Assistant professor Syddansk Universitet Odense, Denmark
Background: Psychotropics are commonly used in the pediatric population.
Objectives: We compared sex-specific prevalences of psychotropic medication use in youths between Denmark (DK) and the United States (US).
Methods: We did a cross-sectional study using data on filled prescriptions for the entire Danish pediatric population and for US commercially-insured pediatric enrollees from a 10% random sample of IQVIA PharMetrics® Plus for Academics. We estimated the annual prevalence from 2010-2020 as the proportion of psychotropic medication use in 3-17-year-old males and females in both countries. We included antipsychotics (excl. lithium), antidepressants, and Attention Deficit Hyperactivity Disorder (ADHD) medication (i.e., stimulants, atomoxetine). The male/female (M/F) prevalence ratio was calculated in each calendar year throughout the study period.
Results: Throughout the study period, the M/F prevalence ratio was higher in US compared to DK for antidepressants and antipsychotics, while it was lower for ADHD medication. Across drug classes and throughout the entire study period, the highest M/F ratio was observed for ADHD medication in both countries, but the ratio decreased more rapidly over time in DK (from 3.3 in 2010 to 2.5 in 2020) compared to US (from 2.3 to 2.2). In DK, the decreasing M/F ratio was due to a steeper increase in the prevalence of ADHD medication among females (57%) compared to males (17%). In US, the prevalence of ADHD medication increased 2.9% among females and decreased 3.0% among males resulting in an almost stable M/F ratio over time. The M/F ratio of antipsychotics decreased over time in both DK (from 1.6 to 1.0) and in US (from 2.0 to 1.4) due to a steeper decrease in antipsychotic prevalence among males compared to females in both countries. In DK, antipsychotic prevalence decreased 44% among males and 9.9% among females. In US, the prevalence decreased 43% among males and 18% among females. For antidepressants, the M/F ratio was stable in DK (from 0.5 to 0.6) and decreased in US (from 1.0 to 0.7). In DK, there was a decreasing prevalence of antidepressants among males (27%) and females (35%). In US, antidepressant prevalence increased 50% among males and 102% among females.
Conclusions: The M/F ratio in prevalence of psychotropic medication decreased or was stable over time in both countries with the greatest ratio observed for ADHD medication. The M/F ratio in the prevalence of antipsychotics decreased over time in both countries mainly due to a steeper decrease in prevalence among males compared to females. The prevalence of antidepressants over time showed opposite directions in US and DK, but the differences between males and females were almost similar towards the end of the study period.
