{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T14:20:12Z","timestamp":1791987612990,"version":"4.4.0"},"reference-count":19,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Psychiatry"],"published-print":{"date-parts":[[2025,8,1]]},"abstract":"<jats:sec id=\"ab-yoi250031-4\">\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi250031-5\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi250031-6\">\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi250031-7\">\n                    <jats:title>Exposure<\/jats:title>\n                    <jats:p>ADHD medication use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi250031-8\">\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>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%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi250031-9\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      There were 247\u202f420 individuals identified (99\u202f361 females [40.2%] and 148\u202f059 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 (\n                      <jats:italic>P<\/jats:italic>\n                      value for trend\u2009&amp;amp;lt;\u2009.01), traffic crashes (\n                      <jats:italic>P<\/jats:italic>\n                      value for trend\u2009&amp;amp;lt;\u2009.01), and crime (\n                      <jats:italic>P<\/jats:italic>\n                      value for trend\u2009&amp;amp;lt;\u2009.01) 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"ab-yoi250031-10\">\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamapsychiatry.2025.1281","type":"journal-article","created":{"date-parts":[[2025,6,25]],"date-time":"2025-06-25T11:31:18Z","timestamp":1750851078000},"page":"830","source":"Crossref","is-referenced-by-count":37,"title":["Increased Prescribing of Attention-Deficit\/Hyperactivity Disorder Medication and Real-World Outcomes Over Time"],"prefix":"10.1001","volume":"82","author":[{"given":"Lin","family":"Li","sequence":"first","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Coghill","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Psychiatry, University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Murdoch Children\u2019s Research Institute, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arvid","family":"Sj\u00f6lander","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Honghui","family":"Yao","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Le","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Kuja-Halkola","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabell","family":"Brikell","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway"},{"name":"Department of Biomedicine, Aarhus University, Aarhus C, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Lichtenstein","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian M.","family":"D\u2019Onofrio","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"Department of Psychological and Brain Sciences, Indiana University, Bloomington, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrik","family":"Larsson","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"},{"name":"School of Medical Sciences, \u00d6rebro University, \u00d6rebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"10222","key":"yoi250031r1","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1016\/S0140-6736(19)33004-1","article-title":"Attention-deficit hyperactivity disorder.","volume":"395","author":"Posner","year":"2020","journal-title":"Lancet"},{"issue":"5","key":"yoi250031r2","doi-asserted-by":"publisher","first-page":"335","DOI":"10.1016\/j.biopsych.2019.04.009","article-title":"Risks and benefits of attention-deficit\/hyperactivity disorder medication on behavioral and neuropsychiatric outcomes: a qualitative review of pharmacoepidemiology studies using linked prescription databases.","volume":"86","author":"Chang","year":"2019","journal-title":"Biol Psychiatry"},{"issue":"10","key":"yoi250031r3","doi-asserted-by":"publisher","first-page":"850","DOI":"10.1001\/jama.2024.0851","article-title":"ADHD pharmacotherapy and mortality in individuals with ADHD.","volume":"331","author":"Li","year":"2024","journal-title":"JAMA"},{"issue":"11","key":"yoi250031r4","doi-asserted-by":"publisher","first-page":"1050","DOI":"10.1056\/NEJMra1917069","article-title":"Pharmacologic treatment of attention deficit-hyperactivity disorder.","volume":"383","author":"Cortese","year":"2020","journal-title":"N Engl J Med"},{"issue":"1","key":"yoi250031r5","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1186\/s13052-023-01456-1","article-title":"The global prevalence of ADHD in children and adolescents: a systematic review and meta-analysis.","volume":"49","author":"Salari","year":"2023","journal-title":"Ital J Pediatr"},{"issue":"10","key":"yoi250031r6","doi-asserted-by":"publisher","first-page":"824","DOI":"10.1016\/S2215-0366(18)30293-1","article-title":"Trends in attention-deficit hyperactivity disorder medication use: a retrospective observational study using population-based databases.","volume":"5","author":"Raman","year":"2018","journal-title":"Lancet Psychiatry"},{"key":"yoi250031r7","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2022.101780","article-title":"Attention-deficit\/hyperactivity disorder medication consumption in 64 countries and regions from 2015 to 2019: a longitudinal study.","volume":"58","author":"Chan","year":"2023","journal-title":"EClinicalMedicine"},{"issue":"8","key":"yoi250031r8","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1111\/jcpp.12882","article-title":"Has the attention deficit hyperactivity disorder phenotype become more common in children between 2004 and 2014? Trends over 10 years from a Swedish general population sample.","volume":"59","author":"Rydell","year":"2018","journal-title":"J Child Psychol Psychiatry"},{"issue":"2","key":"yoi250031r9","doi-asserted-by":"publisher","first-page":"66","DOI":"10.15585\/mmwr.mm6702a3","article-title":"Attention-deficit\/hyperactivity disorder medication prescription claims among privately insured women aged 15\u201344 years\u2014United States, 2003\u20132015.","volume":"67","author":"Anderson","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"4","key":"yoi250031r10","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.5335","article-title":"Overdiagnosis of attention-deficit\/hyperactivity disorder in children and adolescents: a systematic scoping review.","volume":"4","author":"Kazda","year":"2021","journal-title":"JAMA Netw Open"},{"key":"yoi250031r11","doi-asserted-by":"publisher","first-page":"k3532","DOI":"10.1136\/bmj.k3532","article-title":"The reporting of studies conducted using observational routinely collected health data statement for pharmacoepidemiology (RECORD-PE).","volume":"363","author":"Langan","year":"2018","journal-title":"BMJ"},{"key":"yoi250031r12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4515","article-title":"Self controlled case series methods: an alternative to standard epidemiological study designs.","author":"Petersen","year":"2016","journal-title":"BMJ"},{"issue":"4","key":"yoi250031r13","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1136\/ebmental-2020-300231","article-title":"Prediction of treatment dosage and duration from free-text prescriptions: an application to ADHD medications in the Swedish prescribed drug register.","volume":"24","author":"Zhang","year":"2021","journal-title":"Evid Based Ment Health"},{"issue":"21","key":"yoi250031r14","doi-asserted-by":"publisher","first-page":"2006","DOI":"10.1056\/NEJMoa1203241","article-title":"Medication for attention deficit-hyperactivity disorder and criminality.","volume":"367","author":"Lichtenstein","year":"2012","journal-title":"N Engl J Med"},{"issue":"1","key":"yoi250031r15","doi-asserted-by":"publisher","first-page":"66","DOI":"10.1093\/aje\/kwr265","article-title":"Meta-analysis for linear and nonlinear dose-response relations: examples, an evaluation of approximations, and software.","volume":"175","author":"Orsini","year":"2012","journal-title":"Am J Epidemiol"},{"key":"yoi250031r16","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.jpsychires.2020.01.006","article-title":"A literature review and meta-analysis on the effects of ADHD medications on functional outcomes.","volume":"123","author":"Boland","year":"2020","journal-title":"J Psychiatr Res"},{"issue":"1","key":"yoi250031r17","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1007\/s00787-010-0140-6","article-title":"European guidelines on managing adverse effects of medication for ADHD.","volume":"20","author":"Graham","year":"2011","journal-title":"Eur Child Adolesc Psychiatry"},{"issue":"9","key":"yoi250031r18","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1016\/S2215-0366(23)00184-0","article-title":"Conceptual clarity needed in ADHD diagnosis and treatment.","volume":"10","author":"Gyngell","year":"2023","journal-title":"Lancet Psychiatry"},{"issue":"1","key":"yoi250031r19","doi-asserted-by":"publisher","first-page":"404","DOI":"10.1186\/s12888-020-02707-9","article-title":"Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit\/ hyperactivity disorder in girls and women.","volume":"20","author":"Young","year":"2020","journal-title":"BMC Psychiatry"}],"container-title":["JAMA Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamapsychiatry\/articlepdf\/2835661\/jamapsychiatry_li_2025_oi_250031_1753816558.44083.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T15:00:43Z","timestamp":1754492443000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamapsychiatry\/fullarticle\/2835661"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,1]]},"references-count":19,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamapsychiatry.2025.1281","relation":{},"ISSN":["2168-622X"],"issn-type":[{"value":"2168-622X","type":"print"}],"subject":[],"published":{"date-parts":[[2025,8,1]]}}}