Educational and health outcomes of children and adolescents receiving antidepressant medication: Scotland-wide retrospective record linkage cohort study of 766 237 schoolchildren

Fleming, M. , Fitton, C., Steiner, M. F.C., McLay, J. S., Clark, D., King, A., Mackay, D. F. and Pell, J. P. (2020) Educational and health outcomes of children and adolescents receiving antidepressant medication: Scotland-wide retrospective record linkage cohort study of 766 237 schoolchildren. International Journal of Epidemiology, 49(4), pp. 1380-1391. (doi: 10.1093/ije/dyaa002) (PMID:32073627) (PMCID:PMC7660154)

Abstract

Background: Childhood depression is relatively common, under-researched and can impact social and cognitive function and self-esteem. Methods: Record linkage of routinely collected Scotland-wide administrative databases covering prescriptions [prescribing information system (PIS)], hospitalizations (Scottish Morbidity Records 01 and 04), maternity records (Scottish Morbidity Records 02), deaths (National Records of Scotland), annual pupil census, school absences/exclusions, special educational needs (Scottish Exchange of Educational Data; ScotXed), examinations (Scottish Qualifications Authority) and (un)employment (ScotXed) provided data on 766 237 children attending Scottish schools between 2009 and 2013 inclusively. We compared educational and health outcomes of children receiving antidepressant medication with their peers, adjusting for confounders (socio-demographic, maternity and comorbidity) and explored effect modifiers and mediators. Results: Compared with peers, children receiving antidepressants were more likely to be absent [adjusted incidence rate ratio (IRR) 1.90, 95% confidence interval (CI) 1.85–1.95] or excluded (adjusted IRR 1.48, 95% CI 1.29–1.69) from school, have special educational needs [adjusted odds ratio (OR) 1.77, 95% CI 1.65–1.90], have the lowest level of academic attainment (adjusted OR 3.00, 95% CI 2.51–3.58) and be unemployed after leaving school (adjusted OR 1.88, 95% CI 1.71–2.08). They had increased hospitalization [adjusted hazard ratio (HR) 2.07, 95% CI 1.98–2.18] and mortality (adjusted HR 2.73, 95% CI 1.73–4.29) over 5 years’ follow-up. Higher absenteeism partially explained poorer attainment and unemployment. Treatment with antidepressants was less common among boys than girls (0.5% vs 1.0%) but the associations with special educational need and unemployment were stronger in boys. Conclusions: Children receiving antidepressants fare worse than their peers across a wide range of education and health outcomes. Interventions to reduce absenteeism or mitigate its effects should be investigated.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Mackay, Professor Daniel and Fleming, Dr Michael and Pell, Professor Jill
• Authors: Fleming, M., Fitton, C., Steiner, M. F.C., McLay, J. S., Clark, D., King, A., Mackay, D. F., and Pell, J. P.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: International Journal of Epidemiology
• Publisher: Oxford University Press
• ISSN: 0300-5771
• ISSN (Online): 1464-3685
• Published Online: 19 February 2020
• Copyright Holders: Copyright © 2020 The Authors
• First Published: First published in International Journal of Epidemiology 49(4): 1380-1391
• Publisher Policy: Reproduced under a Creative Commons license

Project Code	Award No	Project Name	Principal Investigator	Funder's Name	Funder Ref	Lead Dept
303197		Linking education and health data together to study relationships between various health factors and children's educational and health outcomes	Jill Pell	Medical Research Council (MRC)	MR/S003800/1	HW - Public Health