Life expectancy/years of life lost in adults w ADHD in UK: matched cohort study
92 comments
·January 24, 2025UniverseHacker
9dev
This is so hard to explain, especially to people dear to you. Like, how many times can you say I‘m sorry, I didn’t ignore your messages on purpose, I just… couldn’t before they grow tired of it? And at the same time you notice how you desperately long for the contact, but the guilt and shame for letting people wait indefinitely makes it ever harder to actually reach out. It’s a devious cycle, and constant source of ever-increasing stress.
Don’t have energy cause I fucked things up, fuck things up because I don’t have energy.
UniverseHacker
I know, there is nothing I hate more than letting people down and yet end up doing so multiple times per day- and it’s demoralizing. I have so many systems, reminders, etc. that do help a lot but not enough.
enragedcacti
Substance abuse, suicide, and impulsive behavior are also likely contributors[1]. There are multiple studies that have found medication is associated with a significant reductions in unnatural deaths [2][3].
It really is underappreciated IMO that ADHD medications are some of the most effective pharmacological interventions in all of psychiatry. There are risks and concerns but by and large they are figuratively and literally life-saving.
[1] https://www.adhdevidence.org/evidence#premature-death
DontchaKnowit
I guess it depends on the treatment, but amphetamine based adhd treatment was for me, the fucking devil. It absolutely ruined my life for the 8 years I was on it. Fucked my health up, fucked my personality up, fucked my interpersonal relationships up, etc. But hey I was slightly better at focusing at work. Kinda. When I wasnt habitually dopamine chasing by playing video games or jerking off
cbsmith
> I guess it depends on the treatment, but amphetamine based adhd treatment was for me, the fucking devil.
Fortunately, we now have options other than amphetamines, but yes, in general, like most diseases, ADHD is categorized by symptoms, not really causes, and so lots of treatments that work wonderfully for some people with ADHD are literally the worst thing for other people with ADHD.
UniverseHacker
Adderall was a nightmare for me as well, but methylphenidate (ritalin) seems to have no adverse effects I can notice at all. It helps, but seemingly only with other regular life things and not really with work. Ironically, I am much better at paying attention while doing hobbies and housework but don’t find it easier to start work.
hirvi74
Did you find something that worked because you have literally just described what I have been struggling with all these years. Everything was great in the beginning, but that slowly started to fade away as time progressed, and like you said, the demons started to come out.
drekk
This is how I found out I had both ADHD and bipolar.
hasbot
From the first article: "But people with ADHD had twice the rate of suicide, twice the rate of death by homicide, and a 30 % greater rate of death from unintentional injury"
I get the suicide, but the higher homicide rate is surprising. Any thoughts on why someone with ADHD has a higher chance of being murdered?
ETA: I never considered ADHD people as risk takers (definitely not me) but apparently they are: https://www.webmd.com/add-adhd/features/adhd-dangerous-risky...
cbsmith
In general, people with ADHD do not conform to society's expectations of how a human brain should work. That means they're more likely to be marginalized & targeted, and likely have fewer resources at their disposal if they are at risk; so they are both more likely to become a homicide target and have less protection if they do. They're also more likely to engage in risk taking behaviour, much of which could increase one's risk of being a victim of a homicide.
skissane
> ETA: I never considered ADHD people as risk takers (definitely not me) but apparently they are:
Keep in mind there are officially three types of ADHD: Predominantly Inattentive, Predominantly Hyperactive, and Combined. The risk-taking is much more associated with the second and third types than the first.
floxy
>Any thoughts on why someone with ADHD has a higher chance of being murdered?
Higher risk tolerance and illegal substance abuse, which then result in getting mixed up with drug dealers (and the like) where most people "nope" out of situations before the trouble begins?
s1artibartfast
Gang violence, fights, and interpersonal conflict.
I want to be surprised if there was a correlation with murder as well as homicide
locopati
impulse control plays a role
cbsmith
One could argue that substance abuse, suicide, and impulsive behaviour (and these were all specifically called out in the study) are a reaction to stress. I would certainly say they are a reflection of lack of access to health care and support systems (e.g. a large portion of ADHD substance abuse is self-medicating).
I think it would be interesting to see a follow up study comparing the life expectancy of ADHD folks who are on vs. not on ADHD medications. If nothing else, I would expect it could help with advocacy for better access to them.
hirvi74
> ADHD medications are some of the most effective pharmacological interventions in all of psychiatry.
To me, this says more about how ineffective most psychiatric treatments rather than how effective ADHD treatments are.
So, [2] only concludes a reduction in a two-year long mortality rate, which to be frankly honest, is still somewhat within the "honeymoon" phase of medication.
[3] does not state a specific duration of follow-up for participants, so I am going to assume the durations are quite variable.
I am not against medication -- quite the opposite -- but I am highly skeptical of many of the claims extrapolated research. The medications do seem to be highly efficacious in the short-term. But I have yet to see any compelling evidence that long-term benefits are consistent with short-term benefits. My personal experience, as worthless as they may be, do not reflect this, and I am apparently not alone in this regard:
https://www.nimh.nih.gov/news/science-news/2009/short-term-i...
floxy
People with ADHD are involved in more car crashes:
https://www.publichealth.columbia.edu/news/research-shows-st...
They are also at higher risk for any type of unintentional injury:
https://pmc.ncbi.nlm.nih.gov/articles/PMC10107297/
I believe that people with ADHD are over-represented in first-responder type careers, which also carries more risk:
https://www.ems1.com/ems-products/fitness-mental-health-well...
And are know to engage in more risky behavior in general:
https://neurolaunch.com/no-sense-of-danger-adhd/
And substance abuse among those with ADHD is much higher than the general population:
https://www.webmd.com/add-adhd/adhd-and-substance-abuse-is-t...
hirvi74
I am somewhat skeptical of the car crash research. Being "involved" in a car accident does not paint a clear enough picture. I think it would be more interesting to see that data on whether people with ADHD are more likely to be found at fault in car accidents.
With cellphones and other distractions now, I feel like the data would be even harder to parse through. Is a person with ADHD more likely than the average person to text while driving? I do not think that would be an incorrect assumption, but I would like to see data suggesting this.
cbsmith
Fault is a tricky term in this context.
Humans face a number of challenges when driving. Cars, roads, laws, traffic systems, etc. have all evolved to help them meet those challenges, but it is all shaped by our expectations of the humans. When a human doesn't perform to those expectations, we say it is their fault. When an accident occurs despite them meeting those expectations, it's not their fault.
But folks with ADHD have brains that don't match society's expectations; cars, roads, laws, traffic systems, etc. have not evolved to help them. Their brains are effectively a chaos factor for all the safeguards we have in place... Even their advantages can be disadvantages because everything was designed to help someone who didn't have them.
Even if an accident wasn't their fault, I think it's quite credible that people with ADHD might just be more likely to be in situations where there is a higher risk of an accident... and I'd expect it'd be more common for accidents to be their "fault", because again, how we determine fault is defined by expectations they conform to.
seizethecheese
Yep. Immense stress can also be a learned proactive tactic. You build up stress via procrastination until the level is high enough to overcome any disfunction.
cbsmith
It's taken me most of a lifetime to figure out that this is kind of the opposite of the right way to deal with the problem. You're effectively fighting fire with fire, and the whole thing needs to not be a fight at all.
tstrimple
I called it anxiety based development when I was in dev roles. Worked okay up until the physical symptoms forced me to find alternatives. The alternative for me is I no longer write code for a living.
UniverseHacker
What do you do now, and is it better?
cbsmith
Stress is certainly a killer, but it's a facet of a broader factor.
Society has built up a lot of systems to support people, to protect us from our environment and ourselves, and they've been incredibly successful; average lifespans have increased dramatically... literally by decades.
For the most part, these systems are built in response to and designed around how "we" expect peoples' brains work. If your brain doesn't work those ways, many of those support systems are unnecessary, ineffective, or worse still: harmful. There's also no doubt a bunch of systems that could be designed & built that could to help support & protect people with challenges that are largely non-existent for people whose brains work as we expect.
That the combined consequence of this is less that a decade of life expectancy for people with ADHD is actually quite remarkable, but let's not kid ourselves: we could be doing so much better.
hirvi74
> we could be doing so much better
I do not see that happening in my life time. Modern society values none of the things that would help people with ADHD -- relaxed deadlines, less emphasis on productivity, valuing human lives over profits, etc.. Maybe someday in the future AI can take much of the burden off us, but till then, I only see things getting worse.
cbsmith
> Modern society values none of the things that would help people with ADHD
Yeah, I wouldn't expect that modern society is going to value things that would help people with ADHD. One might hope that modern society might value people with ADHD, at least enough to help them some. It's not like society's expectations of people don't change over time. They do.
That said, my statement that "we could be doing so much better" wasn't really a hopefully statement. It was more a statement of fact, and a recognition that society's expectations are killing a lot of people with ADHD.
amanaplanacanal
Depression is a common co-morbidity also.
AutistiCoder
probably as a result of all the systemic issues surrounding ADHD.
heyjamesknight
It's much simpler and more biomechanical than that.
ADHD at its core is a dopamine disorder. Effort without dopamine is extremely difficult in anyone, and ADHD makes it tough for these dopamine mechanisms to get going. Once that dopamine effect does get going, you're off to the races. That's the ADHD Hyperfocus effect you see.
But when you add in the modern quick dopamine fixes we've surrounded ourselves with—media, social media, processed foods, pornography, etc.—you've built a situation where ADHD individuals are prioritizing those activities over productive ones. This leads to a downward spiral: less productive action means fewer opportunities for future productive actions.
Lock into that mode for weeks at a time and you've got both situationally-supported and biochemical depression.
hirvi74
I completely agree with this. It's hard to not feel like a failure, you don't belong, low motivation, etc. when other people constantly reinforce this idea with both their words and their actions.
I think a lot of this fuels the substance abuse issues in ADHD as well. I have always spent too much time playing video games, doom scrolling, etc.. It's all just an escape. But I think many do not understand -- I, and perhaps many others, escape from this world because I do not belong.
Treatments for ADHD are cute and all, but nothing I have tried has really moved the needle much. At least not for long. There is always a reversion to the mean, and this condition always wins in the end.
giantg2
I wonder if chronic stress leads to a reduced life expectancy for ASD too?
AutistiCoder
also, you're less likely than the general population to get hired and more likely to be fired if you do get a job.
hirvi74
Good luck getting any help if you live in one of the only countries that has healthcare tied to employment. It's easy to slip into a hole with almost no way out.
jrapdx3
After decades of providing treatment for ADHD adults I've come to the conclusion that ADHD is one of the most disabling mental health disorders. In some ways ADHD can be as devastating to a person's life as bipolar disorder or schizophrenia. While ADHD is highly prevalent among adults its manifestations are typically subtle. As a result, symptoms are attributed to incidental factors and the nature of the person's condition remains hidden.
The article does a good job of addressing factors that contribute to ADHD-linked disability, and ways to deal with them. Clearly underdiagnosis sums up the primary issue. Solving a problem starts with recognizing the problem exists. However the article didn't discuss an important reason ADHD is overlooked, that is, widespread tremendous bias against recognizing the realities of adult ADHD.
Reducing the burden of ADHD via social approaches faces a major challenge: how to inform or educate the public about realities of ADHD throughout the life cycle. While there has been marginal improvement over the last 25 years, prejudice or misunderstanding remain predominant.
IMO the place to start is with the provider community. Healthcare practitioners need training to recognize ADHD among comorbidities and participate in its management. Once providers are actively advocating appropriate treatment for ADHD patients, family members, et. al., will likely follow clinicians' lead, become more amenable to helping ADHD individuals.
Economic costs of ADHD are substantial. Reports give estimates that of $143 to $246 billion/year in the US alone.[0] If nothing else these figures illustrate the potential benefits of providing proper care to adults with ADHD.
[0] https://www.jaacap.org/article/S0890-8567(12)00538-2/abstrac...
swatcoder
The ugly possibility, which this (good) study is too shallow to surface, is that a lifetime of pharmaceutical treatment might be at play.
While amphetemines and adjacent drugs may provide critical relief of symptoms and may be experienced differently by sufferers than non-sufferers, they're still deeply unkind drugs to the body, and years or decades of daily use might have inconvenient consequences that show up in data like this, once someone starts looking.
It's not directly implicated by the results, as no particular causitive factors are, but it's an unfortunately possible factor that the authors chose not to suggest in their discussion.
mckirk
This is what I'd hoped to find when I clicked on the link.
Just today I had a discussion with a friend of mine, who is diagnosed with ADHD and currently trying out Elvanse (kind of similar to Adderall), and he was adamant about not wanting to stay on it in the long term. He insisted that it can't be the correct answer, because of how much it 'removed' him from feeling like himself, plus all the negative side effects (e.g. higher risk of cardiovascular diseases). I countered that for some 'conditions', medication just is the correct way to handle it, and so I wouldn't be so quick to rule out the possibility that long-term use of these medications is actually the best way forward (though don't get me wrong, I wouldn't push anyone to use this stuff either-- I'm just hesitant when it comes to blanket statements like 'this can't be the answer').
But that's precisely where more data would be needed. What has the better outcome, for most people? Treating your ADHD with amphetamines, (temporarily) raising your quality of life, but risking damaging your body or brain? Or trying to make due without it, if the situation is at least somewhat manageable with other means such as yoga, meditation etc, and going easier on your body, but possibly never reaching the level of 'focused functioning' and presumably associated lower levels of stress that you might have with the medication?
kqr
You may be underestimating the badness of untreated ADHD. As unkind as the drugs are, they are for many the kinder alternative to staying untreated.
null
hirvi74
I am not so sure. I mean everyone is different, but if you ask me, I have been on medication for a decade now. I am somehow worse in terms of productivity, social life, physical health, etc. than I was before starting medication. Of course, my anecdote proves nothing, but I would be surprised if I were alone.
swatcoder
Not at all. I was specifically careful not to do that.
The discussion isn't about necessity or efficacy, it's about potential long-term consequences and whether this might be revealing some.
People make what compromises they need to, but deserve to understand as much about those tradeoffs as can be identified.
heyjamesknight
In the short-term, yes. But over a lifetime, medication has massive health downsides, and fewer and fewer psychological upsides over time.
enragedcacti
One study cited by the paper looked at long(er) term cardiovascular risk (most likely concern for stimulants) and found that while people with ADHD had significantly higher risk of cardiac events there wasn't a significant difference between medicated and unmedicated individuals (11.8 year average follow-up).
IMO its definitely possible there are increased risks but its unlikely they overshadow the associated significantly reduced risk of unnatural mortality for most people with ADHD. More research, better risk screening, and non-stimulant medication options are all still great directions to move in though.
hirvi74
Maybe it's a catch-22? As in, one can choose either poor health from unmedicated ADHD or poor health from medication?
Oddly enough, the non-stimulant medications, well at least Strattera (Atomoxetine), can be harsh on the heart as well. Nonetheless, Strattera and Guanfacine (another non-stim) are ranked the least safe of the ADHD drugs according to this study:
https://pmc.ncbi.nlm.nih.gov/articles/PMC7215080/
Now, a nice longitudinal study would be nice because I would like to see the data of all the medications after 10, 20, 30+ years.
UniverseHacker
That has been extensively studied, and all cause mortality is much lower for people on ADHD medication than untreated. There is a slightly higher risk of cardiovascular issues from stimulants, but that is tiny compared to the much larger risks of a bunch of other causes of mortality with untreated ADHD.
swatcoder
Unfortunately, the study you cited isn't applicable. It's looking at near-term mortality impact in a cohort of people under 25.
Which is very good to know about, but doesn't provide much insight into the longevity impact from lifelong use, as might be appearing in this one.
UniverseHacker
Thanks. I noticed that, and removed the study link after posting- but these drugs have been used very long term, and the risk vs benefits extensively studied. They do increase CVD risk measurably, but that seems to be compensated for by reduction of other risks.
viraptor
There's a video on this from Russell Barkley https://youtu.be/-byrKlZsUug
localghost3000
Barkley has been HUGE for me in understanding myself and how to manage my symptoms. Cannot recommend him enough.
klipklop
These results sadden me when I know there is such a stigma about treating it. From the doctors to the pharmacist you get treated like crap trying to seek the most effective medication for this disorder, stimulants.
There are so many legal hurdles and shortage BS you gotta go through as well.
chuankl
The study found reduction in life expectancy to be 6.78 years for males and 8.64 years for females. I wonder what could contribute to that difference.
bhelkey
> The apparent reduction in life expectancy for adults with diagnosed ADHD relative to the general population was 6.78 years (95% CI: 4.50 to 9.11) for males, and 8.64 years (95% CI: 6.55 to 10.91) for females.
It's not clear to me that there is a difference. It looks like the confidence intervals overlap.
wizzwizz4
You'd need to do a different analysis to decide whether there's a <5% chance of this data being generated by two identical distributions – but if we're not doing that, then we can't conclude that they're different.
UniverseHacker
This is just pure (somewhat informed) speculation.
ADHD is diagnosed roughly twice as often in men than women, and when diagnosed in women it is much more likely to be of primarily inattentive rather than hyperactive type compared to men. Many suspect ADHD may not actually be rarer in women, but just that the inattentive type is harder to diagnose, and more often never diagnosed- mostly because it is less disruptive to others in school settings.
I speculate that the women that are diagnosed are much more enriched for severe inattentive type ADHD, and I also speculate that inattentive type has a shorter life expectancy than hyperactive type. Just judging from myself, and other adults I know with ADHD: the hyperactive type ones tend to remain really physically active even into old age- unusually so, and the inattentive type tend to have a lot more depression, anxiety, and stress.
hirvi74
Isn't the combined type the most common, or has that type gone away? I find that people that are hyperactive tend to be more impulsive, and if I am not mistaken, impulsivity is the strongest correlated factor in determining longevity in humans. However, I could be wrong about the levels of impulsivity being different. That's just conjecture on my part.
enragedcacti
I might be missing something but I think this may just be because women live longer on average. If we assume an equal increase in risk between men and women then women would automatically have a higher reduction in life expectancy.
solid_fuel
Women typically live longer, so I was curious if this was a similarly proportional reduction in life expectancy for each group. Current life expectancy in the UK:
78.6 years for males, so 6.78 years is 8.6% of the average life expectancy
82.6 years for females, so 8.64 years is 10.4% of the average life expectancy
I think this is a relatively small difference in effect between the two, but I can't say for certain.
snailmailstare
There is a difference in life expectancy in general so it would be remarkable if these are nonzero and the same. (I.e. exact same increase in risk of death at any pre-retirement age for both populations means higher change to life expectancy for women.)
oth001
Females supposedly tend to go undiagnosed (or diagnosed later) moreso than males
hirvi74
Didn't the study only look at people that were officially diagnosed though?
yapyap
Same, maybe giving birth.
swayvil
Our culture demands that you just do the unpleasant activity and suck it up. Often. It's a lifestyle. School, work etc.
Normies just say "ok" and get on with their life.
ADHDers can't really do that. They can't eat it and get on with their life. They get stuck at the threshold. It's a choice between eternal stress or rejecting society. Both deliver a shortened lifespan.
kanwisher
Would love a summary of this
amarcheschi
Copy pasting the article: The aim of this study was to provide the first estimate of life expectancy for UK adults diagnosed with ADHD. We found that adults diagnosed with ADHD are living shorter lives than they should: the apparent years of life lost for males was around 7 years, and for females, 9 years, compared with the general population. We believe that this is unlikely to be because of ADHD itself and likely caused by modifiable factors such as smoking, and unmet mental and physical health support and unmet treatment needs. The findings illustrate an important inequity that demands urgent attention.
UniverseHacker
They establish that people with ADHD live shorter lives by about 6-9 years on average. They speculate on, but do not directly investigate possible reasons for this.
ben30
Via Kagi Universal Summarizer
Title: Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study | The British Journal of Psychiatry | Cambridge Core
ADHD is a neurodevelopmental disorder affecting attention and impulse control, often persisting into adulthood for about 90% of diagnosed children.
The global prevalence of adult ADHD is estimated at 2.8%, yet many adults in the UK remain undiagnosed and unsupported.
Individuals with ADHD face significant social and economic challenges, including educational underachievement, unemployment, and increased risk of substance abuse and mental health issues.
Adults diagnosed with ADHD have a higher likelihood of experiencing various health problems, including cardiovascular diseases and mental health disorders, as well as a greater risk of suicide.
A meta-analysis indicates that individuals with ADHD are twice as likely to die prematurely compared to the general population.
The study estimated that adults with ADHD in the UK experience a loss of approximately 6.78 years of life for males and 8.64 years for females compared to their non-ADHD counterparts.
The research utilized a matched cohort study design, analyzing data from UK electronic health records to assess mortality and life expectancy.
Adults with ADHD often have comorbid conditions that complicate their health outcomes, leading to increased mortality rates.
The findings emphasize the urgent need for improved support services and interventions for adults with ADHD to address their unmet health needs and reduce health disparities.
The study calls for policy initiatives similar to those addressing the life expectancy of autistic individuals, highlighting the necessity for targeted support for adults with ADHD to mitigate the risks associated with the disorder.
Wheaties466
A recent matched cohort study published in the British Journal of Psychiatry analyzed data from over nine million UK adults between 2000 and 2019 to assess life expectancy and years of life lost among those diagnosed with ADHD. The research included 30,039 adults with diagnosed ADHD and compared them to 300,390 matched individuals without the diagnosis. Findings revealed that adults with diagnosed ADHD experienced a significant reduction in life expectancy, losing approximately 6.78 years for males and 8.64 years for females compared to the general population. This disparity is likely driven by modifiable risk factors and unmet mental and physical health needs associated with ADHD and its comorbid conditions. The study underscores the critical need for enhanced support and treatment services for adults with ADHD in the UK to address these preventable health inequalities and improve overall life outcomes.
tcj_phx
I have a friend whose son was prescribed Adderall when he was 12-13 years old. She noticed the adverse effects right away, so she discontinued the drug, and took her son out of school for a year. He did much better getting homeschooled, and was able to return to the public school system after a year.
Most of the "mental health" diagnoses have to do with metabolic problems. Emotional stress is one of the drains on the body's energy reserves.
Stimulants like amphetamine 'shred' our mitochondria. It's okay for a short-term boost, but causes deterioration too: https://news.ycombinator.com/item?id=18211048
hirvi74
I follow the trail of links, but they lead to nowhere. Also the dosage of cocaine is typically orders of magnitude higher than therapeutic amphetamines/mph. Not saying that there is or is not some truth to this, but the jury is still out on this one.
I have ADHD, and I am certain that most of the reduced life expectancy is from chronic stress- a well established killer. With ADHD you frequently don’t have the executive control to do what you decided to do, and needs to get done. This leads to constantly being terrified of failing at everything, and letting everyone in your life down. Often calling yourself (and being called by others) lazy, unreliable, disorganized, etc. even when you care deeply and are doing everything you can to succeed.
It would be nice to figure out what can be done about this. I’ve found I usually have dangerously high blood pressure, but a few minutes of slow exhale breathing exercises and a short walk brings it down to normal. Which I usually feel I am too stressed and busy to do.