Attention deficit hyperactivity disorder (ADHD) and premature mortality: A narrative review of the literature.

Attention-deficit hyperactivity disorder (ADHD) is associated with a higher risk of premature mortality compared to the general population, although reported risks vary. The aim of this paper was to review studies that have examined associations between premature mortality and ADHD and consider factors that could explain variation in risk estimates. A literature search was carried out using online databases (PMC, OVID, and Scopus library) to identify relevant articles. We then considered: sample ascertainment, sample size, method of diagnosing ADHD and age at diagnosis, sex, age range for mortality data, hazard ratio/ mortality rate ratio (95% confidence interval), sample size, and cause of death, as factors that could explain variation in risk estimates. We focus on nine papers that report risk of all-cause mortality in population samples via hazard ratios, odds ratios, and mortality ratios, which varied from 1.07 to 4.44. Higher risk estimates were found in studies that followed up to older ages and among individuals who were female, diagnosed with ADHD later, and had psychiatric comorbidity. Most follow up found non-natural causes (e.g. suicide, accidents) to be the most prevalent cause of death but studies with longer follow up suggested that non-natural causes may be more important in older individuals. Evidence suggests that ADHD medication reduces the risk of premature mortality but findings are clearer for stimulant than for non-stimulant medication. Clinicians need to be aware that females with ADHD, those with a delayed ADHD diagnosis and who show psychiatric comorbidity are at highest risk of premature mortality. However prescribing ADHD medication may reduce this risk.