Trajectories of healthcare utilization and costs of psychiatric and somatic multimorbidity in adults with childhood ADHD – Ebba Du Rietz video abstract

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Dr Ebba Du Rietz gives a video abstract of her paper ‘Trajectories of healthcare utilization and costs of psychiatric and somatic multimorbidity in adults with childhood ADHD: a prospective register‐based study’ first published in Journal of Child Psychology & Psychiatry (JCPP) 1st March 2020.
Read the Open Access paper doi.org/10.1111/jcpp.13206

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Childhood 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. Read the Research Digest.

Authors: Ebba Du Rietz, Andreas Jangmo, Ralf Kuja‐Halkola, Zheng Chang, Brian M. D’Onofrio, Ewa Ahnemark, Tamara Werner‐Kiechle & Henrik Larsson.

Transcript

Hi.  My name is Ebba Du Rietz and I’m a post-doctoral researcher at the Karolinska Institute in Stockholm Sweden.  Today, we’ll talk you through a study my colleagues and I recently published in the Journal of Child Psychology and Psychiatry titled Trajectories of Health Care Utilisation and Costs of Psychiatric and Somatic Multimorbidity in Adults with Childhood ADHD.

ADHD is characterised by impairing levels of inattention, hyperactivity and impulsivity.  It is often diagnosed in childhood, but patients often continue to experience a range of difficulties well into adulthood, not only from the core ADHD symptoms, but also from a range of other behavioural, mental and physical problems, such as depression, anxiety, substance use and asthma.  In this study, we follow children with and without ADHD into adulthood to understand the long-term associations of ADHD with both mental and physical health issues.  We studied almost half a million individuals from the Swedish population and compared how those with and without childhood ADHD used healthcare services in early adulthood, and we also estimated the costs of these services.  Our studies show that young adults who had ADHD in childhood compared to those without ADHD in childhood had more frequent in-patient hospital visits, outpatient doctor visits and were prescribed more medications, both for mental and physical health problems.  In this first figure, you can see the average costs of these healthcare services per person due to mental and physical health issues was 900 euros and those with ADHD compared to 300 euros and those without ADHD.  And this is excluding costs for ADHD treatment.

We found that the costs were mainly driven by psychiatric care, evident from the darker blue and orange parts of the bar parts, compared to the lighter blue and orange parts that represent costs from physical – also called somatic disorders – and costs were especially high for in-patient hospital care.  We further found that the greater use of healthcare services and the higher costs in the ADHD group was fairly consistent across adulthood from 18 to 26 years.  In these next figures, the blue lines represent group differences in healthcare use and costs for mental health issues, and the orange lines represent physical health issues.  And these are plotted over age from 18 to 26 years.  You can see that these mental and physical health issues continued to be high throughout early adulthood for many ADHD patients, and we even saw an increase for psychiatric hospital visits and medications over time.  And finally, we looked at what was driving the high costs of in-patient hospitalisation in ADHD patients and we found that these were mainly driven by drug abuse and injuries, such as traffic accidents.

So, these findings highlight the need for better actions to prevent the development of other mental and physical disorders, which are common in individuals with ADHD and we suggest more targeted efforts to prevent drug abuse and injuries in adulthood.  Support is especially important for patients during the transition from adolescence into adulthood, as there is currently little guidance for clinicians on how to best transition ADHD patients from child to adult services, and service provision in adults is still fairly limited.  If more targeted healthcare efforts would be implemented to support young individuals with ADHD, it may lead to reduced rates of other health problems, which would have a positive impact on both an individual and societal level.

And finally, in terms of future research, it would be informative to establish the effectiveness of continued support and treatments for ADHD to prevent future adult mental and physical health problems.  Thank you for listening to this video abstract and, if you want to learn more about the study, you can read the fuller version online, which is now published in Journal of Child Psychology and Psychiatry.

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