Background & Aims
Self-reported pain and mental health conditions are common among young people (1), but whether this reflects an increase in medical diagnosis is less investigated. The conditions can, among other treatment options, be treated with different prescription drugs. These can be effective in alleviating symptoms and improving function, but their widespread use raises concerns regarding potential adverse effects such as dependency, and long-term consequences. Especially so for opioids. An increased use of opioids in Europe following the steep increase in the US around 2010 has been seen (2-5). Therefore, it’s important to study patterns of prescription over time to investigate if there are any discernible overall trends and if the growing concern specifically related to opioids has led to changes in prescription patterns. Therefore, the aim of this study is to investigate the trends in the prevalence of pain and mental health conditions and the related use of prescribed drugs in young people.
Methods
This cohort study use electronic medical health records from the Skåne Healthcare register (6) that hold information on all delivered care in the Region of Skåne, Sweden (pop=1,4 million). We identify all individuals aged 13-18 years with a registered ICD-10 diagnosis of pain and mental health conditions and calculate the annual prevalence for the years 2011-2022 for the three categories pain, mental health condition and pain and mental health condition. by linkage with the National prescribe drug register data we calculate the annual prevalence of dispensed prescriptions of analgesics, and antidepressants within these patient populations. The prevalence of pain and mental health condition is presented as percentages of the total population and were calculated for each year by sex. The prevalence of prescription drug among those with a diagnosis of pain and mental health conditions respectively use as the numerator the total number with the relevant diagnoses for each sex and year.
Results
The prevalence of pain has slightly decreased over the study period, after a peak in 2012. At the end of the study period, in 2022, the prevalence was 4.1% (girls 5.1%, boys 3.1%) For mental health conditions, the prevalence has increased over the study period. However, the increase for the boys slowed after 2017. In 2022 the prevalence of mental health conditions was 16.8% (girls 19.8% and boys 13.9%). In 2022, the prevalence of mental health conditions among those with concurrent pain was higher than in the general population, 21.5% (25.4% of girls and 16.1% of boys). There was a decrease in prescription for analgesics during the study period. This includes opioids. The prevalence of prescription analgesics was high among those with a registered pain diagnosis but showed a gradual decrease over the study period. The prevalence of prescription analgesics among those with a mental health showed a gradual decrease over the study period.
Conclusions
This study shows a high and increasing prevalence of mental health conditions among adolescents, especially in girls. Those with concurrent pain and mental health conditions had a higher prevalence of all prescription drugs. Positively, a lower usage of opioids was found. Our result underscore the need to put extra focus on mental health conditions, with or without concurrent pain to prevent further negative impact on the individuals, the health-care organization, and the society.
References
1.Castelpietra, G., Knudsen, A. K. S., Agardh, E. E., Armocida, B., Beghi, M., Iburg, K. M., Logroscino, G., Ma, R., Starace, F., Steel, N., Addolorato, G., Andrei, C. L., Andrei, T., Ayuso-Mateos, J. L., Banach, M., Bärnighausen, T. W., Barone-Adesi, F., Bhagavathula, A. S., Carvalho, F., … Monasta, L. (2022). The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990–2019: Findings from the Global Burden of Disease Study 2019. The Lancet Regional Health – Europe, 16, 100341. https://doi.org/10.1016/j.lanepe.2022.100341
2.Jarlbaek, L. (2019). Opioid prescribing habits differ between Denmark, Sweden and Norway—And they change over time. Scandinavian Journal of Pain, 19(3), 491–499. https://doi.org/10.1515/sjpain-2018-0342
3.Mahic, M., Fredheim, O. m., Borchgrevink, P. c., & Skurtveit, S. (2015). Use of prescribed opioids by children and adolescents: Differences between Denmark, Norway and Sweden. European Journal of Pain, 19(8), 1095–1100. https://doi.org/10.1002/ejp.632
4.Shipton, E. A., Shipton, E. E., & Shipton, A. J. (2018). A Review of the Opioid Epidemic: What Do We Do About It? Pain and Therapy, 7(1), 23–36. https://doi.org/10.1007/s40122-018-0096-7
5.Stangeland, H., Handal, M., Skurtveit, S. O., Aakvaag, H. F., Dyb, G., Wentzel-Larsen, T., Baumann-Larsen, M., Zwart, J. A., Storheim, K., & Stensland, S. Ø. (2022). Killing pain?: A population-based registry study of the use of prescription analgesics, anxiolytics, and hypnotics among all children, adolescents and young adults in Norway from 2004 to 2019. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-022-02066-8
6.Löfvendahl S., E C Schelin M., Jöud A. (2020) The value of the Skåne Health-care Register: Prospectively collected individual-level data for population-based studies Scand J Public Health. 48(1):56-63 https://10.1177/1403494819868042
Presenting Author
Fabian Larrosa Pardo
Poster Authors
Anna Jöud
PhD
Department of Clinical Sciences Lund, Ortopedics, Lund University, Lund, Sweden
Lead Author
Fabian Larrosa Pardo (MD PhD)
Department of Clinical Sciences Lund, Ortopedics, Lund University, Lund, Sweden
Lead Author
Elisabeth Bondesson (PhD)
Department of clinical sciences Lund, Lund university, Lund Sweden
Lead Author
Topics
- Epidemiology