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Seasonal trends in antidepressant prescribing, depression, anxiety and self-harm in adolescents and young adults: an open cohort study using English primary care data
  1. Ruth H Jack1,
  2. Rebecca M Joseph1,
  3. Chris Hollis2,3,
  4. Julia Hippisley-Cox4,
  5. Debbie Butler3,
  6. Dave Waldram3,
  7. Carol Coupland1,4
  1. 1 Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
  2. 2 National Institute for Health and Care Research Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
  3. 3 National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
  4. 4 Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
  1. Correspondence to Dr Ruth H Jack, Centre for Academic Primary Care, Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK; ruth.jack{at}nottingham.ac.uk

Abstract

Background There is an increasing demand for mental health services for young people, which may vary across the year.

Objective To determine whether there are seasonal patterns in primary care antidepressant prescribing and mental health issues in adolescents and young adults.

Methods This cohort study used anonymised electronic health records from general practices in England contributing to QResearch. It included 5 081 263 males and females aged 14–18 (adolescents), 19–23 and 24–28 years between 2006 and 2019. The incidence rates per 1000 person-years and the incidence rate ratios (IRRs) were calculated for the first records of a selective serotonin reuptake inhibitor (SSRI) prescription, depression, anxiety and self-harm. The IRRs were adjusted for year, region, deprivation, ethnic group and number of working days.

Findings There was an increase in SSRI prescribing, depression and anxiety incidence in male and female adolescents in the autumn months (September–November) that was not seen in older age groups. The IRRs for SSRI prescribing for adolescents peaked in November (females: 1.75, 95% CI 1.67 to 1.83, p<0.001; males: 1.72, 95% CI 1.61 to 1.84, p<0.001, vs in January) and for depression (females: 1.29, 95% CI 1.25 to 1.33, p<0.001; males: 1.29, 95% CI 1.23 to 1.35, p<0.001). Anxiety peaked in November for females aged 14–18 years (1.17, 95% CI 1.13 to 1.22, p<0.001) and in September for males (1.19, 95% CI 1.12 to 1.27, p<0.001).

Conclusions There were higher rates of antidepressant prescribing and consultations for depression and anxiety at the start of the school year among adolescents.

Clinical implications Support around mental health issues from general practitioners and others should be focused during autumn.

  • child & adolescent psychiatry
  • depression & mood disorders
  • anxiety disorders
  • suicide & self-harm

Data availability statement

Data may be obtained from a third party and are not publicly available. Access to QResearch data is according to the information on the QResearch website (www.qresearch.org).

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Access to QResearch data is according to the information on the QResearch website (www.qresearch.org).

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Footnotes

  • Contributors All authors contributed to the study design and interpretation of the results, critically revised the manuscript, and approved the final version. RHJ prepared and analysed the data and vouches for the data and the analyses presented. RHJ drafted the original manuscript. The corresponding author attests that all listed authors meet the authorship criteria and that no others meeting the criteria have been omitted. The corresponding author is also the guarantor of this manuscript and accepts full responsibility for the work, had access to all the data and was responsible for the decision to publish.

  • Funding The study was funded by the National Institute for Health and Care Research School for Primary Care Research (NIHR SPCR) (grant reference number: 479) and supported by the NIHR Nottingham Biomedical Research Centre.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection, analyses and interpretation of data, writing of the report, or decision to submit the article for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.