Decision aid tool and analytics

According to UK treatment guidelines, children and young people with depression should be assessed by a specialist doctor before they are prescribed any antidepressants.

The purpose of these guidelines is to ensure conditions are treated according to the best available evidence. We looked at health care records of a group of 5 to 17-year-olds who were prescribed antidepressants by their GP to see how many had visited a hospital specialist before or just after they started antidepressants.

Our key findings:

• 37% of 33,031 children and young people visited a hospital paediatrician or psychiatrist around the time they were prescribed an antidepressant.
• Of those aged 12 to 17 prescribed SSRIs (selective serotonin reuptake inhibitors, a particular type of antidepressant), only 24% had visited a child and adolescent psychiatrist. This figure is surprising as we would expect this group to be receiving antidepressants to treat mental health disorders.
• It was difficult for us to find out which conditions were being treated with antidepressants as this was often not recorded in the health care records.

This study summarises what was happening in general practices between 2006 and 2017, but we do not know why many children and young people were being prescribed antidepressants in primary care without visiting a hospital specialist. One possible explanation is the difficulty accessing specialist care and talking therapies.

This research, led by Professor Carol Coupland, was funded by the NIHR Nottingham Biomedical Research Centre. The full article is available online here: https://doi.org/10.1186/s12916-020-01560-7

This type of descriptive study is useful to show what is currently happening in terms of access to healthcare. Although we do not know why the numbers visiting specialists are so low, the results suggest guideline recommendations are not being met. This should encourage those who develop guidelines and those who put them into practice to look into why they are not being met.

We have written a short discussion of these issues, which is available here: https://nottingham-repository.worktribe.com/output/4992928