Racial Disparities in Psychotropic Prescribing Practices During COVID-19

During the COVID-19 pandemic, psychotropic medication prescriptions significantly increased among non-White children and young people (CYP), likely reflecting a persistent decline in mental health for this population.

The COVID-19 pandemic has been consistently linked to adverse mental health outcomes among CYP, likely due to factors like social isolation and disrupted healthcare access. Though the increased rates of depression and anxiety following the pandemic have been consistently reported, relatively little is known about the potential socio-demographic variation in the diagnosis and treatment of psychiatric disorders among CYP during the COVID-19 pandemic.

To address this knowledge gap, researchers conducted a retrospective time series analysis of primary care electronic health records to examine trends in psychotropic prescribing patterns and the diagnosis of common mental disorders by patient ethnicity and social deprivation among CYP in Greater Manchester, England. The researchers used data from the Greater Manchester Care Record (GMCR) to identify patients aged 6 to 24 years from primary care records during phases of the COVID-19 pandemic. The observation period was categorized into 3 phases: Pre-Pandemic (January 2019 to February 2020), Pandemic Phase 1 (March 2020 to June 2021), and Pandemic Phase 2 (July 2021 to May 2022). The primary outcomes of interest included monthly tallies of anxiety disorder and depression diagnoses, the number of psychotropic prescriptions dispensed, and how these diagnoses and prescriptions varied across socio-demographic groups.

Over the study period, the researchers identified 136,953 episodes of anxiety disorders and 132,101 episodes of depression among 747,179 CYP (50.8% boys/men; 66.7% White). During this time, 505,408 anxiolytics and 499,447 antidepressants were prescribed for anxiety disorders and depression, respectively.

The researchers found that diagnoses of anxiety disorders and depression initially decreased sharply at the start of the COVID-19 pandemic, but rebounded to pre-pandemic levels by July 2021.

Relative to Pre-Pandemic levels, girls/women had higher rate ratios for anxiety disorder diagnoses, depression diagnoses, and psychotropic prescriptions than boys/men at both Pandemic Phase 1 and Pandemic Phase 2. Although psychotropic prescription rates were relatively stable among boys/men across the study period, prescriptions for anxiety disorders increased by 25% (rate ratio, 1.25; 95% CI, 1.17-1.34) and prescriptions for depression increased by 23% (rate ratio, 1.23; 95% CI, 1.15-1.31) among girls and women by Pandemic Phase 2 compared with Pre-Pandemic levels.

When stratified by race/ethnicity, the researchers found that anxiety disorder diagnoses increased by 57% (rate ratio, 1.57; 95% CI, 1.32-1.86) among Black girls/women and 60% (rate ratio, 1.60; 95% CI, 1.35-1.89) among girls/women of mixed ethnicity over the study period. Similarly, depression diagnoses increased by 38% (rate ratio, 1.38; 95% CI, 1.21-1.58) among Black girls/women and 47% (rate ratio, 1.47; 95% CI, 1.27-1.69) among girls/women of mixed ethnicity.

The researchers also observed a significant increase in anxiolytics prescriptions among Black and mixed ethnicity CYP by Pandemic Phase 2, relative to pre-pandemic levels. The greatest increase was observed among Black girls/women (rate ratio, 1.90; 95% CI, 1.58-2.29). Further, antidepressant prescriptions increased over the pandemic for all non-White CYP.

“Our findings add to the body of evidence on healthcare and educational provision regarding the potential impact of societal public health measures on the mental health of CYP, should future pandemics arise,” the researchers concluded. “Further evidence on the impact of ethical disparity of access to primary care and treatment regarding prescribing and onward referral to therapeutic services is needed to prevent widening health inequality.”

Study limitations include potential biases from regional-specific lockdown severity, health care access disparities that may have influenced clinical data, and challenges in establishing clear pre-pandemic baselines due to data availability constraints.

This article originally appeared on Psychiatry Advisor