Childhood Predictors of Use and Costs of Antidepressant Medication by Age 24 Years: Findings from the Finnish Nationwide 1981 Birth Cohort Study
Prior studies on antidepressant use in late adolescence and young adulthood have been cross-sectional, and prospective associations with childhood psychiatric problems have not been examined. The objective was to study the association between childhood problems and lifetime prevalence and costs of antidepressant medication by age 24 years.
A total of 5,547 subjects from a nation-wide birth cohort were linked to the National Prescription Register. Information about parent- and teacher-reported conduct, hyperkinetic and emotional symptoms, and self-reported depressive symptoms was gathered at age 8 years. The main outcome measure was national register-based lifetime information about purchases of antidepressants between ages 8 and 24 years. In addition, antidepressant costs were analyzed using a Heckman maximum likelihood model.
In all, 8.8% of males and 13.8% of females had used antidepressants between age 13 and 24 years. Among males, conduct problems independently predicted later antidepressant use. In both genders, self-reported depressive symptoms and living in other than a family with two biological parent at age 8 years independently predicted later antidepressant use. Significant gender interactions were found for conduct and hyperkinetic problems, indicating that more males who had these problems at age 8 have used antidepressants compared with females with the same problems.
Childhood psychopathology predicts use of antidepressants, but the type of childhood psychopathology predicting antidepressant use is different among males and females.
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ABSTRACT: Background: Little is known about the timing of the start of psychotropic drug use and psychotropic polypharmacy use. Aims: This study describes these patterns in a Finnish representative cohort aged between 12 and 25. Methods: 5525 subjects born in 1981 were followed up between 1994 and 2005 using the Finnish National Prescription Register. Results: Survival analysis revealed that the cumulative incidence of any psychotropic drug use was 1.3% by age 15, 6.1% by age 20 and 15.2% by age 25. Antidepressants and benzodiazepines were the most used drug groups, with cumulative incidences of 12.2% and 5.2%, respectively, by age 25. The cumulative incidence of polypharmacy was 0.02% by age 15, 0.9% by age 20 and 4.1% by age 25, i.e. having purchased at least two psychotropic drugs from different classes during the same day. Polypharmacy occurred among the majority of antipsychotic and benzodiazepine users, but among a minority of antidepressant users. More females than males had used any psychotropic drug, antidepressants, the antidepressant-benzodiazepine combination and the antidepressant-mood stabilizer combination. Conclusions: Both general psychotropic drug use and psychotropic polypharmacy use was often started in late adolescence.
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ABSTRACT: The existing knowledge about long-term psychosocial consequences of childhood pain is scarce. The current study investigated childhood pain symptoms as potential risk factors for antidepressant use in adolescence and early adulthood.
A representative sample of eight-year-old children (n=6017) and their parents were asked about the prevalence of the child's headache, abdominal pain, and unspecified pain symptoms. The associations with antidepressant purchases by age 24, based on the nationwide prescription register, were analyzed separately for each symptom and each reporter. Sex, parental educational level, and child-, parent- and teacher-reported child's psychiatric symptoms at baseline were included as confounding variables.
In the sex-adjusted model, the child's own report of headache and other pains, and the parents' report of their child's abdominal pain, predicted antidepressant purchases. When confounding variables were included in the final model, only the child's own report of headache predicted antidepressant use with a dose-response relationship. The hazard ratios and 95% confidence intervals for frequent and for almost daily headache were 1.6 (1.3-2.0) and 2.1 (1.5-2.9), respectively, in the sex-adjusted model, and 1.5 (1.2-1.8) and 1.7 (1.2-2.5) in the final model.
The assessment of each pain symptom was based on one question for each reporter. The specific indications for the described medication could not be defined.
Health care professionals should also ask children themselves about the pain symptoms. They should be aware that children with pain are at increased risk of suffering later from conditions that require antidepressant treatment.
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