Abstract
Background The WHO Comprehensive Mental Health Action Plan 2013-2030 encourages routine collection and reporting of a set of essential mental health indicators, including the availability of psychotropic medicines. The global monitoring of country-level psychotropic medicine consumption trends can provide information on the extent of the availability of psychotropic medicines. The primary objective of this study was to investigate global trends in psychotropic medicines consumption from 2008 to 2019 across 65 countries and regions according to country income level and geographical region.
Methods In this longitudinal trends study, we used pharmaceutical sales data from the IQVIA-Multinational Integrated Data Analysis System (IQVIA-MIDAS). We analysed monthly sales data of psychotropic medicines between Jan 1, 2008, and Dec 31, 2019. Total psychotropic medicine consumption included sales of antidepressants, antipsychotics, tranquilisers, sedatives or hypnotics, and mood stabilisers. Population estimates of each country or region (eight lower middle-income countries, 19 upper-middle-income countries, and 38 high-income countries) were based on the UN World Population Prospects 2019 report. Average annual sales trends of psychotropic medicines, expressed as defined daily dose (DDD) per 1000 inhabitants per day, were estimated using a random-effects model adjusted for income level and region. Relative changes in the annual consumption of psychotropic medicines by income, expressed as DDD per 1000 inhabitants per day, were assessed as percentage change for each medicine class.
Findings Psychotropic medicine sales increased from 28.54 DDD per 1000 inhabitants per day in 2008 to 34.77 DDD per 1000 inhabitants per day in 2019, corresponding to a 4.08% (95% CI 2.96-5.21) relative average increase annually. The absolute annual increase was greater in high-income countries (3.31 DDD per 1000 inhabitants per day, 95% CI 3.01-3.61) compared with upper-middle-income countries (1.94 DDD per 1000 inhabitants per day, 1.45-2.44) and low-middle-income countries (0.88 DDD per 1000 inhabitants per day, 0.62-1.13; p<0.0001). The relative average annual increase in psychotropic medicine sales from 2008 to 2019 was greater in upper-middle-income countries (7.88%, 95% CI 6.99-8.77) than in lower-middle-income countries (2.90%, 2.40-3.39) and high-income countries (1.02%, 0.80-1.24). In 2019, the regional consumption of psychotropic medicines varied greatly, with the highest sales of all psychotropic medicine classes reported in northern America (167.54 DDD per 1000 inhabitants per day) and lowest sales reported in Asia (5.59 DDD per 1000 inhabitants per day). 17 countries had very low consumption of psychotropic medicines in 2019, including high-income countries and countries with a high prevalence of mental disorders.
Interpretation The consumption of psychotropic medicines has increased over a 12-year period, and although the absolute growth rate was highest in high-income countries, the relative growth is highest in middle-income countries and especially upper-middle-income countries. Disparities in psychotropic medicine consumption of countries can only partly be explained by geographical location and income. Greater efforts are needed to increase the availability of psychotropic medicines in countries with very low consumption, which is probably due to financial or cultural reasons as well as scarcity of trained health-care professionals to prescribe psychotropic medicines. Copyright (C) 2021 Elsevier Ltd. All rights reserved.