Temporal trends in annual incidence rates for psychiatric disorders and self-harm among children and adolescents in the UK, 2003–2018

Abstract

Background There has been growing concern in the UK over recent years that a perceived mental health crisis is affecting children and adolescents, although published epidemiological evidence is limited. Methods Two population-based UK primary care cohorts were delineated in the Aurum and GOLD datasets of the Clinical Practice Research Datalink (CPRD). We included data from 9,133,246 individuals aged 1–20 who contributed 117,682,651 person-years of observation time. Sex- and age-stratified annual incidence rates were estimated for attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) (age groups: 1–5, 6–9, 10–12, 13–16, 17–19), depression, anxiety disorders (6–9, 10–12, 13–16, 17–19), eating disorders and self-harm (10–12, 13–16, 17–19) during 2003–2018. We fitted negative binomial regressions to estimate incidence rate ratios (IRRs) to examine change in incidence between the first (2003) and final year (2018) year of observation and to examine sex-specific incidence. Results The results indicated that the overall incidence has increased substantially in both boys and girls in between 2003 and 2018 for anxiety disorders (IRR 3.51 95% CI 3.18–3.89), depression (2.37; 2.03–2.77), ASD (2.36; 1.72–3.26), ADHD (2.3; 1.73–3.25), and self-harm (2.25; 1.82–2.79). The incidence for eating disorders also increased (IRR 1.3 95% CI 1.06–1.61), but less sharply. The incidence of anxiety disorders, depression, self-harm and eating disorders was in absolute terms higher in girls, whereas the opposite was true for the incidence of ADHD and ASD, which were higher among boys. The largest relative increases in incidence were observed for neurodevelopmental disorders, particularly among girls diagnosed with ADHD or ASD. However, in absolute terms, the incidence was much higher for depression and anxiety disorders. Conclusion The number of young people seeking help for psychological distress appears to have increased in recent years. Changes to diagnostic criteria, reduced stigma, and increased awareness may partly explain our results, but we cannot rule out true increases in incidence occurring in the population. Whatever the explanation, the marked rise in demand for healthcare services means that it may be more challenging for affected young people to promptly access the care and support that they need.

Incidence of Attention Deficit Hyperactivity Disorder (ADHD) Diagnoses in Navarre (Spain) from 2003 to 2019

“…After a plateau period, it started decreasing in 2015, reaching rates in 2019 even lower than those at the beginning of the study. So far, most epidemiological studies on ADHD incidence have shown a continuously increasing temporal trend, which is not in line with the decreasing trend observed in Navarre over the last few years [21][22][23][24][25]. In contrast, and similarly to our study, a large population-based study in Israel found a dramatic increase in the rate of ADHD diagnoses from 2005, peaking in 2011, before declining in 2014 [33].…”

“…Most of the studies analyzing the ADHD incidence in the long term reported an increasing trend in the incidence rate over the course of the years studied [21][22][23][24][25]. In contrast, a study including children and adolescents aged 4-17 years from Catalonia (Spain) did not observe a statistically significant increase in the incidence of ADHD diagnoses between 2009 and 2017 [26].…”

Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa

“…The authors ascribe this finding to a decreasing trend in incidence of bulimia nervosa and a stable level of anorexia nervosa incidence, but they did not report rates per eating disorder diagnosis. Another primary care study among 10- to 19-year-olds in the UK reported an increased incidence rate in the age group of 13–16 years for all eating disorders combined, comparing 2018 rates to those in 2003 [ 15 ]. It is unclear whether this reflects a true increase in incidence or a shifting in age at detection.…”

Still too much delay in recognition of autism spectrum disorder

“…This is a 75% increase from children born in 2009. These trends are consistent with other reported birth cohort analyses, although the national slope and profile of the cumulative incidence curve show different trajectories (Schendel and Thorsteinsson, 2018 ; Segev et al ., 2019 ; Rah et al ., 2020 ; Cybulski et al ., 2021 ; Sasayama et al ., 2021 ). However, also these findings suggest that ASD cumulative incidence has not stabilised, and the appearance of ASD condition in the administrative health databases with increasing age indicates a delay in the interception of ASD status.…”