Suicide attempt risk among patients receiving methylphenidate: a retrospective cohort study
AI Summary
Methylphenidate initiation linked to higher subsequent suicide attempt risk compared with unexposed individuals in both 2001-2002 and 2004-2005 cohorts.
Duration-response observed: hazard ratios fell with longer cumulative use, from 1.60/1.84 for under 30 days to 1.45/1.65 for ≥180 days.
Beneficial effect of prolonged methylphenidate on suicide attempt risk remained consistent over time; association did not weaken between analyses.
BACKGROUND: Methylphenidate may reduce suicide risk among patients with attention-deficit hyperactivity disorder. Several studies have noted that the association between methylphenidate use and suicidality is weakening.
METHODS: Data were collected from Taiwan’s National Health Insurance Research Database to assess the association between methylphenidate exposure and suicide attempt risk across two exposure periods (main analysis: 2001-2002; duplication analysis: 2004-2005). We compared suicide attempt risk between patients who initiated methylphenidate treatment and those with no recorded psychiatric treatment or methylphenidate exposure during the same period.
RESULTS: In both the main and duplication analyses, patients receiving methylphenidate exhibited a higher subsequent risk of suicide attempts than unexposed individuals. A duration-response pattern was observed in both cohorts: the hazard ratio of suicide attempts declined with longer cumulative methylphenidate use, from 1.60/1.84 for < 30 days to 1.45/1.65 for ≥ 180 days. Because hazard ratios were closely aligned across 2001-2002 and 2004-2005, the association of methylphenidate with reduced suicide attempt risk did not appear to decrease over time.
DISCUSSION: Longer use of methylphenidate was associated with a lower risk of subsequent suicide attempts among patients in Taiwan receiving methylphenidate. The beneficial effect of methylphenidate on suicide risk remained consistent over time.
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