Dispensing of psychotropic medications to Australian children and adolescents before and during the COVID‐19 pandemic, 2013–2021: a retrospective cohort study

Abstract

Objective To determine longitudinal patterns of dispensing of antidepressant, anxiolytic, antipsychotic, psychostimulant, and hypnotic/sedative medications to children and adolescents in Australia during 2013–2021. Design Retrospective cohort study; analysis of 10% random sample of Pharmaceutical Benefits Scheme (PBS) dispensing data. Participants, setting People aged 18 years or younger dispensed PBS‐subsidised psychotropic medications in Australia, 2013–2021. Main outcome measures Population prevalence of dispensing of psychotropic medications to children and adolescents, by psychotropic class, gender, and age group (0–6, 7–12, 13–18 years). Results The overall prevalence of psychotropic dispensing to children and adolescents was 33.8 per 1000 boys and 25.2 per 1000 girls in 2013, and 60.0 per 1000 boys and 48.3 per 1000 girls in 2021. The prevalence of psychotropic polypharmacy was 5.4 per 1000 boys and 3.7 per 1000 girls in 2013, and 10.4 per 1000 boys and 8.3 per 1000 girls in 2021. Prevalent dispensing during 2021 was highest for psychostimulants (boys, 44.0 per 1000; girls, 17.4 per 1000) and antidepressants (boys, 20.4 per 1000; girls, 33.8 per 1000). During 2021, the prevalence of dispensing was higher than predicted by extrapolation of 2013–2019 data for many classes, including antidepressants (boys: +6.1%; 95% CI, 1.1–11.1%; girls: +22.2%; 95% CI, 17.4–26.9%), and psychostimulants (boys: +14.5%; 95% CI, 8.0–21.1%; girls: +27.7%; 95% CI, 18.9–36.6%). The increases were greatest for girls aged 13–18 years (antidepressants: +20.3%; 95% CI, 16.9–23.7%; psychostimulants: +39.0%; 95% CI, 27.9–50.0%). Conclusions The prevalence of both psychotropic dispensing and psychotropic polypharmacy for children and adolescents were twice as high in 2021 as in 2013. The reasons and appropriateness of the marked increases in psychotropic dispensing during the COVID‐19 pandemic, particularly to adolescent girls, should be investigated.

Psychotropic Medication Prescribing for Children and Adolescents After the Onset of the COVID-19 Pandemic

“…The most substantial increases in rates and trends of prescriptions concerned anxiolytic, hypnotic and sedative, and antidepressant medications. This finding is in line with the growing prevalence of mood and anxiety disorders recently reported in the pediatric population, whose first-line treatment often involves the prescribing of these specific psychotropic medication classes . Before the pandemic onset, anxiolytics and hypnotics and sedatives were the only psychotropic medication classes with decreasing prescription trends in the pediatric population in France.…”

“…Antipsychotic medications are usually prescribed for the treatment of psychotic and conduct disorders and only as second-line treatments for major behavioral and bipolar disorders . Finally, despite a more steeply increasing trend after the pandemic onset, prescriptions of psychostimulants did not rise above expected rates in France, as opposed to other countries . This finding should be interpreted with caution, as the acceleration of the prescription trend may also be associated with a modification of methylphenidate prescribing conditions in France.…”

“…This study has some limitations. First, previous studies have shown significant differences between men and women in the association between the pandemic and mental health and psychotropic medication use . The X-ponent database did not reliably record this information throughout the entire study period, preventing us from stratifying our analysis by sex.…”

Impact of COVID-19 pandemic on prescription of psychotropic medications in the Italian paediatric population during 2020

“…Despite the increase observed in 2020 in Italy, the comparison with published international epidemiological studies performed at the onset of the COVID-19 pandemic showed that the prescription of psychotropic medications in Italian paediatric population resulted still much lower than those observed in the USA, Australia and in some EU countries [ 42 , 45 , 46 , 49 , 51 ].…”

“…When comparing April 2020 − 2019, antipsychotics had the largest year-over-year percent change (41.9%), followed by antidepressants (37.9%), mood stabilizers (34.4%), and ADHD medications (20.4%); in September 2020, when the number of treated youths was similar to pre-pandemic, the year-over-year percent change in ADHD medication prescription decreased (− 2.8%), while other psychotropic classes increased between 3.1% and 5.0% compared to September 2019 [ 45 , 46 ]. A marked increase in psychotropic medications use in children and adolescents was also observed in Australia [ 47 , 48 ], with a prevalence passing from 33.8 to 60.0 per 1,000 children between 2013 and 2021 [ 49 ].…”