Trends and variation in the incidence and prevalence of primary care antidepressant prescribing in children and young people in England: a population-based cohort study

Conference:

SAPC ASM 2020 - cancelled due to pandemic

Talk Code:

P.5

Presenter:

Ruth Jack

Co-authors:

Chris Hollis 1,2, Carol Coupland 1, Richard Morriss 1,2, Roger David Knaggs 1, Debbie Butler 2, Andrea Cipriani 3,4, Samuele Cortese 1,2,5,6,7, Julia Hippisley-Cox 3

Author institutions:

1 University of Nottingham, 2 NIHR Biomedical Research Centre and NIHR MindTech MedTech Co-operative, Nottingham, 3 University of Oxford, 4 Oxford Health NHS Foundation Trust, 5 University of Southampton, 6 Solent NHS Trust, 7 New York University Child Study Center

Problem

The use of antidepressants in children and adolescents remains controversial. In recent years antidepressant prescribing for young people has increased both in the UK and other countries. However, there is little evidence about variation in prescribing, particularly taking other factors into account. We aimed to describe trends over time and variation in primary care antidepressant prescribing in England, using the largest cohort of children and young people to date. We examined variation by social deprivation, region and ethnicity, and analysed whether the drugs prescribed reflect UK licensing and National Institute for Health and Care Excellence (NICE) guidelines.

Approach

The study’s open cohort was defined as all eligible children (aged 5-11 years) and adolescents (aged 12-17 years) in 1998-2017 from the QResearch primary care database. Incidence and prevalence rates of antidepressant prescriptions were calculated in each year 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.

Findings

Of the 4.3 million children and adolescents in the cohort, 49,434 (1.1%) were prescribed antidepressants for the first time during 20 million years of follow-up between 1998 and 2017. Of the first antidepressant prescribed, 82% were TCAs in children, and 68% were SSRIs in adolescents. Antidepressant prescribing incidence rates decreased in children over the study period to less than 0.3 per 1000 person-years for both sexes in 2017, but more than doubled in adolescents between 2005 and 2017, to 9.7 and 4.2 per 1000 person-years in females and males respectively. Prevalence rates also more than doubled in adolescents in the same period to 16.4 in females and 7.9 in males, per 1000 person-years. The lowest prescription incidence rates were in London and the highest were in the South East, and those living in more deprived areas were more likely to be prescribed antidepressants, for all sex and age groups. Prescribing rates were highest in White and lowest in Black adolescents. The five most commonly first prescribed antidepressants representing 90% of prescriptions were either licensed in the UK for use in children and young people or included in NICE guidelines.

Consequences

Our analysis provides evidence of a continuing rise of antidepressant prescribing in adolescents since 2005, driven by SSRI prescriptions. The variation in prescribing found by deprivation, region and ethnicity could represent inequities. Future research should examine whether prescribing trends and variation are due to differences in need and risk factors, access to diagnosis or treatment, prescribing behaviour or young people’s help seeking behaviour.

Submitted by:

Ruth Jack

Funding acknowledgement:

This research was funded by the NIHR Nottingham Biomedical Research Centre.