A conversation with Joshua Stott, Ph.D., and Lucy Corrigan about the 70% higher mortality risk associated with ADHD

People with ADHD face a 71% higher risk of death from any cause than people without ADHD, according to the results of a recent meta-analysis published in JAMA Network Open, titled ‘Mortality Among People With Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis.’

Senior author Joshua Stott, Ph.D., first author Lucy Corrigan, and their team analyzed 19 studies with more than 15.9 million participants.

In a pooled analysis of three studies, ADHD medication use among people with ADHD was associated with a 25% lower hazard of all-cause mortality. The authors cautioned that the finding rests on a small number of studies and may reflect confounding, so it does not establish that medication causes the lower risk.

The analysis also found a 27% higher risk of natural-cause death. The authors said this may reflect higher rates of physical health conditions among people with ADHD.

This latest finding builds on Stott’s previous research published in the British Journal of Psychiatry, which found that UK adults with diagnosed ADHD had an estimated reduction in life expectancy of 4.5 to 9 years for men and 6.5 to 11 years for women, compared with matched peers without ADHD. That study did not have cause-of-death data, a gap the new meta-analysis begins to address by examining suicide, injury and natural-cause mortality separately.

Stott and Corrigan recently sat down with Managed Healthcare Executive to talk about their study, what it means and how health systems can better support patients with ADHD.

The following has been edited for length and clarity.

MHE: The study found that ADHD medication was associated with a lower risk of death. How large was the reduction?

Corrigan: We didn’t analyze it separately to understand which age groups were most specifically affected. The studies that we did include were adjusted for that.

Stott: The studies were also quite different from one another, making it difficult to estimate the size of the effect reliably. What’s notable is that the data suggest a possible association, particularly because medication has sometimes been discussed in connection with cardiovascular risks. We can’t yet explain the reasons for the association.

MHE: Why did you group causes of death into suicide, unintentional injury and natural causes?

Corrigan: The categories were just what was most common in the current evidence base. We were then able to group them together and then analyze them.

Stott: Suicide and accidental injury were also important to examine given the known mental health challenges associated with ADHD and the potential connection between impulsivity and accidents.

MHE: What surprised you about the study’s results?

Stott: The possible association between medication and lower mortality was surprising. We also found the increase in deaths from natural causes somewhat less expected than the increases in deaths by suicide or accidental injury. It may relate to challenges people with ADHD face in accessing healthcare, but that needs further investigation.

MHE: How could healthcare systems better support people with ADHD?

Stott: Services could make practical adjustments that help people attend appointments and engage with care, for example, clear instructions, structured follow-up and frequent text reminders. Mental health services could also consider how ADHD interacts with conditions such as anxiety or experiences like rejection sensitivity, so existing treatments are more accessible and useful.

Support beyond healthcare matters too. People with ADHD may have experienced difficulties at school, in employment or in other social settings, sometimes because their needs were poorly understood. Making systems more supportive could help people participate in healthcare work and community life.

MHE: How common is ADHD among older adults, and how much is it underdiagnosed?

Stott: It’s important to distinguish diagnosed prevalence from the estimated prevalence in the community, including people who have not been diagnosed. One UK analysis used an estimated adult prevalence of approximately 2.58%, based on global meta-analyses. Using that benchmark, the study estimated that approximately 93.5% of people aged 65 and older who might be expected to have ADHD were not diagnosed.

Those figures depend on the benchmark estimate, and there isn’t a perfect way to measure community prevalence. Diagnostic rates have been rising quickly among younger and middle-aged people, but substantial underdiagnosis remains among older adults.

MHE: What is the main message you hope readers take away?

Stott: ADHD was associated with increased mortality risk in the study, but that does not mean a person with ADHD will die younger. The risks may be modifiable, which makes diagnosis and appropriate support important. The medication finding is preliminary, but it does not suggest that medication shortens life; it raises the possibility of a protective association that needs more research.

MHE: What is next for this research?

Stott: Mortality is hard to study because, fortunately, it’s not a common outcome when you’re studying a group of people ages 30 or 40, thankfully.

We may be able to use secondary healthcare data, such as primary-care records, to investigate age differences and other questions. A major focus is also understanding the factors that may underpin these outcomes — for example, mental health and access to support. We’ve studied how people with ADHD are served by talking therapies in England, and we’re also exploring the lived experiences of adults aged 50 and older with ADHD.