CoChat
Sign Up
Cited by 140Attention Deficit Hyperactivity DisorderSuicide and Self-Harm StudiesOpioid Use Disorder Treatment

Association of risk of suicide attempts with methylphenidate treatment

Open access
Man, Kenneth K. C., Coghill, David, Chan, Esther W., Lau, Wallis C. Y., Hollis, Chris, Liddle, Elizabeth, Banaschewski, Tobias, McCarthy, Suzanne +17 more·2017·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2017.2183PMC PMC5710471
Open this paper in CoChat — free accountOpen PDF

Abstract

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 during methylphenidate 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 of methylphenidate treatment. The risk remained elevated immediately after the start of methylphenidate 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.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jamapsychiatry.2017.2183

Cites

45 of 45 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 5

  1. [10]10. National Institute for Health and Clinical Excellence. Attention deficit hyperactivity disorder: diagnosis and management. https://www.nice.org .uk/guidance/cg72/chapter/recommendations. Accessed June 20, 2017.
  2. [15]15. Can J Psychiatry. 2012;57(2):93-101.
  3. [20]20. EMA. European Medicines Agency Makes Recommendations for Safer Use of Ritalin and Other Methylphenidate-Containing Medicines in the EU. London: European Medicines Agency Press Office; 2009.
  4. [35]35. Hospital Authority Head Office IT Department. Clinical Data Analysis & Reporting System (CDARS) User's Manual: 2.0 ed. Hong Kong, Hong Hospital Authority; 2003:3.
  5. [42]42. Thomas KH, Davies N, Metcalfe C, Windmeijer F, Martin RM, Gunnell D. Validation of suicide and self-harm records in the Clinical Practice Research Datalink. Br J Clin Pharmacol. 2013;76(1):145-157.

Cited by

Sorted by citations

Related

Authors
Man, K. K. C., Coghill, D., Chan, E. W., Lau, W. C. Y., Hollis, C., Liddle, E., Banaschewski, T., McCarthy, S., Neubert, A., Sayal, K., Ip, P., Schuemie, M. J., Sturkenboom, M. C. J. M., Sonuga-Barke, E., Buitelaar, J., Carucci, S., Zuddas, A., Kovshoff, H., Garas, P., Nagy, P., Inglis, S. K., Konrad, K., Häge, A., Rosenthal, E., & Wong, I. C. K.
Affiliations
  • Erasmus MC (NL)
  • The University of Melbourne (AU)
  • University of Hong Kong (HK)
  • University of Nottingham (GB)
  • Heidelberg University (DE)
  • University College Cork (IE)
  • Universitätsklinikum Erlangen (DE)
  • Janssen Research & Development, LLC, Titusville, New Jersey
  • University of Southampton (GB)
  • Radboud University Medical Center (NL)
  • University of Cagliari (IT)
  • The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium16Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
  • University of Dundee (GB)
  • RWTH Aachen University (DE)
  • The Attention Deficit Hyperactivity Disorder Drugs Use Chronic Effects Consortium19Evelina London Children’s Hospital, London, England
  • UCL School of Pharmacy (GB)
Corresponding author
Wong, Ian C. K.
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2017-10-01
Volume
74
Issue
10
Pages
1048
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2017.2183
PMC
PMC5710471
OpenAlex
W2737635599
Semantic Scholar
bd6ed547efa8fcaad1263996a40b0865f1f83258
Cited by
140
References
45
Citations by year
2026: 8 · 2025: 13 · 2024: 9 · 2023: 24 · 2022: 17 · 2021: 22 · 2020: 23 · 2019: 17 · 2018: 6 · 2017: 1
FWCI
10.56
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • UNICA IRIS Institutional Research Information System (University of Cagliari) (submittedVersion)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
  • RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • Discovery Research Portal (University of Dundee) (submittedVersion, other-oa)
  • Nottingham ePrints (University of Nottingham) (submittedVersion)
  • UCL Discovery (University College London) (submittedVersion)
  • The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
  • JuSER (Forschungszentrum Jülich) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion, other-oa)
  • Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
  • RWTH Publications (RWTH Aachen) (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
Funders
  • University of Dundee
  • Università degli Studi di Cagliari
  • National Institute for Health and Care Research (NF-SI-0514-10119)
  • University of Southampton
  • University College London
  • European Commission (260576)
  • University College Cork
  • Hospital Authority
  • Radboud Universitair Medisch Centrum
  • RWTH Aachen University
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Keywords
suicide attempts, methylphenidate, attention deficit hyperactivity disorder, stimulant medication, drug safety, self-controlled case series, children and adolescents, electronic health records, self-harm risk
MeSH terms
Suicide Prevention, Adolescent, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Male, Methylphenidate, Statistics as Topic, Suicide, Suicide, Attempted, Incidence, Young Adult, Patient Outcome Assessment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review