Mortality in individuals with childhood ADHD or subthreshold symptoms - a prospective perinatal risk cohort study over 40 years

Nella Schiavone; Maarit Virta; Sami Leppämäki; Jyrki Launes; Ritva Vanninen; Annamari Tuulio-Henriksson; Ilkka Järvinen; Eliisa Lehto; Katarina Michelsson; Laura Hokkanen

doi:10.1186/s12888-022-03967-3

Mortality in individuals with childhood ADHD or subthreshold symptoms - a prospective perinatal risk cohort study over 40 years

BMC Psychiatry. 2022 May 9;22(1):325. doi: 10.1186/s12888-022-03967-3.

Affiliations

¹ Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland. nella.schiavone@helsinki.fi.
² Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.
³ Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland.
⁴ Department of Clinical Radiology, Kuopio University Hospital and School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland.
⁵ Children's Hospital, Helsinki University Hospital, Retired, Helsinki, Finland.

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) is associated with negative life outcomes and recent studies have linked it to increased mortality. These studies have examined nationwide registers or clinic-referred samples and mostly included participants up until the age of 30. No studies have investigated mortality associated with subthreshold levels of ADHD symptoms. Our aim was to analyze mortality in a perinatal risk cohort of 46-year-old adults with childhood ADHD (cADHD) and milder childhood attention problems (including hyperactivity and inattention; cAP) compared with a group with similar birth risks but no or low levels of childhood ADHD symptoms (Non-cAP). Causes of death obtained from a national register were examined.

Methods: Mortality was analyzed with Cox proportional hazard models for all-cause mortality, cause-specific mortality (natural and unnatural causes), and age-specific mortality (under and over age 30). All models were adjusted with gender. The total n in the study was 839 (cADHD n = 115; cAP n = 216; Non-cAP n = 508).

Results: By the age of 46, 11 (9.6%) deaths occurred in the cADHD group, 7 (3.2%) in the cAP group, and 20 (3.9%) in the Non-cAP group. The cADHD group had the highest mortality risk (adjusted hazard ratio = 2.15; 95% CI 1.02, 4.54). Mortality was not elevated in the cAP group (adjusted hazard ratio = 0.72; 95% CI .30, 1.72). Mortality in the cADHD group was mainly attributed to unnatural causes of death (adjusted hazard ratio = 2.82; 95% CI 1.12, 7.12). The mortality risk in the cADHD group was sixfold before age 30 (adjusted hazard ratio = 6.20; 95% CI 1.78, 21.57).

Conclusions: Childhood ADHD was associated with a twofold risk of premature death by the age of 46 in this prospective longitudinal cohort study. Our results corroborate previous findings and the morbidity of ADHD. Subthreshold levels of childhood ADHD symptoms were not linked to increased mortality. Our results suggest that mortality risk is higher in young than middle adulthood. Future studies should examine mortality associated with ADHD in different ages in adulthood to identify those in greatest risk of premature death.

Keywords: ADHD; Adult; Cohort; Mortality; Perinatal risk; Subthreshold ADHD.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Attention Deficit Disorder with Hyperactivity* / complications
Attention Deficit Disorder with Hyperactivity* / diagnosis
Cohort Studies
Female
Humans
Longitudinal Studies
Middle Aged
Pregnancy
Prospective Studies
Risk Factors