Recent trends in the incidence of anxiety and prescription of anxiolytics and hypnotics in children and young people: An e-cohort study

•Concerns have been raised relating to the medicalisation of stress and unhappiness.•Population based electronic cohort of children and young people (CYP) 2003-2011.•Incidence of anxiety symptoms recorded in primary care in CYP has more than tripled.•Incidence of anxiety diagnoses in CYP remains comparatively stable.•Anxiolytic prescriptions have increased significantly for 15-18 year olds (IRR 1.62, 95% CIs 1.30-2.02) over the study period.•Guidance is required on the management of anxiety and use of anxiolytics in CYP.

BackgroundLittle 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.MethodA 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.ResultsWe 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).LimitationsThere was a lack of reliable information regarding other interventions available or received at a primary, secondary or tertiary level such as psychological treatments.ConclusionsThere 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.