The University of Southampton
University of Southampton Institutional Repository

Incidence and prevalence of primary care antidepressant prescribing in children and young people in England, 1998-2017: a population-based cohort study

Incidence and prevalence of primary care antidepressant prescribing in children and young people in England, 1998-2017: a population-based cohort study
Incidence and prevalence of primary care antidepressant prescribing in children and young people in England, 1998-2017: a population-based cohort study
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 four 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 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 while 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 1000 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 1000 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 five most commonly prescribed antidepressants were either licensed in the UK for use in children and young people, or included in national guidelines. Limitations of the study are that, as 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.
1549-1277
Jack, Ruth H.
769e9c62-53e7-4d96-a583-0036a514d337
Hollis, Chris
fe8adc7a-cfcd-4966-b397-1dd22048bbc8
Coupland, Carol
6efd69d5-8f84-45ac-9777-d4b07feeb2e2
Morriss, Richard
fb48ce6f-f557-4e5d-a309-5eb7f6ee6c2e
Knaggs, Roger David
c27800fb-a779-4416-8e6a-c8bd557d76f6
Butler, Debbie
282e315a-60ce-4f2f-8664-7e0b4fee6b90
Cipriani, Andrea
5f3097c8-4901-4a9b-b371-d17aeac9b686
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Hippisley-Cox, Julia
7be524e3-9066-4179-b58f-cb2e16cd02ec
Jack, Ruth H.
769e9c62-53e7-4d96-a583-0036a514d337
Hollis, Chris
fe8adc7a-cfcd-4966-b397-1dd22048bbc8
Coupland, Carol
6efd69d5-8f84-45ac-9777-d4b07feeb2e2
Morriss, Richard
fb48ce6f-f557-4e5d-a309-5eb7f6ee6c2e
Knaggs, Roger David
c27800fb-a779-4416-8e6a-c8bd557d76f6
Butler, Debbie
282e315a-60ce-4f2f-8664-7e0b4fee6b90
Cipriani, Andrea
5f3097c8-4901-4a9b-b371-d17aeac9b686
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Hippisley-Cox, Julia
7be524e3-9066-4179-b58f-cb2e16cd02ec

Jack, Ruth H., Hollis, Chris, Coupland, Carol, Morriss, Richard, Knaggs, Roger David, Butler, Debbie, Cipriani, Andrea, Cortese, Samuele and Hippisley-Cox, Julia (2020) Incidence and prevalence of primary care antidepressant prescribing in children and young people in England, 1998-2017: a population-based cohort study. PLoS Medicine, 17 (7). (doi:10.1371/journal.pmed.1003215).

Record type: Article

Abstract

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 four 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 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 while 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 1000 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 1000 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 five most commonly prescribed antidepressants were either licensed in the UK for use in children and young people, or included in national guidelines. Limitations of the study are that, as 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.

Text
Plos Medicine revision2 CLEAN
Download (114kB)

More information

Accepted/In Press date: 23 June 2020
e-pub ahead of print date: 22 July 2020

Identifiers

Local EPrints ID: 449961
URI: http://eprints.soton.ac.uk/id/eprint/449961
ISSN: 1549-1277
PURE UUID: d6b2eb11-2959-4dd6-a953-ce7a94037c62
ORCID for Samuele Cortese: ORCID iD orcid.org/0000-0001-5877-8075

Catalogue record

Date deposited: 29 Jun 2021 17:03
Last modified: 17 Mar 2024 05:43

Export record

Altmetrics

Contributors

Author: Ruth H. Jack
Author: Chris Hollis
Author: Carol Coupland
Author: Richard Morriss
Author: Roger David Knaggs
Author: Debbie Butler
Author: Andrea Cipriani
Author: Samuele Cortese ORCID iD
Author: Julia Hippisley-Cox

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×