Zheng Chang

Zheng Chang

Principal Researcher
Telephone: +46852482412
Visiting address: Nobelsväg 12a, 17165 SOLNA
Postal address: C8 Medicinsk epidemiologi och biostatistik, C8 MEB I Chang, 171 77 Stockholm
Part of:

About me

Research

  • Effectiveness and safety of pharmacological treatments for psychiatric disorders

    While randomized controlled trials are the gold standard for evaluating the effectiveness and safety of pharmacological treatments, they are often unfeasible or unethical for certain psychiatric research questions. My research addresses these gaps by applying advanced pharmacoepidemiological methods on large-scale, real-world health data to assess the effectiveness and safety of pharmacological treatments for psychiatric conditions. We examine a broad spectrum of outcomes, ranging from short-term adverse events and rare safety signals to long-term health risks, mortality, and functional outcomes. By integrating rigorous causal inference frameworks with real-world data, my work bridges the gap between clinical trials and everyday clinical practice, generating insights that inform clinical guidelines and public health policy.

    1. Zhang L, Zhu N, Sjölander A, ... , Chang Z. ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials. BMJ. 2025 Aug 13;390:e083658. PMID: 40803836
    2. Li L, Coghill D, Sjölander A, ... , Chang Z. Increased Prescribing of Attention-Deficit/Hyperactivity Disorder Medication and Real-World Outcomes Over Time. JAMA Psychiatry. 2025 Aug 1;82(8):830-837. PMID: 40560574
    3. Li L, Zhu N, Zhang L, ... , Chang Z. ADHD pharmacotherapy and mortality in individuals with ADHD: a target trial emulation study with observational data. JAMA. 2024 Mar 12;331(10):850-860. PMID: 38470385 
    4. Virtanen S, Lagerberg T, Takami Lageborn C, ... , Chang Z. Antidepressant Use and Risk of Manic Episodes in Children and Adolescents With Unipolar Depression. JAMA Psychiatry. 2024 Jan 1;81(1):25-33. PMID: 37755835
    5. Brikell I, Yao H, Li L, ... , Klungsøyr K, Chang Z. ADHD medication discontinuation and persistence across the lifespan: a retrospective observational study using population-based databases. Lancet Psychiatry. 2024 Jan;11(1):16-26. PMID: 38035876

    Psychiatric comorbidity in chronic physical disease

    Mental and physical illnesses are closely interconnected, yet mental health is often insufficiently considered in the management of chronic physical diseases. My research uses nationwide registers, clinical quality registers, and multinational real-world data to investigate how psychiatric conditions influence disease progression, treatment adherence, and long-term prognosis, with a particular focus on kidney and cardiometabolic diseases. I lead the KI team of TIMESPAN, an EU Horizon 2020 project investigating how adult ADHD affects the prognosis and management of obesity, type 2 diabetes, and cardiovascular disease.

    1. Zhu N, Faucon AL, Kuja-Halkola R, … , Chang Z. Prevalence of Severe Mental Illness and Its Associations With Health Outcomes in Patients With CKD: A Swedish Nationwide Study. American Journal of Kidney Diseases. 2025;85(5):577–588.e1. PMID: 40010484.
    2. Zhu N, Xu H, Lagerberg T, Johnell K, Carrero JJ, Chang Z. Comparative Safety of Antidepressants in Adults with CKD. Clinical Journal of the American Society of Nephrology. 2024;19(2):178–188. PMID: 38032000.
    3. Yao H, Zhou Y, Li L, …, Chang Z. ADHD and adherence to antihypertensive medication treatment: a multinational cohort study. BMC Medicine. 2026;24(1):122. PMID: 41721349.
    4. Yao H, Brikell I, Larsson H, … , Chang Z. Attention-deficit/hyperactivity disorder and cardiometabolic risk profile in patients with acute myocardial infarction: data from the SWEDEHEART registry. European Journal of Preventive Cardiology. 2025;zwaf151. PMID: 40215106.
    5. Zhang L, Li L, Andell P, … , Chang Z. ADHD medications and long-term risk of cardiovascular diseases: a nationwide nested case-control study in Sweden. JAMA Psychiatry 2024 Feb 1;81(2):178-187. PMID: 37991787

    Psychiatric disorders in forensic psychiatry and prisons

    Psychiatric and substance use disorders are common among people involved in the criminal justice system and may influence the risks of poor health and reoffending. My research investigates how psychiatric conditions and their treatment are related to these outcomes. A central aim is to move beyond describing risk and identify modifiable factors and appropriate treatment that can guide treatment, rehabilitation, and decisions in forensic psychiatric care and prisons.

    1. Sitter TM, Savinen S, Andiné P, … , Chang Z. Association of psychotropic medications with the use of coercive measures and recidivism during forensic psychiatric care: a Swedish nationwide register-based study. BMJ Ment Health. 2026 Jun 17;29(1):e302515. PMID: 42309566.
    2. Sitter TM, Virtanen S, Edberg H, … , Chang Z. Pharmacological treatment and psychiatric polypharmacy in forensic psychiatric care in Sweden. European Psychiatry. 2025;68(1):e78. PMID: 40495520.
    3. Virtanen S, Aaltonen M, Latvala A, Forsman M, Lichtenstein P, Chang Z. Effectiveness of substance use disorder treatment as an alternative to imprisonment. BMC Psychiatry. 2024 Apr 9;24(1):260. PMID: 38589822.
    4. Chang Z, Lichtenstein P, Långström N, Larsson H, Fazel S. Association Between Prescription of Major Psychotropic Medications and Violent Reoffending After Prison Release. JAMA. 2016;316(17):1798–1807. PMID: 27802545.

    My research work has been supported by the Swedish Research Council (VR), the Swedish Research Council for Health, Working Life, and Welfare (Forte), the Horizon 2020 Framework Programme for research and innovation, the Research Council of Norway, National Institute on Drug Abuse (NIDA), and Karolinska Institutet Faculty Board and Research Fund.

Articles

All other publications

Grants

  • Swedish Research Council
    1 January 2025 - 31 December 2029
    Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder marked by significant comorbidity and serious outcomes. The use of ADHD medication has surged in Sweden and many other countries, and it prompts questions about its effectiveness and safety amid broadened diagnostic criteria. Despite the general efficacy of these medications, patient responses vary, and high discontinuation rates prevail, highlighting an urgent need for more personalized treatment strategies. This proposal aims to enhance our understanding of the individualized treatment effects of ADHD medication related to patient characteristics and to develop a decision-aid tool for personalized treatment decisions. It focuses on key clinical decisions: whether to initiate medication and the choice of first- and second-line treatments. Utilizing extensive healthcare data from Sweden, Denmark, and the US, we plan to employ cutting-edge study designs and statistical methods. The decision-aid tool, created with end-user collaboration, will be evaluated in a pilot study. The project will be carried out by an interdisciplinary team of researchers from Karolinska Institutet, clinicians from region Stockholm and Skåne, and international experts in the field. This innovative approach aims to improve patient outcomes, reduce side effects, and tackle the challenges associated with the rising use of ADHD medications, marking a substantial step towards personalized ADHD treatment.
  • Swedish Research Council
    1 December 2024 - 30 November 2028
    The rising prevalence of youth mental health disorders has outpaced the capacity of existing services. To address this, we propose register-based research innovations to support prevention at the societal level and improve individualized treatment in primary and specialist care. We integrate national Registers with novel data from the general population, primary, and specialist care, combined with recent advances in large language models (LLMs) and causal machine learning. Our interdisciplinary team of epidemiologists, health care providers and AI computer scientists aim to advance the use of LLMs in register-based research, by developing a language model architecture for unstructured medical records and prescription data, which will be implemented in three specific aims:1) Identify emerging risk factors to guide prevention using causal inference and longitudinal survey data linked with national registers 2) Strengthen youth mental health services by applying new data and methods to improve patient stratification in primary care3) Optimize treatment in specialist youth mental health services, by better understanding individualized treatment effects based on patient characteristics This research will improve youth mental health, develop innovative methods for register-based research, including a large language model to handle unstructured data, and train the next generation of register-based researchers to address healthcare-relevant questions using cutting-edge AI methods.

Employments

  • Principal Researcher, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 2022-
  • Assistant Professor, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 2018-2021

Degrees and Education

  • Degree Of Doctor Of Philosophy, Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 2014
  • Degree Of Master Of Medical Science Two Years With A Major In, Karolinska Institutet, 2009

Visiting research fellowships

  • Postdoc researcher, University of Oxford, 2014-2015

News from KI

Events from KI