University of Oulu

Antti Mustonen, Anni-Emilia Alakokkare, James G. Scott, Anu-Helmi Halt, Miika Vuori, Tuula Hurtig, Alina Rodriguez, Jouko Miettunen & Solja Niemelä (2023) Association of ADHD symptoms in adolescence and mortality in Northern Finland Birth Cohort 1986, Nordic Journal of Psychiatry, 77:2, 165-171, DOI: 10.1080/08039488.2022.2073389

Association of ADHD symptoms in adolescence and mortality in Northern Finland Birth Cohort 1986

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Author: Mustonen, Antti1,2,3; Alakokkare, Anni-Emilia2,4,5; Scott, James G.6,7,8;
Organizations: 1Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
2Center for Life Course Health Research, University of Oulu, Oulu, Finland
3Department of Psychiatry, Seinäjoki Central Hospital, Seinäjoki, Finland
4Department of Psychiatry, University of Turku,Turku, Finland
5Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
6QIMR Berghofer MedicalResearch Institute, Brisbane, Queensland, Australia
7Queensland Centre for Mental Health Research, Wacol, Australia
8Metro North MentalHealth Service, Herston, Australia
9Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
10Department of Psychiatry, OuluUniversity Hospital, Oulu, Finland
11Turku Institute of Advanced Studies, Department of Teacher Education, University of Turku, Finland
12PEDEGO Research Unit, Clinic of Child Psychiatry, University of Oulu, Oulu University Hospital, Oulu, Finland
13Department of Epidemiologyand Biostatistics, Imperial College London, London, UK
14Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health,Queen Mary University of London, London, UK
15Addiction Psychiatry Unit, Department of Psychiatry, Turku University Hospital, Turku, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.2 MB)
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Language: English
Published: Informa, 2022
Publish Date: 2023-08-11


Background: Diagnosis of attention deficit hyperactive disorder (ADHD) has been associated with increased risk of mortality in large register samples. However, there is less known about the association between symptoms of ADHD in adolescents and risk of mortality in general population samples.

Methods: The Northern Finland Birth Cohort 1986 (n = 9432 at recruitment in early pregnancy) linked to nationwide register data for deaths was utilized to study the association between parent-rated ADHD symptoms assessed using Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) questionnaire and mortality until age 33 years. Cox-regression analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) was used to study the association between SWAN inattentive, hyperactive, and combined symptom scores and risk of death.

Results: Sixty-three (0.9%) of the 6685 participants died during the follow-up. Higher SWAN inattentive (crude HR = 2.30, 95% CI 1.46–3.63), SWAN hyperactive (crude HR = 2.43, 95% CI 1.29–4.56), and SWAN combined (crude HR = 2.69, 95% CI 1.57–4.61) scores were associated with increased risk of death. After adjustments for sex, family structure, and lifetime parental psychiatric disorder, these associations persisted. Further adjustment for frequent alcohol intoxication, cannabis, and other substance use in adolescence attenuated these to below statistical significance.

Conclusions: These results extend previous findings on the risk of mortality in adolescents who have symptoms of ADHD. Further research with larger samples are needed to determine whether the association between ADHD symptoms and mortality is independent of adolescent substance use.

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Series: Nordic journal of psychiatry
ISSN: 0803-9488
ISSN-E: 1502-4725
ISSN-L: 0803-9488
Volume: 77
Issue: 2
Pages: 165 - 171
DOI: 10.1080/08039488.2022.2073389
Type of Publication: A1 Journal article – refereed
Field of Science: 3124 Neurology and psychiatry
Funding: NFBC1986 has received funding from EU QLG1-CT-2000-01643 (EUROBLCS) Grant no. E51560, NorFA Grant no. 731, 20056, 30167, USA/NIH 2000 G DF682 Grant no. 50945. For this study AM has received funding from Juho Vainio Foundation, Emil Aaltonen Foundation, The Hospital District of South Ostrobothnia and The Finnish Foundation for Alcohol Studies. AHH and TH have received funding from Terttu foundation. SN has received funding from Juho Vainio foundation, Sohlberg foundation and speaker fees (Shire-Takeda), and travel fees (Shire-Takeda). AHH has received travel fees (Lundbeck). JGS is supported by a National Health and Medical Research Council Practitioner Fellowship (APP1105807). JM has received funding from Juho Vainio Foundation and from the Yrjö Jahnsson Foundation. MV reports no potential conflicts of interest.
Dataset Reference: NFBC data is available from the University of Oulu, Infrastructure for Population Studies. Permission to use the data can be applied for research purposes via electronic material request portal. In the use of data, we follow the EU general data protection regulation (679/2016) and Finnish Data Protection Act. The use of personal data is based on cohort participant’s written informed consent at his/her latest follow-up study, which may cause limitations to its use. Please contact NFBC project center ( and visit the cohort website ( for more information.
Copyright information: © 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis GroupThis is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (,which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.