Incidence and prevalence of primary care antidepressant prescribing in children and young people in England, 1998–2017: A population-based cohort study
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Ruth H. Jack aff001; Chris Hollis aff002; Carol Coupland aff001; Richard Morriss aff002; Roger David Knaggs aff006; Debbie Butler aff004; Andrea Cipriani aff007; Samuele Cortese aff002; Julia Hippisley-Cox aff012
Působiště autorů:
Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, United Kingdom
aff001; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
aff002; National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham, United Kingdom
aff003; NIHR MindTech MedTech Co-operative, Nottingham, United Kingdom
aff004; NIHR Applied Research Collaboration East Midlands, Nottingham, United Kingdom
aff005; School of Pharmacy, University of Nottingham, Nottingham, United Kingdom
aff006; Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
aff007; Centre for Innovation in Mental Health, School of Psychology, Life and Environmental Sciences, University of Southampton, Southampton, United Kingdom
aff008; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom
aff009; Solent NHS Trust, Southampton, United Kingdom
aff010; New York University Child Study Center, New York, New York, United States of America
aff011; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
aff012
Vyšlo v časopise:
Incidence and prevalence of primary care antidepressant prescribing in children and young people in England, 1998–2017: A population-based cohort study. PLoS Med 17(7): e32767. doi:10.1371/journal.pmed.1003215
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pmed.1003215
Souhrn
Background
The use of antidepressants in children and adolescents remains controversial. We examined trends over time and variation in antidepressant prescribing in children and young people in England and whether the drugs prescribed reflected UK licensing and guidelines.
Methods and findings
QResearch is a primary care database containing anonymised healthcare records of over 32 million patients from more than 1,500 general practices across the UK. All eligible children and young people aged 5–17 years in 1998–2017 from QResearch were included. Incidence and prevalence rates of antidepressant prescriptions in each year were calculated overall, for 4 antidepressant classes (selective serotonin reuptake inhibitors [SSRIs], tricyclic and related antidepressants [TCAs], serotonin and norepinephrine reuptake inhibitors [SNRIs], and other antidepressants), and for individual drugs. Adjusted trends over time and differences by social deprivation, region, and ethnicity were examined using Poisson regression, taking clustering within general practitioner (GP) practices into account using multilevel modelling. Of the 4.3 million children and young people in the cohort, 49,434 (1.1%) were prescribed antidepressants for the first time during 20 million years of follow-up. Males made up 52.0% of the cohorts, but only 34.1% of those who were first prescribed an antidepressant in the study period. The largest proportion of the cohort was from London (24.4%), and whilst ethnicity information was missing for 39.5% of the cohort, of those with known ethnicity, 75.3% were White. Overall, SSRIs (62.6%) were the most commonly prescribed first antidepressant, followed by TCAs (35.7%). Incident antidepressant prescribing decreased in 5- to 11-year-olds from a peak of 0.9 in females and 1.6 in males in 1999 to less than 0.2 per 1,000 for both sexes in 2017, but incidence rates more than doubled in 12- to 17-year-olds between 2005 and 2017 to 9.7 (females) and 4.2 (males) per 1,000 person-years. The lowest prescription incidence rates were in London, and the highest were in the South East of England (excluding London) for all sex and age groups. Those living in more deprived areas were more likely to be prescribed antidepressants after adjusting for region. The strongest trend was seen in 12- to 17-year-old females (adjusted incidence rate ratio [aIRR] 1.12, 95% confidence interval [95% CI] 1.11–1.13, p < 0.001, per deprivation quintile increase). Prescribing rates were highest in White and lowest in Black adolescents (aIRR 0.32, 95% CI 0.29–0.36, p < 0.001 [females]; aIRR 0.32, 95% CI 0.27–0.38, p < 0.001 [males]). The 5 most commonly prescribed antidepressants were either licensed in the UK for use in children and young people (CYP) or included in national guidelines. Limitations of the study are that, because we did not have access to secondary care prescribing information, we may be underestimating the prevalence and misidentifying the first antidepressant prescription. We could not assess whether antidepressants were dispensed or taken.
Conclusions
Our analysis provides evidence of a continuing rise of antidepressant prescribing in adolescents aged 12–17 years since 2005, driven by SSRI prescriptions, but a decrease in children aged 5–11 years. The variation in prescribing by deprivation, region, and ethnicity could represent inequities. Future research should examine whether prescribing trends and variation are due to true differences in need and risk factors, access to diagnosis or treatment, prescribing behaviour, or young people’s help-seeking behaviour.
Klíčová slova:
Adolescents – Antidepressants – Depression – Drug licensing – England – Ethnicities – Mental health and psychiatry – Primary care
Zdroje
1. World Health Organization. Global Accelerated Action for the Health of Adolescents (AA-HA!): guidance to support country implementation. Geneva: World Health Organization; 2017.
2. Soria-Saucedo R, Walter HJ, Cabral H, England MJ, Kazis LE. Receipt of Evidence-Based Pharmacotherapy and Psychotherapy Among Children and Adolescents With New Diagnoses of Depression. Psychiat Serv. 2016;67(3):316–23. doi: 10.1176/appi.ps.201500090 26725295
3. Department of Health and Social Care and Department of Education. Transforming Children and Young People's Mental Health Provision: a Green Paper. 2017 [cited 2020 May 11]. Available from: https://www.gov.uk/government/consultations/transforming-children-and-young-peoples-mental-health-provision-a-green-paper
4. Hopkins K, Crosland P, Elliott N, Bewley S, Clinical Guidelines Update Committee B. Diagnosis and management of depression in children and young people: summary of updated NICE guidance. BMJ. 2015;350:h824. doi: 10.1136/bmj.h824 25739880
5. National Institute for Health and Care Excellence. Depression in children and young people: identification and management (NICE guideline NG134). 2019 [cited 2020 May 11]. Available from: https://www.nice.org.uk/guidance/ng134
6. Sadler K, Vizard T, Ford T, Marchesell F, Pearce N, Mandalia D, et al. Mental Health of Children and Young People in England, 2017 [Internet]. 2018 [cited 2020 May 11]. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/mental-health-of-children-and-young-people-in-england/2017/2017
7. Cipriani A, Zhou X, Del Giovane C, Hetrick SE, Qin B, Whittington C, et al. Comparative efficacy and tolerability of antidepressants for major depressive disorder in children and adolescents: a network meta-analysis. Lancet. 2016;388(10047):881–90. doi: 10.1016/S0140-6736(16)30385-3 27289172
8. Paediatric Formulary Committee. BNF for Children (online) London: BMJ Group, Pharmaceutical Press, and RCPCH Publications. 2020 [cited 2020 May 11]. Available from: https://about.medicinescomplete.com/publication/british-national-formulary-for-children/
9. Birmaher B, Brent D, AACAP Work Group on Quality Issues, Bernet W, Bukstein O, Walter H, et al. Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. J Am Acad Child Adolesc Psychiatry. 2007;46(11):1503–26. doi: 10.1097/chi.0b013e318145ae1c 18049300
10. National Institute for Health and Care Excellence. Obsessive-compulsive disorder and body dysmorphic disorder: treatment (Clinical guideline CG31). 2005 [cited 2020 May 11]. Available from: https://www.nice.org.uk/guidance/cg31
11. National Institute for Health and Care Excellence. Bedwetting in under 19s (Clinical guideline CG111). 2010 [cited 2020 May 11]. Available from: https://www.nice.org.uk/guidance/cg111
12. National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management (Clinical guideline CG150) London: National Institute for Health and Care Excellence. 2012 (updated 2015) [cited 2020 May 11]. Available from: https://www.nice.org.uk/guidance/cg150
13. Vezyridis P, Timmons S. Evolution of primary care databases in UK: a scientometric analysis of research output. BMJ Open. 2016;6(10):e012785. doi: 10.1136/bmjopen-2016-012785 27729352
14. Jack RH, Joseph RM, Coupland C, Butler D, Hollis C, Morriss R, et al. Secondary care specialist visits made by children and young people prescribed antidepressants in primary care: a descriptive study using the QResearch database. BMC Medicine. 2020;18(1):93. doi: 10.1186/s12916-020-01560-7 32349753
15. Wijlaars LPMM, Nazareth I, Petersen I Trends in Depression and Antidepressant Prescribing in Children and Adolescents: A Cohort Study in The Health Improvement Network (THIN). PLoS ONE. 2012;7(3):e33181. doi: 10.1371/journal.pone.0033181 22427983
16. John A, Marchant AL, Fone DL, McGregor JI, Dennis MS, Tan JOA, et al. Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study. Psychol Med. 2016;46(16):3315–27. doi: 10.1017/S0033291716002099 27879187
17. Mars B, Heron J, Kessler D, Davies NM, Martin RM, Thomas KH, et al. Influences on antidepressant prescribing trends in the UK: 1995–2011. Soc Psychiatry Psychiatr Epidemiol. 2017;52(2):193–200. doi: 10.1007/s00127-016-1306-4 27885400
18. Sarginson J, Webb RT, Stocks SJ, Esmail A, Garg S, Ashcroft DM. Temporal trends in antidepressant prescribing to children in UK primary care, 2000–2015. J Affect Disorders. 2017;210:312–8. doi: 10.1016/j.jad.2016.12.047 28068620
19. Tiffin PA, Mediavilla JL, Close H, Kasim AS, Welsh P, Paton LW, et al. What were the impacts of the Committee on Safety of Medicines warning and publication of the NICE guidelines on trends in child and adolescent antidepressant prescribing in primary care? A population based study. BMJ Open. 2019;9(8):e028201. doi: 10.1136/bmjopen-2018-028201 31391190
20. Bachmann CJ, Aagaard L, Burcu M, Glaeske G, Kalverdijk LJ, Petersen I, et al. Trends and patterns of antidepressant use in children and adolescents from five western countries, 2005–2012. Eur Neuropsychopharm. 2016;26(3):411–9. doi: 10.1016/j.euroneuro.2016.02.001 26970020
21. Schröder C, Dörks M, Kollhorst B, Blenk T, Dittmann RW, Garbe E, et al. Outpatient antidepressant drug use in children and adolescents in Germany between 2004 and 2011. Pharmacoepidem Dr S. 2017;26(2):170–9. doi: 10.1002/pds.4138 27868277
22. Revet A, Montastruc F, Raynaud JP, Baricault B, Montastruc JL, Lapeyre-Mestre M. Trends and Patterns of Antidepressant Use in French Children and Adolescents From 2009 to 2016: A Population-Based Study in the French Health Insurance Database. J Clin Psychopharm. 2018;38(4):327–35. doi: 10.1097/JCP.0000000000000891 29851707
23. Lagerberg T, Molero Y, D'Onofrio BM, Fernandez de la Cruz L, Lichtenstein P, Mataix-Cols D, et al. Antidepressant prescription patterns and CNS polypharmacy with antidepressants among children, adolescents, and young adults: a population-based study in Sweden. Eur Child Adoles Psy. 2019;28(8):1137–45. doi: 10.1007/s00787-018-01269-2 30659386
24. Grigoroglou C, Munford L, Webb RT, Kapur N, Ashcroft DM, Kontopantelis E. Prevalence of mental illness in primary care and its association with deprivation and social fragmentation at the small-area level in England. Psychol Med. 2020;50(2):293–302. doi: 10.1017/S0033291719000023 30744718
25. Walters P, Ashworth M, Tylee A. Ethnic density, physical illness, social deprivation and antidepressant prescribing in primary care: ecological study. Br J Psychiatry. 2008;193(3):235–9. doi: 10.1192/bjp.bp.107.038299 18757984
26. Schofield P, Das-Munshi J, Mathur R, Congdon P, Hull S. Does depression diagnosis and antidepressant prescribing vary by location? Analysis of ethnic density associations using a large primary-care dataset. Psychol Med. 2016;46(6):1321–9. doi: 10.1017/S0033291715002913 26879871
27. Jack RH, Hollis C, Coupland C, Morriss R, Knaggs RD, Cipriani A, et al. Trends in antidepressant prescriptions in children and young people in England, 1998–2017: protocol of a cohort study using linked primary care and secondary care datasets. Evid Based Ment Health. 2019;22(3):129–33. doi: 10.1136/ebmental-2019-300097 31253602
28. Townsend P. Deprivation. J Soc Policy. 1987;16:125–46. doi: 10.1017/S0047279400020341 WOS:A1987J267500001
29. Gould WW. Linear splines and piecewise linear functions. Stata Technical B. 1993;15:13–7.
30. Children's Commissioner. Early access to mental health support. London: Children's Commissioner for England; 2019.
31. Rocks S, Fazel M, Tsiachristas A. Variation in spend on young mental health across Clinical Commissioning Groups in England: a cross-sectional observational study. BMJ Open. 2019;9(10):e030011. doi: 10.1136/bmjopen-2019-030011 31594880
32. Kontopantelis E, Stevens RJ, Helms PJ, Edwards D, Doran T, Ashcroft DM. Spatial distribution of clinical computer systems in primary care in England in 2016 and implications for primary care electronic medical record databases: a cross-sectional population study. BMJ Open. 2018;8(2):e020738. doi: 10.1136/bmjopen-2017-020738 29490968
33. Rainer C, Crellin R. Finding Help: Children, young people and families navigating the system to get the mental health support they need. London, UK: The Children's Society; 2019.
34. Wang Z, Whiteside SPH, Sim L, Farah W, Morrow AS, Alsawas M, et al. Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders: A Systematic Review and Meta-analysis. JAMA Pediatr. 2017;171(11):1049–56. doi: 10.1001/jamapediatrics.2017.3036 28859190
35. National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management (Clinical guideline CG113). 2011 [cited 2020 May 11]. Available from: https://www.nice.org.uk/guidance/cg113 22536620
36. National Institute for Health and Care Excellence. Self-harm in over 8s: long-term management (Clinical guideline CG133). 2011 [cited 2020 May 11]. Available from: https://www.nice.org.uk/guidance/cg133
37. Morgan C, Webb RT, Carr MJ, Kontopantelis E, Green J, Chew-Graham CA, et al. Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care. BMJ. 2017;359. doi: 10.1136/bmj.j4351 29046278
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