Attention‐deficit/hyperactivity disorder medication and risk of suicide attempt: A meta‐analysis of observational studies

Purpose Epidemiologic findings are inconsistent regarding the association between attention‐deficit/hyperactivity disorder (ADHD) medication exposure and suicide attempt in individuals with ADHD. Methods A systematic literature search of PubMed, Embase and Cochrane Library up to February 2020 was performed. A meta‐analysis was conducted for outcomes in which a summary risk ratio (RR) was calculated when taking heterogeneity into account. Results Both population‐level and within‐individual analyzes showed that ADHD medication was associated with lower odds of suicide attempts (RR = 0.76, 95% confidence interval [CI], 0.58‐1.00; P = .049 and RR = 0.69; 95% CI, 0.49‐0.97; P = .049, respectively). However, the association only existed for participants who were treated with stimulants (RR = 0.72; 95% CI, 0.53‐0.99; P = .042 on population‐level analysis and RR = 0.75; 95% CI, 0.66‐0.84; P  < .001 on within‐individual analysis). Furthermore, a lower risk of suicide attempts was not observed in subjects who took ADHD medication for 1 to 90 days (RR = 0.91; 95% CI, 0.74‐1.13; P = .416 on within‐individual analysis). Conclusion The results indicate that non‐stimulant treatment is not associated with a higher risk of suicide attempt, but stimulant treatment is associated with a lower risk of suicide attempt.