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

BMC Medicine

Research Article

Samuele Cortese¹  Andrea Cipriani²  Rebecca M. Joseph³  Carol Coupland³  Ruth H. Jack³  Debbie Butler⁴  Richard Morriss⁵  Chris Hollis⁵  Julia Hippisley-Cox⁶  Roger David Knaggs⁷ 

[1] Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK;Solent NHS Trust, Southampton, UK;Department of Child and Adolescent Psychiatry, Hassenfeld Children’s Hospital at NYU Langone, New York, NY, USA;Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK;Department of Psychiatry, University of Oxford, Oxford, UK;Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK;Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK;National Institute of Health Research MindTech MedTech Co-operative, The Institute of Mental Health, University of Nottingham, Nottingham, UK;National Institute of Health Research MindTech MedTech Co-operative, The Institute of Mental Health, University of Nottingham, Nottingham, UK;National Institute of Health Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK;Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK;Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK;School of Pharmacy, University of Nottingham, Nottingham, UK;

关键词: Antidepressants;    SSRIs;    Epidemiology;    Primary health care;    Child;    Adolescent;    Depression;    Anxiety;    Mental health;   

DOI  :  10.1186/s12916-020-01560-7

 received in 2019-11-26, accepted in 2020-03-16,  发布年份 2020

来源: Springer

【 摘 要 】

BackgroundAntidepressants 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. The aim of this study was to summarise visits to mental health specialists and indications recorded around the time of antidepressant initiation in children and young people in UK primary care.MethodsThe study used linked English primary care electronic health records and Hospital Episode Statistics 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 and related antidepressants) and by age group (5–11 years, 12–17 years).ResultsIn total, 33,031 5–17-year-olds were included. Of these, 12,149 (37%) had a record of visiting a paediatrician or a psychiatric specialist in the specified time window. The majority of recorded visits (7154, 22%) were to paediatricians. Of those prescribed SSRIs, 5463/22,130 (25%) had a record of visiting a child and adolescent psychiatrist. Overall, 17,972 (54%) patients had a record of at least one of the pre-specified indications. Depression was the most frequently recorded indication (12,501, 38%), followed by anxiety (4155, 13%).ConclusionsThe results suggest many children and young people are being prescribed antidepressants without the recommended involvement of a relevant specialist. 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. Further research is needed to explore factors that influence how and why GPs prescribe antidepressants to children and young people and the real-world practice barriers to adherence to clinical guidelines.

【 授权许可】

CC BY   
© The Author(s) 2020

【 图 表 】

13690_2023_1170_Article_IEq199.gif

12888_2023_5142_Article_IEq19.gif

12936_2023_4724_Article_IEq15.gif

Fig. 1

13690_2023_1170_Article_IEq180.gif