Medicalisation of young minds: new study reveals 28% rise in antidepressant prescribing amongst 6-18 year olds « Swansea University

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Antidepressant prescribing amongst children and young people has shown a significant increase of 28% in the past decade, even though recorded diagnoses of depression have gone down, according to new research published today.

One in ten children and young people suffer from some kind of mental health problem, including depression and anxiety. Concerns about under-diagnosis and under-treatment contrast with worries about over-prescribing and the medicalisation of unhappiness in young people.

The research, published in Psychological Medicine, and carried out by a team which included several Swansea University experts, was led by Ann John, associate professor at Swansea University Medical School, who is also a qualified GP. The team looked at data from 358,000 registered patients between 6 and 18 years old, living in Wales, UK, between 2003 and 2013. The data was drawn from GPs and other NHS primary care services.

The research found that:
• Antidepressant prescribing rose significantly, by 28%, mainly in older adolescents
• Depression diagnoses showed a steady decline by just over a quarter, while symptoms of depression more than doubled
• Unlicensed citalopram prescribing occurs outside current guidelines, despite its known toxicity in overdose
• Just over half of new antidepressant prescriptions were associated with depression. The rest were associated with diagnoses such as anxiety and pain

The findings led the researchers to call for new strategies to implement current guidance for managing depression in children and young people.

Dr Ann John, associate professor at Swansea University Medical School, said: “These findings add to the growing debate over increasing prescribing of anti-depressants to children and young people.

The main issue is whether they being prescribed with enough cause. The rise in prescribing may reflect a genuine increase in depression and its symptoms, or increased awareness and better treatment by GPs, or poor access to psychological therapies and specialist care, or even increased help-seeking.

Whatever the explanation it’s important that each individual young person is listened to and gets the right kind of help for their problem. We need to support those who support young people and their families, helping them to act in keeping with current guidance.”

Dr John underlined the importance of responding appropriately to the needs of young people:

“The teenage years are a phase of gaining independence, engaging with the world and testing boundaries. This can result in a normal developmental range of emotional responses- stress, loneliness, sadness and frustration. For others the mental health issues are more serious, and historically they were often not recognised, talked about or treated.

Teenagers may be moving into adulthood without many of the skills necessary to deal with these issues if we don’t manage them well at an early age.

It can be hard to distinguish between what is emotional turmoil and what warrants a mental health diagnosis in a young person.

We need to ensure GPs are trained to really understand the lives and moods of young people, as well as knowing what warning signs they should look out for. For some young people reassurance that this is within the range of normal human experience may be appropriate. For others, talking therapies may be the best option, as they have a proven track record of improving symptoms for those with mild and moderate depression.
In more serious cases, anti-depressants should be used together with talking therapies. Improving access to talking therapies is very important. Otherwise, if waiting times are too long, it’s more likely that a prescription will be given. If an antidepressant is required, fluoxetine should be the first option.”

via Swansea University – Medicalisation of young minds: new study reveals 28% rise in antidepressant prescribing amongst 6-18 year olds

The full paper, published in Psychological Medicine, “Recent trends in primary-care antidepressant prescribing to children and young people: an e-cohort study” by A. John, A. L. Marchant, D. L. Fone, J. I. McGregor, M. S. Dennis, J. O. A. Tan and K. Lloyd has been published Open Access and can be viewed here free of charge.

Rising risk of obesity among China’s ‘left behind children’

Boys in Rural ChinaThe December Nutrition Society paper of the month, is from Public Health Nutrition and is entitled, ‘A multi-level analysis of the relationship between parental migration and left-behind children’s macronutrient intakes in rural China.’

Some 61 million rural children left behind by parents moving to China’s booming urban centres are at risk from increased fat and reduced protein in their diets.

The study of 975 children from 140 rural villages in nine provinces carefully analysed nutritional intake and showed a particular risk to boys who were left behind in the care of grandparents or a mother who sought work away from home.

There are sound financial reasons why so many people move from rural to urban areas in China, but the benefits that more money brings to a family can often be at the expense of child nutrition. The Chinese government needs to recognise this growing problem among rural communities and this research provides some evidence to target health policies on encouraging a balanced diet.

The study finds that ‘left behind’ boys in particular consumed more fat and less protein than those from complete families, which potentially leaves them at increased risk of obesity and stunted growth. This has important policy implications in a specific cultural-context where son preferences are powerful.

Although the results of the study don’t provide reasons for this change in diet, we speculate that mothers moving away from home generally earn less, and that these lower earnings act in combination with grandparents’ poorer dietary knowledge or willingness to spend more on food.

Another factor at work could be that prices of protein-based foods such as eggs and meat have increased faster than many households’ incomes – meaning that even though money is being sent home from one or both parents, nutrition doesn’t always improve.

The process of parental migration is complex and the reasons for problems in boys’ nutrition are not straightforward, however we can see that both parents and grandparents in rural areas need to be educated about good diet.

Because raising children can fall on all members of the family, good care-giving practice needs to become more widespread.

The paper, ‘A multi-level analysis of the relationship between parental migration and left-behind children’s macronutrient intakes in rural China,’ was published in the journal, Public Health Nutrition and is available to read in full at http://journals.cambridge.org/ns/dec15

Authors Nan Zhang, Laia Bécares and Tarani Chandola

Funding- Economic and Social Research Council (ESRC) Postgraduate Scholarship

Causes of Death among the Young

Blog Post by Nisha Doshi, Editorial, Cambridge University Press

On 11th September 2009, the World Health Organization (WHO) announced the findings of their investigation into the leading causes of death among young people. This was the first study of global mortality patterns among those aged 10-24, and its results indicate that road accidents, suicide, complications during childbirth and pregnancy, violence, HIV/AIDS and tuberculosis are the principal causes of death.

In the light of this study, readers may be particularly interested in Roger Byard’s Sudden Death in Infancy, Childhood and Adolescence, the second edition of which was published in 2004 and the third edition is scheduled to be published in 2010. Highly illustrated with more than 800 colour figures, this third edition contains new sections on sexual abuse, pregnancy-related deaths and rare natural diseases, as well as expanded coverage of unexpected death in young adults up to the age of 30 years. Chapters cover all aspects of natural death, as well as accidents, suicides and homicides.

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