Over the last 20 years there has been a dramatic increase in the number of children and young people who attended UK healthcare services with symptoms of poor mental health, and who were prescribed mental health medications. One possible explanation for this increase is that more children and young people are experiencing mental illness, but evidence from surveys suggests that this is unlikely to be the only explanation. It is possible that some young people are seeking and receiving help where previously their problems went unrecognised, or that for some children normal experiences are being over-medicalised. If the latter is true, this could mean they are exposed to harmful side effects of treatments with limited benefit.
Currently, we know little about which children and young people are attending GP surgeries with mental health problems and whether they receive appropriate treatment. We will investigate what treatments they received, and whether similar treatments were provided regardless of where they lived, their ethnicity, or the level of deprivation in their area. We will also examine how long their mental health difficulties lasted. Lastly, we will study whether antidepressant medications were, on average, effective for children with symptoms of depression, anxiety and self-harm.
Importantly, the study results will be helpful for determining how to direct resources to support children and young people with their mental health in a fair and effective manner. In addition, the results can help young people and their caregivers to make informed decisions about treatment.
Aim
To describe, in detail, the treatment and diagnostic profiles of children and young people (CYP) presenting to primary care with mental health problems; whether these are determined by key demographic characteristics; and to estimate the effectiveness of prescribing in CYP.
Exposures
Primary and secondary care contacts with symptoms of: anxiety, depression, psychosis, autism, ADHD, substance/alcohol problems, eating or personality disorders. Treatment with psychotropic medications and referrals to mental health services.
Methods
We shall address this aim using three stages. First, we shall re-investigate trends in CYP mental health presentations to primary care by key demographic subgroups of age, gender, ethnicity, and deprivation. We shall contrast these with trends from high-quality, national surveys to ascertain whether there is evidence that CYP in some groups are increasingly likely to be treated for the same level of mental health symptoms.
During the second stage, we shall investigate treatments for those CYP who present with mental health symptoms to primary care. This shall be investigated for specific time periods from CYP’s first contact with services. We shall investigate how demographics (such as ethnicity) affect the likelihood that CYP receive psychotropic medications using Poisson regression models, adjusting for potential confounders.
During the final stage, we shall examine the effectiveness of antidepressant prescribing in CYP first presenting to primary care with symptoms of depression, anxiety or having self-harmed. Two study designs will be used to triangulate information and improve the robustness of our results. The first will be using the primary care data to emulate a trial, using pre-specified inclusion and exclusion criteria. Observed confounding will be accounted for using propensity score models. The second will use GP prescribing preference in an instrumental variable analysis in an attempt to account for unobserved confounding.
Contacts in primary or secondary care services with mental health problems, using clinical codes relating to: diagnoses; symptoms; referrals to specialist mental health services; psychotropic medications.
Mental health problems will be defined using the categories: depression; anxiety; psychosis (affective and non-affective); substance or alcohol misuse; eating disorder; personality disorder; self-harm; autism spectrum disorders (ASD); and attention deficit hyperactivity disorder (ADHD); death by suicide.
Matthias Pierce - Chief Investigator - University of Manchester
Matthias Pierce - Corresponding Applicant - University of Manchester
Holly Hope - Collaborator - University of Manchester
Kathryn Abel - Collaborator - University of Manchester
Morwenna Senior - Collaborator - University of Manchester
Paraskevi Taxiarchi - Collaborator - University of Manchester
Morwenna Senior - Collaborator - University of Manchester
HES Admitted Patient Care;HES Outpatient;ONS Death Registration Data;Patient Level Index of Multiple Deprivation;Practice Level Index of Multiple Deprivation