Over-diagnosed and over-treated: a survey of Australian public attitudes towards the acceptability of drug treatment for depression and ADHD

Abstract

BackgroundOver the last decade the use of psychotropic medications to treat common mental health problems has increased in Australia. This paper explores: 1) public attitudes towards the acceptability of using prescription drugs to treat depression and attention deficit hyperactivity disorder (ADHD), and 2) beliefs about over-diagnosis of depression and ADHD.Method1293 members of the general public were surveyed about their attitudes towards drug treatment for depression and ADHD through the Queensland Social Survey (QSS), an omnibus state-wide survey of households in the state of Queensland. The survey was administered through a CATI (computer-assisted telephone interviewing) system. Logistic regression analyses were used to predict belief that drug treatment is acceptable, and that depression and ADHD are over-diagnosed.ResultsMost participants (60.9%) said that it was acceptable to use prescription drugs to treat depression. In contrast, attitudes towards the use of prescription drugs to treat ADHD were much less positive with around the same proportion saying it was acceptable (42.1%) as unacceptable (38.2%). More than half of the sample agreed that too many people are diagnosed with depression when they don’t really have it (57.7%), and 78.3% of participants agreed that too many children are diagnosed with ADHD when they don’t really have it. Participants who said depression or ADHD were over-diagnosed were less likely to say that it is acceptable to treat these conditions with prescription drugs.ConclusionsDespite increases in prescribing rates there is still considerable scope for increasing the public’s acceptance of treating common mental illnesses with psychotropic drugs. Furthermore, the public’s views on over-diagnosis of depression and ADHD appear to reflect ongoing controversy about the proper identification of these conditions, and these views negatively impact attitudes towards drug treatment. This may be a barrier to effective treatment of these conditions given that drug treatment is often recommended as a first line response.

Prevalence of Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis

“…There is significant community 22 and professional 23 concern that ADHD is overdiagnosed. Some researchers 24 have argued that to determine if overdiagnosis of ADHD has occurred, a comparison of actual diagnoses with the prevalence estimate of a large-scale, well-conducted, national representative study would be suitable.…”

Factors Associated with Parental Treatment Attitudes and Information-Seeking Behaviors for Childhood ADHD

“…It may be beneficial to use this information when developing informational programs that aim to understand and increase treatment-seeking. For example, if parents understand that symptoms drive stigma more strongly than a diagnostic label, these parents may be more likely (Partridge, Lucke, & Hall, 2014). In addition, the public endorses the use of medication as less acceptable for ADHD than medication treatment for depression (Partridge, Lucke, & Hall, 2012;Partridge et al, 2014).…”

“…For example, if parents understand that symptoms drive stigma more strongly than a diagnostic label, these parents may be more likely (Partridge, Lucke, & Hall, 2014). In addition, the public endorses the use of medication as less acceptable for ADHD than medication treatment for depression (Partridge, Lucke, & Hall, 2012;Partridge et al, 2014). These public perceptions are important to consider when examining the context within which parents make treatment decisions as these public views negatively affect ADHD medication treatment attitudes (Partridge et al, 2014).…”

“…Parents of children with ADHD may fear public stigma about themselves or their children as well as harbor personal stigma about ADHD and its evidence-based treatments (Ahmed et al, 2013;Bussing et al, 2012;DosReis et al, 2010). These fears and attitudes as well as a lack of knowledge about treatments such as stimulants may lead to decreased acceptability ratings of medication for ADHD (Partridge et al, 2012(Partridge et al, , 2014Sciutto, 2015). Additionally, perception of childhood symptoms (e.g., externalizing vs. internalizing) as well as their own selfperceived parenting effectiveness affects what types of treatment parents prefer (Bennet et al, 1996).…”

Unmet needs in paediatric psychopharmacology: Present scenario and future perspectives

“…Reservations around medication treatment for ADHD have been expressed both in society at large and within the medical profession for many years (Ruel and Hickey, 1992;Zwi et al, 2000). On a broader scale, treating children and adolescents with psychotropic drugs has encountered growing resistance in many patient families and in society as a whole: the media have become increasingly critical about the use of medications in children and adolescents, particularly for psychiatric disorders (Thomas et al, 2013;Partridge et al, 2014); at least in some countries, parents tend to favour psychological treatments, cognitive training, or natural remedies (often not evidence-based) as a means of "steering away from pharmacology" more than was the case 10 years ago; society, media and even health professionals, including many paediatricians, have become more critical and cautious about medication effects on the developing brain.…”