Ontario study finds variation in mental health medication use in children and youth
A new study from ICES and Unity Health Toronto found that mental health medication use in Ontario children and youth differs by age, between females and male and where individuals live in the province.
Guidelines suggest non-medication options (including talk therapy) as first-line treatments for children and youth with mental health disorders, except in the case of psychosis. However, wait times for publicly funded therapy to treat these disorders are at an all-time high.
To explore mental health medication use in children and youth, researchers with expertise in epidemiology, children’s mental health, and drug safety studied anonymous administrative health records of all Ontario residents aged 0 to 24 years who were dispensed benzodiazepines, stimulants, antipsychotics, or antidepressants between January 1, 2018, and December 31, 2018—a period in which all children and youth in Ontario had medication costs covered by the provincial drug plan.
The study, published in BMC Public Health, showed that:
- There was large variation in psychotropic use according to where children and youth lived in Ontario.
- Most children and youth prescribed antipsychotics and stimulants were male (53.7% and 68.8%, respectively).
- Most children and youth receiving benzodiazepines and antidepressants were female (63.2% and 64.9%, respectively).
- There was greater use of stimulants in the highest relative to the lowest income neighbourhoods (24.4% vs. 18.9%), with the reverse being true for antipsychotics (17.3% vs. 26.0%).
- Greater regional availability of mental health facilities for children and youth was associated with less antipsychotic use. Conversely, greater regional availability of these services was associated with higher rates of stimulant use.
Overall, there was a fair amount of variation in the use of these drugs across Ontario, with the type of medication used differing according to factors such as patient sex and neighbourhood income.
The researchers speculate that some of the differences could reflect known patterns of mental health illness and long-wait times for publicly funded non-drug (e.g., counselling) mental health services for children and youth. This might be especially true for the greater use of antipsychotics in children and youth living in low-income neighbourhoods, because higher-income families may be able to pay for services that are not covered by OHIP (e.g., private counselling), with low-income families needing to rely on clinics and medical settings for care in which the mainstay of treatment is medication.
“Antipsychotic drugs require regular monitoring for side effects,” says lead author Tony Antoniou, a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, a site of Unity Health Toronto, and ICES “Targeted investment in regions with long wait times for publicly-funded non-drug therapies and novel collaborative service models may help promote best practices in treating mental health conditions in children and youth.”
The study, “Geographic variation and sociodemographic correlates of prescription psychotropic drug use among children and youth in Ontario, Canada: a population-based study” was published in BMC Public Health.
Author block: Antoniou T, McCormack D, Kitchen S, Pajer K, Gardner W, Lunsky Y, Penner M, Tadrous M, Mamdani M, Juurlink D, Gomes T
ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: @ICESOntario
About St. Michael's
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future healthcare professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.
About Unity Health Toronto
Unity Health Toronto, comprised of St. Joseph’s Health Centre, St. Michael’s Hospital and Providence Healthcare, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.
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