Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Department of Child Health, University of Aberdeen, Aberdeen, UK.
Int J Epidemiol. 2020 Aug 1;49(4):1380-1391. doi: 10.1093/ije/dyaa002.
Childhood depression is relatively common, under-researched and can impact social and cognitive function and self-esteem.
Record linkage of routinely collected Scotland-wide administrative databases covering prescriptions [prescribing information system (PIS)], hospitalizations (Scottish Morbidity Records 01 and 04), maternity records (Scottish Morbidity Records 02), deaths (National Records of Scotland), annual pupil census, school absences/exclusions, special educational needs (Scottish Exchange of Educational Data; ScotXed), examinations (Scottish Qualifications Authority) and (un)employment (ScotXed) provided data on 766 237 children attending Scottish schools between 2009 and 2013 inclusively. We compared educational and health outcomes of children receiving antidepressant medication with their peers, adjusting for confounders (socio-demographic, maternity and comorbidity) and explored effect modifiers and mediators.
Compared with peers, children receiving antidepressants were more likely to be absent [adjusted incidence rate ratio (IRR) 1.90, 95% confidence interval (CI) 1.85-1.95] or excluded (adjusted IRR 1.48, 95% CI 1.29-1.69) from school, have special educational needs [adjusted odds ratio (OR) 1.77, 95% CI 1.65-1.90], have the lowest level of academic attainment (adjusted OR 3.00, 95% CI 2.51-3.58) and be unemployed after leaving school (adjusted OR 1.88, 95% CI 1.71-2.08). They had increased hospitalization [adjusted hazard ratio (HR) 2.07, 95% CI 1.98-2.18] and mortality (adjusted HR 2.73, 95% CI 1.73-4.29) over 5 years' follow-up. Higher absenteeism partially explained poorer attainment and unemployment. Treatment with antidepressants was less common among boys than girls (0.5% vs 1.0%) but the associations with special educational need and unemployment were stronger in boys.
Children receiving antidepressants fare worse than their peers across a wide range of education and health outcomes. Interventions to reduce absenteeism or mitigate its effects should be investigated.
儿童抑郁症较为常见，但研究不足，可能会影响社交和认知功能以及自尊心。
记录苏格兰范围内的常规行政数据库（涵盖处方[处方信息系统（PIS）]、住院治疗（苏格兰发病记录 01 和 04）、产妇记录（苏格兰发病记录 02）、死亡（苏格兰国家记录）、年度学生普查、学校缺勤/开除、特殊教育需求（苏格兰教育数据交换；ScotXed）、考试（苏格兰资格管理局）和（失业）（ScotXed））的数据，纳入了 2009 年至 2013 年期间在苏格兰学校就读的 766 237 名儿童。我们比较了接受抗抑郁药物治疗的儿童与同龄人的教育和健康结果，调整了混杂因素（社会人口统计学、产妇和合并症），并探讨了调节因素和中介因素。
与同龄人相比，接受抗抑郁药物治疗的儿童更有可能缺课[调整后的发病率比（IRR）1.90，95%置信区间（CI）1.85-1.95]或被开除（调整后的 IRR 1.48，95%CI 1.29-1.69），有特殊教育需求[调整后的优势比（OR）1.77，95%CI 1.65-1.90]，学业成绩最低（调整后的 OR 3.00，95%CI 2.51-3.58），毕业后失业（调整后的 OR 1.88，95%CI 1.71-2.08）。他们在 5 年的随访中住院治疗[调整后的风险比（HR）2.07，95%CI 1.98-2.18]和死亡率（调整后的 HR 2.73，95%CI 1.73-4.29）增加。更高的缺勤率部分解释了较差的学业成绩和失业。与女孩（0.5%比 1.0%）相比，男孩接受抗抑郁药物治疗的比例较低，但与特殊教育需求和失业的关联在男孩中更强。
接受抗抑郁药物治疗的儿童在广泛的教育和健康结果方面表现不如同龄人。应调查减少缺勤或减轻其影响的干预措施。
