Autoři: 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
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.
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.
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.
Adolescents – Antidepressants – Depression – Drug licensing – England – Ethnicities – Mental health and psychiatry – Primary care
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