outcomes, but these associations appear to weaken alongside shifts in the patient population, highlighting the need for ongoing review of treatment guidelines.
Abstract
Importance The prescription of attention-deficit/hyperactivity disorder (ADHD) medications has risen substantially in many countries over the last 20 years. However, whether the real-world benefits of ADHD medications change with increased prescription rates within a society remains unknown.
Objective To examine whether the associations between ADHD medications and real-world outcomes (self-harm, unintentional injury, traffic crashes, and crime) change as prescription rates rise.
Design, Setting, and Participants This study used a self-controlled case series design. It was a population-based study using Swedish National Registers that included individuals who used ADHD medications in Sweden between 2006 and 2020. Data were analyzed from October 2023 to November 2024.
Exposure ADHD medication use.
Main Outcomes and Measures Rates of self-harm, unintentional injury, traffic crashes, and crime during medicated vs nonmedicated periods. The associations between ADHD medication and these real-world outcomes were examined across 3 time periods, 2006 to 2010, 2011 to 2015, and 2016 to 2020, during which ADHD medication prevalence increased from 0.6% to 2.8%.
Results There were 247 420 individuals identified (99 361 females [40.2%] and 148 059 males [59.8%]) aged 4 to 64 years in Sweden who used ADHD medications between 2006 and 2020. ADHD medication was consistently associated with lower risks for self-harm (incidence rate ratio [IRR] ranged from 0.77; 95% CI, 0.73-0.81 to 0.85; 95% CI, 0.82-0.88), unintentional injury (IRR ranged from 0.87; 95% CI, 0.84-0.89 to 0.93, 95% CI, 0.91-0.95), traffic crashes (IRR ranged from 0.71; 95% CI, 0.67-0.77 to 0.87; 95% CI, 0.83-0.91), and crime (IRR ranged from 0.73; 95% CI, 0.71-0.75 to 0.84; 95% CI, 0.82-0.85) across different age groups, sexes, and over time. However, the associations between ADHD medication use and lower risks of unintentional injury (P value for trend < .01), traffic crashes (P value for trend < .01), and crime (P value for trend < .01) appear to weaken over time as prescription rates increased. Changes in age and sex distribution of individuals receiving ADHD medication did not fully explain the weakening trend for unintentional injury and traffic crashes.
Conclusions and Relevance In this study, ADHD medication remained associated with reduced risks of several serious real-world outcomes. However, the magnitude of these associations appears to have decreased alongside rising prescription rates over time. Thus, it is important to regularly evaluate medication use in different patient populations.
