Recent trends in the incidence of anxiety and prescription of anxiolytics and hypnotics in children and young people: An e-cohort study
Recent trends in the incidence of anxiety and prescription of anxiolytics and hypnotics in children and young people: An e-cohort study
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DOI：
10.1016/j.jad.2015.05.002
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发表时间：
2015-09-01
影响因子：
6.6
通讯作者：
Lloyd, K.
中科院分区：
文献类型：
--
作者：
John, A.;Marchant, A. L.;Lloyd, K.
背景：在初级保健中，对儿童和青少年（CYP）焦虑的认识知之甚少。本研究调查了初级保健中焦虑的呈现、识别和记录以及抗焦虑药和催眠药处方的趋势。方法：在安全匿名信息链接数据库（SAIL）初级保健数据库中创建2003年至2011年间6-18岁的人群回顾性电子队列。发病率的计算使用危险年（PYAR）作为分母，考虑剥夺、年龄和性别。结果：我们确定了一个由311,343名注册个体组成的队列，提供了总共1,546,489人年的随访。在研究期间，焦虑症状的发生率增加了两倍多（发病率比(IRR)=3.55, 95% CI 2.65-4.77），而诊断的发生率保持稳定。整个队列的抗焦虑药/催眠药处方随着时间的推移没有显著变化；然而，15-18岁年龄组抗焦虑药处方显著增加（IRR 1.62, 95% CI 1.30-2.02）。局限性：缺乏关于在一级、二级或三级可用或接受的其他干预措施（如心理治疗）的可靠信息。结论：随着时间的推移，CYP患者似乎更倾向于记录一般症状，而不是诊断焦虑。15-18岁人群抗焦虑药处方的增加与目前的处方指南不符。需要具体指导评估和管理初级保健中出现焦虑的CYP，特别是年龄较大的青少年。(C) 2015年作者。这是一篇基于CC by-nc-nd许可（http://creativecommons.org/licenses/by-nc-nd/4.0/）的开放获取文章。
Background: Little is known regarding the recognition of anxiety in children and young people (CYP) in primary care. This study examined trends in the presentation, recognition and recording of anxiety and of anxiolytic and hypnotic prescriptions for CYP in primary care.Method: A population based retrospective electronic cohort of individuals aged 6-18 years between 2003 and 2011 within the Secure Anonymised Information Linkage (SAIL) Databank primary care database was created. Incidence rates were calculated using person years at risk (PYAR) as a denominator accounting for deprivation, age and gender.Results: We identified a cohort of 311,343 registered individuals providing a total of 1,546,489 person years of follow up. The incidence of anxiety symptoms more than tripled over the study period (Incidence Rate Ratio (IRR)=3.55, 95% CI 2.65-4.77) whilst that of diagnosis has remained stable. Anxiolytic/hypnotic prescriptions for the cohort as a whole did not change significantly over time; however there was a significant increase in anxiolytic prescriptions for the 15-18 year age group (IRR 1.62, 95% CI 1.30-2.02).Limitations: There was a lack of reliable information regarding other interventions available or received at a primary, secondary or tertiary level such as psychological treatments.Conclusions: There appears to be a preference over time for the recording of general symptoms over diagnosis for anxiety in CYP. The increase in anxiolytic prescriptions for 15-18 year olds is discrepant with current prescribing guidelines. Specific guidance is required for the assessment and management of CYP presenting with anxiety to primary care, particularly older adolescents. (C) 2015 The Authors. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).