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The impact of published guidance on trends in the pharmacological management of depression in children and adolescents- a whole population e-cohort data linkage study in Wales, UK

Amanda Marchant Orcid Logo, Joanna McGregor Orcid Logo, Marcos del Pozo Banos Orcid Logo, Keith Lloyd Orcid Logo, David Williams, A. Thapar, Alan Watkins Orcid Logo, Ann John Orcid Logo

Psychological Medicine, Pages: 1 - 13

Swansea University Authors: Amanda Marchant Orcid Logo, Joanna McGregor Orcid Logo, Marcos del Pozo Banos Orcid Logo, Keith Lloyd Orcid Logo, David Williams, Alan Watkins Orcid Logo, Ann John Orcid Logo

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DOI (Published version): 10.1017/s0033291724002861

Abstract

BackgroundThis study evaluated the impact of 2015/2016 prescribing guidance on antidepressant prescribing choices in children.MethodsA retrospective e-cohort study of whole population routine electronic healthcare records was conducted. Poisson regression was undertaken to explore trends over time f...

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Published in: Psychological Medicine
ISSN: 0033-2917 1469-8978
Published: Cambridge University Press (CUP) 2025
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URI: https://cronfa.swan.ac.uk/Record/cronfa68230
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Poisson regression was undertaken to explore trends over time for depression, antidepressant prescribing, indications and secondary care contacts. Time trend analysis was conducted to assess the impact of guidance. ResultsA total of 643,322 primary care patients in Wales UK, aged 6-17 years from 2010-2019 contributed 3,215,584 person-years of follow-up. Adjusted incidence of depression more than doubled (IRR for 2019 = 2.8[2.5-3.2]) with similar trends seen for antidepressants. Fluoxetine was the most frequently prescribed first-line antidepressant. Citalopram comprised less than 5% of first prescriptions in younger children but 22.9% (95% CI 22.0-23.8; 95% CI 2533) in 16&#x2013;17-year-olds. Approximately half of new antidepressant prescribing was associated with depression. Segmented regression analysis showed that prescriptions of &#x2018;all&#x2019; antidepressants, Fluoxetine and Sertraline were increasing before the guidance. This upward trend flattened for both &#x2018;all&#x2019; antidepressants and Fluoxetine and steepened for Sertraline. Citalopram prescribing was decreasing significantly pre guidance being issued with no significant change afterward. Conclusions&#x2018;Targeted intervention is needed to address rising rates of depression in children. Practitioners are partially adhering to local and national guidance. The decision-making process behind prescribing choices is likely to be multi-factorial. Activities to support implementation of guidance should be adopted in relation to safety in prescribing of antidepressants in children including timely availability of talking therapies and specialist mental health services. Further research is needed to explore GPs' prescribing preferences.</abstract><type>Journal Article</type><journal>Psychological Medicine</journal><volume>0</volume><journalNumber/><paginationStart>1</paginationStart><paginationEnd>13</paginationEnd><publisher>Cambridge University Press (CUP)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>0033-2917</issnPrint><issnElectronic>1469-8978</issnElectronic><keywords>antidepressants; children; depression; policy; SSRIs; young people</keywords><publishedDay>8</publishedDay><publishedMonth>1</publishedMonth><publishedYear>2025</publishedYear><publishedDate>2025-01-08</publishedDate><doi>10.1017/s0033291724002861</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders>This work was funded by MQ Mental Health Research Charity through the Adolescent Mental Health Data Platform (ADP) (Grant Reference MQBF/3ADP), MRC Pathfinder (MC_PC_17211) and ESRC funded ADR UK (grant ES/S007393/1). This work was supported by the Wolfson Centre for Young Peoples Mental Health (Grant Reference 517483) and by the MRC and HDRUK through DATAMIND (MR/W014386/1).</funders><projectreference/><lastEdited>2025-01-15T15:08:04.8376307</lastEdited><Created>2024-11-12T13:10:16.9363720</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Health Data Science</level></path><authors><author><firstname>Amanda</firstname><surname>Marchant</surname><orcid>0000-0001-7013-6980</orcid><order>1</order></author><author><firstname>Joanna</firstname><surname>McGregor</surname><orcid>0000-0003-0242-4600</orcid><order>2</order></author><author><firstname>Marcos</firstname><surname>del Pozo Banos</surname><orcid>0000-0003-1502-389X</orcid><order>3</order></author><author><firstname>Keith</firstname><surname>Lloyd</surname><orcid>0000-0002-1440-4124</orcid><order>4</order></author><author><firstname>David</firstname><surname>Williams</surname><order>5</order></author><author><firstname>A.</firstname><surname>Thapar</surname><order>6</order></author><author><firstname>Alan</firstname><surname>Watkins</surname><orcid>0000-0003-3804-1943</orcid><order>7</order></author><author><firstname>Ann</firstname><surname>John</surname><orcid>0000-0002-5657-6995</orcid><order>8</order></author></authors><documents><document><filename>68230__33343__eefb9a1621be46cbb56770dee65b36b2.pdf</filename><originalFilename>68230.VoR.pdf</originalFilename><uploaded>2025-01-15T15:03:23.1004654</uploaded><type>Output</type><contentLength>429099</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; The Author(s), 2025. 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spelling 2025-01-15T15:08:04.8376307 v2 68230 2024-11-12 The impact of published guidance on trends in the pharmacological management of depression in children and adolescents- a whole population e-cohort data linkage study in Wales, UK 0776f450dd575004ba7c69930c579cae 0000-0001-7013-6980 Amanda Marchant Amanda Marchant true false caa651da7e3807cbeac8ec2f40643677 0000-0003-0242-4600 Joanna McGregor Joanna McGregor true false f141785b1c0ab9efe45665d35c081b84 0000-0003-1502-389X Marcos del Pozo Banos Marcos del Pozo Banos true false a13aaa0df9045c205e82ed3b95d18c10 0000-0002-1440-4124 Keith Lloyd Keith Lloyd true false 8ba25801a54cbc3d79a3194b83c8bcdd David Williams David Williams true false 81fc05c9333d9df41b041157437bcc2f 0000-0003-3804-1943 Alan Watkins Alan Watkins true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 2024-11-12 MEDS BackgroundThis study evaluated the impact of 2015/2016 prescribing guidance on antidepressant prescribing choices in children.MethodsA retrospective e-cohort study of whole population routine electronic healthcare records was conducted. Poisson regression was undertaken to explore trends over time for depression, antidepressant prescribing, indications and secondary care contacts. Time trend analysis was conducted to assess the impact of guidance. ResultsA total of 643,322 primary care patients in Wales UK, aged 6-17 years from 2010-2019 contributed 3,215,584 person-years of follow-up. Adjusted incidence of depression more than doubled (IRR for 2019 = 2.8[2.5-3.2]) with similar trends seen for antidepressants. Fluoxetine was the most frequently prescribed first-line antidepressant. Citalopram comprised less than 5% of first prescriptions in younger children but 22.9% (95% CI 22.0-23.8; 95% CI 2533) in 16–17-year-olds. Approximately half of new antidepressant prescribing was associated with depression. Segmented regression analysis showed that prescriptions of ‘all’ antidepressants, Fluoxetine and Sertraline were increasing before the guidance. This upward trend flattened for both ‘all’ antidepressants and Fluoxetine and steepened for Sertraline. Citalopram prescribing was decreasing significantly pre guidance being issued with no significant change afterward. Conclusions‘Targeted intervention is needed to address rising rates of depression in children. Practitioners are partially adhering to local and national guidance. The decision-making process behind prescribing choices is likely to be multi-factorial. Activities to support implementation of guidance should be adopted in relation to safety in prescribing of antidepressants in children including timely availability of talking therapies and specialist mental health services. Further research is needed to explore GPs' prescribing preferences. Journal Article Psychological Medicine 0 1 13 Cambridge University Press (CUP) 0033-2917 1469-8978 antidepressants; children; depression; policy; SSRIs; young people 8 1 2025 2025-01-08 10.1017/s0033291724002861 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) This work was funded by MQ Mental Health Research Charity through the Adolescent Mental Health Data Platform (ADP) (Grant Reference MQBF/3ADP), MRC Pathfinder (MC_PC_17211) and ESRC funded ADR UK (grant ES/S007393/1). This work was supported by the Wolfson Centre for Young Peoples Mental Health (Grant Reference 517483) and by the MRC and HDRUK through DATAMIND (MR/W014386/1). 2025-01-15T15:08:04.8376307 2024-11-12T13:10:16.9363720 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science Amanda Marchant 0000-0001-7013-6980 1 Joanna McGregor 0000-0003-0242-4600 2 Marcos del Pozo Banos 0000-0003-1502-389X 3 Keith Lloyd 0000-0002-1440-4124 4 David Williams 5 A. Thapar 6 Alan Watkins 0000-0003-3804-1943 7 Ann John 0000-0002-5657-6995 8 68230__33343__eefb9a1621be46cbb56770dee65b36b2.pdf 68230.VoR.pdf 2025-01-15T15:03:23.1004654 Output 429099 application/pdf Version of Record true © The Author(s), 2025. This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence. true eng http://creativecommons.org/licenses/by/4.0/
title The impact of published guidance on trends in the pharmacological management of depression in children and adolescents- a whole population e-cohort data linkage study in Wales, UK
spellingShingle The impact of published guidance on trends in the pharmacological management of depression in children and adolescents- a whole population e-cohort data linkage study in Wales, UK
Amanda Marchant
Joanna McGregor
Marcos del Pozo Banos
Keith Lloyd
David Williams
Alan Watkins
Ann John
title_short The impact of published guidance on trends in the pharmacological management of depression in children and adolescents- a whole population e-cohort data linkage study in Wales, UK
title_full The impact of published guidance on trends in the pharmacological management of depression in children and adolescents- a whole population e-cohort data linkage study in Wales, UK
title_fullStr The impact of published guidance on trends in the pharmacological management of depression in children and adolescents- a whole population e-cohort data linkage study in Wales, UK
title_full_unstemmed The impact of published guidance on trends in the pharmacological management of depression in children and adolescents- a whole population e-cohort data linkage study in Wales, UK
title_sort The impact of published guidance on trends in the pharmacological management of depression in children and adolescents- a whole population e-cohort data linkage study in Wales, UK
author_id_str_mv 0776f450dd575004ba7c69930c579cae
caa651da7e3807cbeac8ec2f40643677
f141785b1c0ab9efe45665d35c081b84
a13aaa0df9045c205e82ed3b95d18c10
8ba25801a54cbc3d79a3194b83c8bcdd
81fc05c9333d9df41b041157437bcc2f
ed8a9c37bd7b7235b762d941ef18ee55
author_id_fullname_str_mv 0776f450dd575004ba7c69930c579cae_***_Amanda Marchant
caa651da7e3807cbeac8ec2f40643677_***_Joanna McGregor
f141785b1c0ab9efe45665d35c081b84_***_Marcos del Pozo Banos
a13aaa0df9045c205e82ed3b95d18c10_***_Keith Lloyd
8ba25801a54cbc3d79a3194b83c8bcdd_***_David Williams
81fc05c9333d9df41b041157437bcc2f_***_Alan Watkins
ed8a9c37bd7b7235b762d941ef18ee55_***_Ann John
author Amanda Marchant
Joanna McGregor
Marcos del Pozo Banos
Keith Lloyd
David Williams
Alan Watkins
Ann John
author2 Amanda Marchant
Joanna McGregor
Marcos del Pozo Banos
Keith Lloyd
David Williams
A. Thapar
Alan Watkins
Ann John
format Journal article
container_title Psychological Medicine
container_volume 0
container_start_page 1
publishDate 2025
institution Swansea University
issn 0033-2917
1469-8978
doi_str_mv 10.1017/s0033291724002861
publisher Cambridge University Press (CUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
active_str 0
description BackgroundThis study evaluated the impact of 2015/2016 prescribing guidance on antidepressant prescribing choices in children.MethodsA retrospective e-cohort study of whole population routine electronic healthcare records was conducted. Poisson regression was undertaken to explore trends over time for depression, antidepressant prescribing, indications and secondary care contacts. Time trend analysis was conducted to assess the impact of guidance. ResultsA total of 643,322 primary care patients in Wales UK, aged 6-17 years from 2010-2019 contributed 3,215,584 person-years of follow-up. Adjusted incidence of depression more than doubled (IRR for 2019 = 2.8[2.5-3.2]) with similar trends seen for antidepressants. Fluoxetine was the most frequently prescribed first-line antidepressant. Citalopram comprised less than 5% of first prescriptions in younger children but 22.9% (95% CI 22.0-23.8; 95% CI 2533) in 16–17-year-olds. Approximately half of new antidepressant prescribing was associated with depression. Segmented regression analysis showed that prescriptions of ‘all’ antidepressants, Fluoxetine and Sertraline were increasing before the guidance. This upward trend flattened for both ‘all’ antidepressants and Fluoxetine and steepened for Sertraline. Citalopram prescribing was decreasing significantly pre guidance being issued with no significant change afterward. Conclusions‘Targeted intervention is needed to address rising rates of depression in children. Practitioners are partially adhering to local and national guidance. The decision-making process behind prescribing choices is likely to be multi-factorial. Activities to support implementation of guidance should be adopted in relation to safety in prescribing of antidepressants in children including timely availability of talking therapies and specialist mental health services. Further research is needed to explore GPs' prescribing preferences.
published_date 2025-01-08T20:35:59Z
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