A three-country comparison of psychotropic medication prevalence in youth

Abstract

BackgroundThe study aims to compare cross-national prevalence of psychotropic medication use in youth.MethodsA population-based analysis of psychotropic medication use based on administrative claims data for the year 2000 was undertaken for insured enrollees from 3 countries in relation to age group (0–4, 5–9, 10–14, and 15–19), gender, drug subclass pattern and concomitant use. The data include insured youth aged 0–19 in the year 2000 from the Netherlands (n = 110,944), Germany (n = 356,520) and the United States (n = 127,157).ResultsThe annual prevalence of any psychotropic medication in youth was significantly greater in the US (6.7%) than in the Netherlands (2.9%) and in Germany (2.0%). Antidepressant and stimulant prevalence were 3 or more times greater in the US than in the Netherlands and Germany, while antipsychotic prevalence was 1.5–2.2 times greater. The atypical antipsychotic subclass represented only 5% of antipsychotic use in Germany, but 48% in the Netherlands and 66% in the US. The less commonly used drugs e.g. alpha agonists, lithium and antiparkinsonian agents generally followed the ranking of US>Dutch>German youth with very rare (less than 0.05%) use in Dutch and German youth. Though rarely used, anxiolytics were twice as common in Dutch as in US and German youth. Prescription hypnotics were half as common as anxiolytics in Dutch and US youth and were very uncommon in German youth. Concomitant drug use applied to 19.2% of US youth which was more than double the Dutch use and three times that of German youth.ConclusionProminent differences in psychotropic medication treatment patterns exist between youth in the US and Western Europe and within Western Europe. Differences in policies regarding direct to consumer drug advertising, government regulatory restrictions, reimbursement policies, diagnostic classification systems, and cultural beliefs regarding the role of medication for emotional and behavioral treatment are likely to account for these differences.

Drug utilization patterns of antidepressants in Federal Neuro-Psychiatric Hospital Lagos, Nigeria

“…In contrast to the findings of this study, SSRIs were the most frequently prescribed drugs in studies carried out in Asia, Europe, North America and India [3,14,15,21,[31][32][33][34] with decreased use of TCAs. Factors such as differences in culture, practice, promotional activity [32,35,36] and national income [37] contribute to these regional differences.…”

International variation in the usage of medicines: A review of the literature

“…(Table 1). 9 They found relatively modest cross-national differences in the prevalence of total anti-psychotics (from 0.34 per 100 youth in Germany to 0.76 per 100 youth in the United States), but the proportion of AAPs in relation to total anti-psychotic use was much lower in Germany (5 per cent) than in the two comparator countries (48 per cent in the Netherlands and 66 per cent in the United States). The authors discussed a number of factors that might explain observed variations in psychotropic medication in young people in the three countries although they did not distinguish factors specifically related to AAP use.…”

“…Indeed, most studies reviewed here pointed to differences in access to specialists as a likely driver of international variation in areas such as atypical anti-psychotics, 9 dementia, 14 15 and rheumatic arthritis. 18 For example, studies highlighted that there is great variation among European countries in whether or not GPs are authorised to initiate and/or continue dementia treatment initiated by specialists.…”

“…Potential explanatory factors put forward include differences in diagnostic classification between the United States (using Diagnostic and Statistical Manual (DSM) criteria) and European countries (application of the International Classification of Diseases version 10); higher prevalence of concomitant use of two or more medications in the United States; and access to specialists such as child psychiatrists, which tended to be lower in European countries; however, the authors did not provide empirical evidence in support of this discussion. 9 Four studies analysed cross-national variation in AAP use among selected, psychiatric (in)patient populations in different countries, usually focusing on prescription patterns. Thus, Hübner-Liebermann et al (2005) compared inpatient treatment of patients with schizophrenia in two hospitals in Germany and Japan, using data from the psychiatric basic documentation system in 1997.…”

Rising antipsychotic prescriptions for children and youth: cross-sectoral solutions for a multimodal problem

“…[1][2][3][4][5] According to Canadian pharmacoepidemiologic data, antipsychotic medications have been prescribed for the treatment of attentiondeficit/hyperactivity disorder (17%), mood and conduct disorders (14%-16%) and psychosis (13%) in young people. 4 Currently, aripiprazole, a second-generation antipsychotic drug, is approved in Canada for the treatment of bipolar I disorder (manic or mixed episodes) in youth 13-17 years old and for schizophrenia in those 15-17 years old. In the United States, the Food and Drug Administration has approved a number of secondgeneration antipsychotic medications for the treatment of bipolar disorder, schizophrenia, and irritability (in the context of autism) in youth.…”