Evidence map›Paper›PMID 32349753›Full record

ArticleBMC medicine2020

Secondary care specialist visits made by children and young people prescribed antidepressants in primary care: a descriptive study using the QResearch database.

Ruth H Jack, Rebecca M Joseph, Carol Coupland, Debbie Butler, Chris Hollis, Richard Morriss, Roger David Knaggs, Andrea Cipriani, Samuele Cortese, Julia Hippisley-Cox

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
0.7field-weighted citation impact, top 19% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 9 citations in OpenAlex.

  1. Article
  2. Article
  3. Article
  4. Antidepressants in adolescence.Australian prescriber · 2022
    Review
  5. Article
  6. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 1 country.

Ruth H JackDivision of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK. ruth.jack@nottingham.ac.uk.ORCID https://orcid.org/0000-0003-4009-020X
Rebecca M JosephDivision of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK.ORCID https://orcid.org/0000-0002-0147-0712
Carol CouplandDivision of Primary Care, School of Medicine, University of Nottingham, Nottingham, UK.ORCID https://orcid.org/0000-0002-2327-3306
Debbie ButlerNational Institute of Health Research MindTech MedTech Co-operative, The Institute of Mental Health, University of Nottingham, Nottingham, UK.
Chris HollisNational Institute of Health Research MindTech MedTech Co-operative, The Institute of Mental Health, University of Nottingham, Nottingham, UK.ORCID https://orcid.org/0000-0003-1083-6744
Richard MorrissNational Institute of Health Research MindTech MedTech Co-operative, The Institute of Mental Health, University of Nottingham, Nottingham, UK.ORCID https://orcid.org/0000-0003-2910-4121
Roger David KnaggsSchool of Pharmacy, University of Nottingham, Nottingham, UK.ORCID https://orcid.org/0000-0003-1646-8321
Andrea CiprianiDepartment of Psychiatry, University of Oxford, Oxford, UK.ORCID https://orcid.org/0000-0001-5179-8321
Samuele CorteseDivision of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.ORCID https://orcid.org/0000-0001-5877-8075
Julia Hippisley-CoxNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.ORCID https://orcid.org/0000-0002-2479-7283
University of Nottingham · GBNottingham University Hospitals NHS Trust · GBOxford Health NHS Foundation Trust · GBUniversity of Oxford · GB

Funding

Department of Health RP-2017-08-ST2-006National Institute for Health Research NIHR Nottingham Biomedical Research Centre [IS-BRC-1215-20003]National Institute for Health Research NIHR Oxford Health Biomedical Research Centre [BRC-1215-20005]National Institute for Health Research RP-2017-08-ST2-006
6 · The paper itself

Abstract

backgroundAntidepressants may be used to manage a number of conditions in children and young people including depression, anxiety, and obsessive-compulsive disorder. UK guidelines for the treatment of depression in children and young people recommend that antidepressants should only be initiated following assessment and diagnosis by a child and adolescent psychiatrist. The aim of this study was to summarise visits to mental health specialists and indications recorded around the time of antidepressant initiation in children and young people in UK primary care.

methodsThe study used linked English primary care electronic health records and Hospital Episode Statistics secondary care data. The study included 5-17-year-olds first prescribed antidepressants between January 2006 and December 2017. Records of visits to paediatric or psychiatric specialists and potential indications (from a pre-specified list) were extracted. Events were counted if recorded less than 12 months before or 6 months after the first antidepressant prescription. Results were stratified by first antidepressant type (all, selective serotonin reuptake inhibitors (SSRIs), tricyclic and related antidepressants) and by age group (5-11 years, 12-17 years).

resultsIn total, 33,031 5-17-year-olds were included. Of these, 12,149 (37%) had a record of visiting a paediatrician or a psychiatric specialist in the specified time window. The majority of recorded visits (7154, 22%) were to paediatricians. Of those prescribed SSRIs, 5463/22,130 (25%) had a record of visiting a child and adolescent psychiatrist. Overall, 17,972 (54%) patients had a record of at least one of the pre-specified indications. Depression was the most frequently recorded indication (12,501, 38%), followed by anxiety (4155, 13%).

conclusionsThe results suggest many children and young people are being prescribed antidepressants without the recommended involvement of a relevant specialist. These findings may justify both greater training for GPs in child and adolescent mental health and greater access to specialist care and non-pharmacological treatments. Further research is needed to explore factors that influence how and why GPs prescribe antidepressants to children and young people and the real-world practice barriers to adherence to clinical guidelines.

Indexed as

AdolescentAntidepressive AgentsChildDatabases, FactualFemaleHumansMalePrimary Health CareResearch DesignSecondary Health CareSpecializationAntidepressive AgentsAdolescentAntidepressantsAnxietyChildDepressionEpidemiologyMental healthPrimary health careSSRIs

Identifiers

PMID32349753
PMCPMC7191694
OpenAlexW3022601201

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.