Trajectories of healthcare utilization and costs of psychiatric and somatic multimorbidity in adults with childhood ADHD: a prospective register‐based study

Abstract

BackgroundA better understanding of the trajectories and economic burden of psychiatric and somatic disorders (multimorbidity) in ADHD from childhood to adulthood is important for guiding more targeted areas for treatment of ADHD and prevention of multimorbidity, and for forecasting demands on the medical infrastructure. This study aimed to investigate patterns of healthcare utilization and costs of multimorbidity across young adulthood in individuals with a childhood ADHD diagnosis, and additionally in individuals who continue to have ADHD‐related contact with health services (persisters) and those who do not (remitters).MethodsWe prospectively followed a cohort (N = 445,790) born 1987–1990 from the ages of 18 to 26 years. Data on healthcare utilization were obtained from the Swedish National Patient Register (inpatient and outpatient care) and the Prescribed Drug Register (medication prescriptions).ResultsMean annual costs per capita from multimorbidity was €890 ($1,223) in individuals with a childhood ADHD diagnosis (persisters/remitters: €1,060[$1,456]/€609[$837]) and €304 ($418) in individuals without. Costs were largely driven by inpatient hospital admissions, mainly from drug abuse and injuries. Healthcare utilization and costs of psychiatric and somatic disorders at 18 years was significantly higher in individuals with childhood ADHD compared to those without. These group differences remained stable or increased across young adulthood for most outcomes and were generally larger in women than in men. ADHD remitters continued to show significantly greater healthcare utilization and costs compared to individuals without childhood ADHD, although their profiles were not as severe as ADHD persisters.ConclusionsChildhood ADHD has long‐term associations with both psychiatric and somatic disorders. Findings demonstrate the individual and societal burden of ADHD in adulthood and highlight the importance of continued support from childhood–adolescent to adult health services and early prevention of multimorbidity. Findings also point to specific targets for intervention that may be effective, such as drug abuse and injuries.

Mapping phenotypic and aetiological associations between ADHD and physical conditions in adulthood in Sweden: a genetically informed register study

“… 6 Although there is a plethora of research that has shown the frequent co-occurrence of psychiatric disorders with ADHD, 7 associations with physical health conditions have been less studied, despite health-care costs in ADHD being substantially driven by both psychiatric and physical comorbid conditions. 8 , 9 Physical conditions that have shown robust and replicated association with ADHD, especially in childhood, include metabolic disorders, sleep disorders, and asthma. 10 A few studies have suggested tentative associations between ADHD and dementia, 11 diseases of the basal ganglia and cerebellum (eg, Parkinson's disease), 12 and cardiovascular disease.…”

The Characteristics of Mood Polarity, Temperament, and Suicide Risk in Adult ADHD

“…The present study was designed to investigate the differences in suicidal ideation, temperament, and manic and hypomanic symptoms between patients with adult ADHD and healthy controls. ADHD in adulthood, especially when concurrent with other mental diseases, may lead to major consequences for public health, such as higher healthcare costs and more difficult patient management [11].…”

“…Higher healthcare utilization and costs for multimorbidity, especially for the inpatient care of psychiatric disorders, are generally reported among adults who have had childhood ADHD, remitted or not [11]. Many studies report the presence of comorbid psychiatric disorders in adults with ADHD [12][13][14] and also report ADHD in individuals with at least one psychiatric disorder [15].…”

Cognitive behavioural group therapy for adolescents with ADHD: a study of satisfaction and feasibility

“…Adolescents with ADHD are at increased risk of many adverse outcomes and a negative life trajectory into adulthood [3,4]. Appropriate treatment and care for this group will potentially reduce the risk of harmful outcomes and hence be cost-effective on many levels for individuals, families and society [5,6].…”