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
- The proportion of the population dispensed antipsychotics,
antidepressants, anxiolytics and hypnotics increases with age, and is
particularly high among individuals aged ≥70 years.
- The dispensing of antipsychotics has decreased progressively over the
past 10 years for individuals aged ≥80 years.
- The dispensing of antidepressants increased after 2018, most markedly
for individuals aged 10-19 years and 20-29 years.
- A larger proportion of women than men were dispensed antidepressants,
anxiolytics and hypnotics, but more men than women were dispensed
antipsychotics between 2013 and 2022.
- The observed pattern of dispensing of medications suggest that the
prevalence of mental health problems is higher in later than earlier
life.
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