PhD student University of Maryland School of Pharmacy, Baltimore, Maryland, USA University of Maryland School of Pharmacy Baltimore Baltimore City, United States
Background: Psychotropic medication use among youths has increased in many countries. Few cross-national studies have compared age differences in psychotropic use.
Objectives: To compare age differences in psychotropic prevalence among youths in the US and Denmark (DK).
Methods: We conducted a population-based study of annual psychotropic prevalence from 2010-2020 among youths 3-17 years-old in each study year. The US population was derived from a 10% random sample of the IQVIA PharMetrics® Plus for Academics database representing the commercially insured US national population. The DK population included all Danish children and was coupled to data from the Danish National Prescription Registry. Age-stratified groups were 3–4, 5–9, 10–13, 14–17 years-old. Psychotropic classes included attention-deficit/hyperactivity disorder (ADHD) medications (i.e., stimulants, atomoxetine), antidepressants, and antipsychotics. Relative change in prevalence ratios of older/younger youths (reference: 5-9 years-old) was evaluated for each study year in both countries.
Results: Of the 127,893 US and 66,840 DK youths with at least one psychotropic medication from 2010-2020, 73% (US) and 80% (DK) were ≥ 10 years-old. Overall psychotropic prevalence was approximately 6% in the US and 2% in DK in each study year. In both countries, the 2010-2020 overall psychotropic prevalence decreased for ages 5-9, remained stable for ages 10-13, and increased for ages 14-17. Across ages 5-17 years, ADHD medication prevalence was 2-3 times higher and antipsychotic prevalence was 2-5 times higher in the US than DK. Antidepressant prevalence was markedly higher in the US than DK, 30 times in 5-9 years-old, 15 times in 10-13 years-old, and 7 times in 14-17 years-old. Psychotropic prevalence ratios for 10-13/5-9 and 14-17/5-9, respectively, increased in the US (2010: 2.0 and 2.3; 2020: 2.5 and 3.9) and DK (2010: 2.5 and 3.8; 2020: 3.6 and 5.5). ADHD medication prevalence ratios grew slightly in the US (2010: 1.9 and 1.7; 2020: 2.3 and 2.3) and almost doubled in DK (2010: 2.3 and 2.2; 2020: 3.5 and 4.2). The 14-17/5-9 antidepressant prevalence ratios increased from 6.9 in 2010 to 11.9 in 2020 in the US and from 34.0 in 2010 to 39.8 in 2020 in DK. The 14-17/5-9 antipsychotic prevalence ratios doubled in the US from 2.8 in 2010 to 5.6 in 2020 and more than doubled in DK from 8.3 in 2010 to 18.6 in 2020. Smaller prevalence ratio differences for 10-13/5-9 were observed for antidepressant and antipsychotic from 2010 to 2020.
Conclusions: Psychotropic prevalence overall and by class was higher in the US than in DK across all age groups. The prevalence ratio increases reflected lower use among younger children relative to adolescents, which was consistent across countries.
