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

Jack, Ruth H.; Joseph, Rebecca M.; Coupland, Carol; Butler, Debbie; Hollis, Chris; Morriss, Richard; Knaggs, Roger David; Cipriani, Andrea; Cortese, Samuele; Hippisley-Cox, Julia

Abstract

© 2020 The Author(s). Background: Antidepressants 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. Methods: The 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). Results: In 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%). Conclusions: The 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.

Citation

Jack, R. H., Joseph, R. M., Coupland, C., Butler, D., Hollis, C., Morriss, R., …Hippisley-Cox, J. (2020). Secondary care specialist visits made by children and young people prescribed antidepressants in primary care: A descriptive study using the QResearch database. BMC Medicine, 18(1), Article 93. https://doi.org/10.1186/s12916-020-01560-7

• Journal Article Type: Article
• Acceptance Date: Mar 16, 2020
• Online Publication Date: Apr 30, 2020
• Publication Date: Apr 30, 2020
• Deposit Date: Mar 18, 2020
• Publicly Available Date: Apr 30, 2020
• Journal: BMC Medicine
• Electronic ISSN: 1741-7015
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 18
• Issue: 1
• Article Number: 93
• DOI: https://doi.org/10.1186/s12916-020-01560-7
• Keywords: General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/4163694
• Publisher URL: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01560-7
• Additional Information: Received: 26 November 2019; Accepted: 16 March 2020; First Online: 30 April 2020; : The study used anonymised data provided by QResearch and NHS Digital. The project has been reviewed in accordance with the QResearch agreement with East Midlands Derby Research Ethics Committee [reference 18/EM/0400].; : Not applicable; : CH was the chair of the NICE guideline for psychosis in children and young people (CG155) and a member of the NICE ADHD Guideline update committee (NG87).SC has received honoraria for talks/lectures from the Association for Child and Adolescent Mental Health (ACAMH), British Association of Psychopharmacology (BAP), Canadian ADHD Alliance Resource (CADDRA), and Healthcare Convention.JHC is a professor of clinical epidemiology and general practice at the University of Oxford and co-director of QResearch®—a not-for-profit organisation which is a joint partnership between the University of Oxford and Egton Medical Information Systems (the leading commercial supplier of IT for 60% of general practices in the UK). JHC was also a paid director of ClinRisk Ltd. which produces open and closed source software to ensure the reliable and updatable implementation of clinical risk equations within clinical computer systems to help improve patient care.RHJ, RMJ, CC, DB, RM, RDK, and AC declare that they have no competing interests.