Dispensing of Psychotropic Medications in Australia between 2013 and 2022
Osvaldo P. Almeida, PhD (https://orcid.org/0000-0002-8689-6199)
Medical School, University of Western Australia, Perth, Australia.
Christopher Etherton-Beer, PhD (https://orcid.org/0000-0001-5148-0188)
Medical School, University of Western Australia, Perth, Australia.
Frank Sanfilippo, PhD (https://orcid.org/0000-0003-3639-0787)
School of Population and Global Health, University of Western Australia, Perth, Australia
David B. Preen, PhD (https://orcid.org/0000-0002-2982-2169)
School of Population and Global Health, University of Western Australia, Perth, Australia
Amy Page, PhD ( https://orcid.org/0000-0002-2084-8469)
School of Allied Health, University of Western Australia, Perth, Australia
Running title : Psychotropics in Australia
Word count : 1467
References : 15
Tables : 1
Figures : 1
Correspondence : Prof. Osvaldo P. Almeida, WA Centre for Health & Ageing (M577), University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia. E: osvaldo.almeida@uwa.edu.au
ACKNOWLEDGEMENTS
We thank Services Australia for granting us access to the data described in this report.
AUTHOR CONTRIBUTION
OPA conceived the study, analysed the data, and drafted the initial version of the manuscript. All authors contributed to obtaining funding for this project. AP prepared the data for analyses. OPA analysed the data for this study and completed the initial draft of the manuscript. All authors reviewed the paper and contributed to the drafting of the final version. All authors approved the final version of the paper for submission to the journal.
DATA AVAILABILITY
The 10% PBS data are available from Services Australia (https://www.servicesaustralia.gov.au).
FUNDING STATEMENT
This research was funded through infrastructure grants from the WA Department of Health to OPA, CEB, FS and DP.
INFORMED CONSENT
The University of Western Australia Human Research Ethics Committee approved and oversaw the conduction of the study.
ETHICAL STATEMENT
All activities of this study were conducted in accordance with the Declaration of Helsinki.
CONFLICT OF INTEREST STATEMENT
CBE is a member of the Drug Utilisation Sub-Committee of the Pharmaceutical Benefits Advisory Committee, but the contents of this publication are responsibility of the authors alone. The authors declare no other interests.
ABSTRACT
Purpose : To determine the proportion of Australians dispensed psychotropic medications between 2013 and 2022 according to their age.
Methods : Services Australia provided a de-identified 10% random Pharmaceutical Benefits Scheme (PBS) sample that allowed us to determine the proportion of Australians dispensed at least one script per year for the use of antipsychotics, antidepressants, anxiolytics, and hypnotics. The classification of medications followed Anatomical Therapeutic Chemical (ATC) coding. Participants were stratified into 10-year age groups from 0-9 to ≥90 years, and sex was coded as male/female. We used logit models to analyse the data.
Results : The number of records per year ranged from 1,540,520 to 1,746,402, and 54.10% were for females. A greater proportion of older adults, particularly those aged ≥70 years, were dispensed antipsychotics, antidepressants, anxiolytics, and hypnotics than any other age-group. The proportion of people dispensed antipsychotics, anxiolytics, and hypnotics declined between 2013 and 2022, but increased for antidepressants, most markedly for adolescents and young adults. Females were more frequently dispensed antidepressants, anxiolytics, and hypnotics than males, but males were more frequently dispensed antipsychotics than females.
Conclusions : Older age groups and females are the most frequent recipients of psychotropic medications dispensed in Australia. The organisation and resourcing of health services should reflect this reality.
Keywords : antipsychotic, antidepressant, anxiolytic, hypnotic, prevalence, epidemiology, age.
KEY POINTS
PLAIN LANGUAGE SUMMARY
Information about the dispensing of medications offers helpful insights into the health of the population. We used a 10% random sample of the Australian Pharmaceutical Benefits Scheme to examine the patterns of dispensing of medications commonly used to manage mental disorders for individuals aged 0-9, 10-19, 20-29, 30-39, 40-49, 50-59, 60-69, 70-70, 80-89, and ≥90 years. We found that the dispensing of antipsychotics, antidepressants, anxiolytics, and hypnotics increased with age and was particularly high among individuals older than 70 years. More men than women were dispensed antipsychotics, but more women than men were dispensed antidepressants, anxiolytics and hypnotics between 2013 and 2022. The dispensing of antipsychotics, anxiolytics and hypnotics declined with time between 2013 and 2022, but increased for antidepressants after 2019, most markedly for people aged 10 to 39 years. These data suggest that psychological and behavioural symptoms affect a disproportionate number of older adults, while temporal changes in the pattern of use of antidepressants after 2019 implies that the mood of adolescents and young adults may have been more affected by the COVID19 pandemic than other age groups.
1 | INTRODUCTION
An increasing number of people are exposed to psychotropic medications every year,1 with recent released data showing that 1 in every 6 Australians filled a script for a mental health disorder in the 2020-2021 financial year.2 There is also evidence that the proportion of individuals dispensed certain psychotropic medications, such as antidepressants, has been increasing among adolescents and young adults, although people aged ≥45 years continue to be the most frequent consumers of antidepressants and other psychotropic medications.3,4
Data about the dispensing of psychotropic medications offer indirect information about the mental health of the population, as well as about health service use and needs. Recent reports have been mostly limited to specific classes of medications (such as antidepressants), or to particular age-groups (e.g., adolescents), making it difficult to draw conclusions about the overall pattern of psychotropic use of the entire population. In addition, limiting the reporting of data to the proportion of people using a certain class of medications may lead to inaccurate conclusions if the results fail to consider the sizeable proportion of people not included in these databases. For example, if 20% of people aged 20-29 years included in a pharmaceutical database are dispensed an antidepressant, but only 40% of people in this age group are dispensed a medication that leads to the inclusion of the individual in the dataset, this would mean that 8% rather than 20% of individuals aged 20-29 years would have received an antidepressant during the relevant period.
This study aimed to determine the proportion of Australian residents dispensed antipsychotics, antidepressants, anxiolytics, and hypnotics between 2013 and 2022. We included all age-groups and completed additional analyses to account for people not dispensed any medications.
2 | METHODS