School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada; Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong, China; The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China.
The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China; School of Public Health, Shenzhen University Medical School, Shenzhen University, Shenzhen, Guangdong, China.
Lancet Psychiatry. 2024 Oct;11(10):807-817. doi: 10.1016/S2215-0366(24)00245-1. Epub 2024 Sep 3.
People with mental health conditions were potentially more vulnerable than others to the neuropsychiatric effects of the COVID-19 pandemic and the global efforts taken to contain it. The aim of this multinational study was to examine the changes in psychotropic drug prescribing during the pandemic among people with depressive and anxiety disorders.
This study included electronic medical records and claims data from nine databases in six countries (France, Germany, Italy, the UK, South Korea, and the USA) of patients with a diagnosis of depressive or anxiety disorders between 2016 and 2021. The outcomes were monthly prevalence rates of antidepressant, antipsychotic, and anxiolytic drug prescribing. The associations between the pandemic and psychotropic drug prescribing were examined with interrupted time series analyses for the total sample and stratified by sex and age group. People with lived experience were not involved in the research and writing process.
Between Jan 1, 2016 and Dec 31, 2020, an average of 16 567 914 patients with depressive disorders (10 820 956 females [65·31%] and 5 746 958 males [34·69%]) and 15 988 451 patients with anxiety disorders (10 688 788 females [66·85%] and 5 299 663 males [33·15%]) were identified annually. Most patients with depressive disorders and anxiety disorders were aged 45-64 years. Ethnicity data were not available. Two distinct trends in prescribing rates were identified. The first pattern shows an initial surge at the start of the pandemic (eg, antipsychotics among patients with depressive disorders in MDCD_US (rate ratio [RR] 1·077, 95% CI 1·055-1·100), followed by a gradual decline towards the counterfactual level (RR 0·990, 95% CI 0·988-0·992). The second pattern, observed in four databases for anxiolytics among patients with depressive disorders and two for antipsychotics among patients with anxiety disorders, shows an immediate increase (eg, antipsychotics among patients with anxiety disorders in IQVIA_UK: RR 1·467, 95% CI 1·282-1·675) without a subsequent change in slope (RR 0·985, 95% CI 0·969-1·003). In MDCD_US and IQVIA_US, the anxiolytic prescribing rate continued to increase among patients younger than 25 years for both disorders.
The study reveals persistently elevated rates of psychotropic drug prescriptions beyond the initial phase of the pandemic. These findings underscore the importance of enhanced mental health support and emphasise the need for regular review of psychotropic drug use among this patient group in the post-pandemic era.
University Grants Committee, Research Grants Council, The Government of the Hong Kong Special Administrative Region.
与其他人相比，患有精神健康状况的人更容易受到 COVID-19 大流行及其全球防控措施的神经精神影响。本多国研究旨在考察大流行期间抑郁和焦虑障碍患者精神药物处方的变化。
本研究纳入了来自六个国家（法国、德国、意大利、英国、韩国和美国）的九个数据库的电子病历和理赔数据，纳入了 2016 年至 2021 年间被诊断为抑郁或焦虑障碍的患者。结果是抗抑郁药、抗精神病药和抗焦虑药的每月患病率。采用截断时间序列分析对总样本以及按性别和年龄组分层的人群进行了大流行与精神药物处方之间的关联分析。有过患病经历的人没有参与研究和写作过程。
2016 年 1 月 1 日至 2020 年 12 月 31 日，每年平均有 16567914 名抑郁障碍患者（10820956 名女性[65.31%]和 5746958 名男性[34.69%]）和 15988451 名焦虑障碍患者（10688788 名女性[66.85%]和 5299663 名男性[33.15%]）被确诊。大多数抑郁障碍和焦虑障碍患者的年龄在 45-64 岁之间。种族数据不可用。确定了两种不同的处方率趋势。第一种模式显示大流行开始时出现了最初的激增（例如，在 MDCD_US 中，抗精神病药治疗抑郁障碍患者的比率[RR]为 1.077，95%CI 为 1.055-1.100），随后逐渐降至基准水平（RR 0.990，95%CI 为 0.988-0.992）。第二种模式在四个数据库中观察到了抗抑郁药治疗抑郁障碍患者的即刻增加，在两个数据库中观察到了抗精神病药治疗焦虑障碍患者的即刻增加，表明没有随后的斜率变化（RR 0.985，95%CI 为 0.969-1.003）。在 MDCD_US 和 IQVIA_US，两种疾病的 25 岁以下患者的抗焦虑药处方率继续增加。
该研究揭示了大流行初期过后，精神药物处方率持续升高。这些发现强调了加强心理健康支持的重要性，并强调了在大流行后时期，需要定期审查这一患者群体的精神药物使用情况。
大学教育资助委员会、研究资助局、香港特别行政区政府。
