ADHD increases the risk of sexually transmitted infection, but ADHD medications may reduce it

Attention-deficit/hyperactivity disorder (ADHD) increases the risk of subsequent sexually transmitted infections (STIs) among adolescent and young adult populations by about three times, reports a study published in the January 2018 issue of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP).

The authors also found that short- and long-term use of ADHD medication reduced the risk of subsequent STIs among men by 30% and 41%, respectively.

“ADHD is the most common neurodevelopmental disorder, and affects approximately 5%–7% of children and adolescents and 2% of young adults,” said lead author Mu-Hong Chen, MD, a physician at the Taipei Veterans General Hospital and the College of Medicine, National Yang-Ming University, Taipei. “Increasing evidence supports an association between ADHD and various health-risk behaviors, such as risky driving, substance abuse, and risky sexual behaviors. Clinical psychiatrists [should] focus on the occurrence of risky sexual behaviors and the risk of STIs among patients with ADHD, and emphasize that treatment with ADHD medications may be a protective factor for prevention of STIs.”

The findings are based on the Taiwan National Health Insurance Research Database, which is a nationally representative database of medical claims and healthcare data from more than 99% of the entire Taiwan population.

A cohort of 17,898 adolescents and young adults who were diagnosed with ADHD and 71,592 age and sex-matched non-ADHD controls who did not have STIs prior to enrollment were studied.

Adolescents aged 12-17 years and young adults aged 18-29 years were followed from January 1, 2001 through December 31, 2009. The researchers tracked data related to risk of STIs, including HIV, syphilis, genital warts, gonorrhea, chlamydial infection, and trichomoniasis, psychiatric comorbidity, and pharmacologic treatment for ADHD (methylphenidate or atomoxetine).

The researchers found that adolescents and young adults with ADHD had greater incidence of any STI (1.2% versus 0.4%), and developed STIs at a younger age (20.51 ± 4.48 versus 21.90 ± 4.49) as compared to age- and sex-matched peers.

They also found that those adolescents and young adults with ADHD had a higher prevalence of psychiatric comorbidity, including disruptive behavior disorder (13.5% v. 0.3%), alcohol use disorders (1.1% versus 0.5%), and substance use disorders (2.5% versus 0.8%).

Male short-term (HR 0.70) and long-term (HR 0.59) ADHD medication users had a significantly lower risk of developing any STI during follow-up.

In addition to Dr. M-H Chen, study authors include Ju-Wei Hsu, MD, Kai-Lin Huang, MD, Ya-Mei Bai, MD, Tung-Ping Su, MD, Cheng-Ta Li, MD, PhD, and Wei-Chen Lin, MD, Shih-Jen Tsai, MD, PhD, of the Taipei Veterans General Hospital and the College of Medicine, National Yang-Ming University, Taipei, Nai-Ying Ko, PhD, of the College of Medicine, National Chang Kung University and Hospital, Tai-Long Pan, PhD, of the school of traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan, the Research Center for Industry of Human Ecology, Chang Gung University, Taoyuan, and the Liver Research Center, Division of Hepatology, Chang Gung Memorial Hospital, Taoyuan Wen-Han Chang, MSc, of the Taipei Veterans General Hospital, and Tzeng-Ji Chen, MD, PhD, of the Taipei Veterans General Hospital and the Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei.

The research was supported by the Taipei Veterans General Hospital (V103E10-001, V104E10-002, V105E10-001-MY2-1, V105A-049, V106B-020). Full author disclosures are listed in the article.

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The article is “Sexually Transmitted Infection Among Adolescents and Young Adults With Attention-Deficit/Hyperactivity Disorder: A Nationwide Longitudinal Study,” by Mu-Hong Chen, Ju-Wei Hsu, Kai-Lin Huang, Ya-Mei Bai, Nai-Ying Ko, Tung-Ping Su, Cheng-Ta Li, Wei-Chen Lin, Shih-Jen Tsai, Tai-Long Pan, Wen-Han Chang, and Tzeng-Ji Chen (http://dx.doi.org/10.1016/j.jaac.2017.09.438). It appears in the Journal of the American Academy of Child and Adolescent Psychiatry, volume 57, issue 1 (January 2018), published by Elsevier.

Copies of this paper are available to credentialed journalists upon request; please contact Mary Billingsley at mbillingsley@aacap.org or +1 202 587 9672. Journalists wishing to interview the authors may contact Ju-Wei Hsu, MD, Department of Psychiatry, No. 201, ShihPai Road, Sec. 2, 11217, Taipei, Taiwan; e-mail: jwhsu@vghtpe.gov.tw

About JAACAP 
Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today’s psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families. www.jaacap.org 
The Journal’s purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.

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