Secondary care visits by children and young people prescribed antidepressants in primary care: a descriptive study using the QResearch database

Conference:

SAPC ASM 2020 - cancelled due to pandemic

Talk Code:

P.6

Presenter:

Rebecca Joseph

Co-authors:

Ruth H Jack, Carol Coupland, Debbie Butler, Chris Hollis, Richard Morriss, Roger D Knaggs, Andrea Cipriani, Samuele Cortese, Julia Hippisley-Cox

Author institutions:

University of Nottingham, NIHR Nottingham Biomedical Research Centre and NIHR MindTech MedTech Cooperative, University of Oxford,  Oxford Health NHS Foundation Trust, University of Southampton,  Solent NHS Trust, New York University Child Study Center

Problem

Antidepressants may be used to manage a number of conditions in children and young people including depression, anxiety, and obsessive compulsive disorder. UK guidelines for the treatment of depression in children and young people recommend that antidepressants should only be initiated following assessment and diagnosis by a child and adolescent psychiatrist. This study aimed to summarise visits to specialists and indications recorded around the time of antidepressant initiation in children and young people in UK primary care.

Approach

English primary care electronic health records provided by QResearch were linked to Hospital Episode Statistics (HES) secondary care data. The study included 5-17-year-olds first prescribed antidepressants between January 2006 and December 2017. Records of visits to paediatric or psychiatric specialists and potential indications (from a pre-specified list) were extracted. Events were counted if recorded less than 12 months before or 6 months after the first antidepressant prescription. Results were stratified by first antidepressant type (all, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs)), and by age group (5-11, 12-17 years old).

Findings

In total, 33,031 5-17-year-olds were included. The majority were aged 12-17 years (30,701, 93%) and were female (22,279, 67%). The first antidepressant prescribed was an SSRI for 22,130 (67%) patients. Overall, 12,149 (37%) visited a paediatric or psychiatric specialist in the specified time window. Most recorded visits (7154, 22% of the study population) were to paediatricians. Of those prescribed SSRIs, 5463/22,130 (25%) visited a child and adolescent psychiatrist. The proportion who visited a paediatrician increased steadily over the study window, while the proportion visiting a child and adolescent psychiatrist peaked in 2013, before starting to decline. By patient age, 1157/2239 (50%) 5-11-year-olds and 10,992/30,701 (36%) 12-17-year-olds had a record of visiting a paediatric or psychiatric specialist. Overall 17,972 (54%) patients had a record of at least one of the pre-specified indications. This proportion was higher for those prescribed SSRIs (15,295/22,130, 69%) than those prescribed TCAs (2463/10,489, 24%). Depression was recorded most frequently overall (12,501, 38%), followed by anxiety (4155, 13%). Over half of the 12-17-year-olds first prescribed an SSRI had a record of depression (11,474/21,478, 53%).

Consequences

These results suggest antidepressants are frequently prescribed to children and young people in primary care without the recommended involvement of specialists. As possible indications were identified for just over half of prescriptions, it is difficult to determine whether antidepressants were prescribed in children and young people for evidence-based indications. These findings may justify both greater training for GPs in child and adolescent mental health, and greater access to specialist care and non-pharmacological treatments.

Submitted by:

Rebecca Joseph

Funding acknowledgement:

This work has been funded by the National Institute for Health Research (NIHR). The research reported in this paper was conducted by the NIHR Nottingham Biomedical Research Centre. RM is supported by the NIHR MindTech MedTech and in Vitro Fertilisation Collaboration and the NIHR Applied Research Collaboration East Midlands. AC is supported by the NIHR Oxford Cognitive Health Clinical Research Facility, by an NIHR Research Professorship (grant RP-2017-08-ST2-006) and by the NIHR Oxford Health Biomedical Research Centre (grant BRC-1215-20005). The views represented are the views of the authors alone and do not necessarily represent the views of the Department of Health in England, NHS, or the National Institute for Health Research.