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.

Funding

None.

中文翻译：

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2008-19 年 65 个国家和地区的精神药物消费：一项纵向研究

背景

世卫组织 2013-2030 年精神卫生综合行动计划鼓励定期收集和报告一组基本精神卫生指标，包括精神药物的可用性。对国家级精神药物消费趋势的全球监测可以提供关于精神药物供应范围的信息。本研究的主要目的是根据国家收入水平和地理区域调查 65 个国家和地区 2008 年至 2019 年精神药物消费的全球趋势。

方法

在这项纵向趋势研究中，我们使用了来自 IQVIA-跨国综合数据分析系统 (IQVIA-MIDAS) 的药品销售数据。我们分析了 2008 年 1 月 1 日至 2019 年 12 月 31 日期间精神药物的月度销售数据。精神药物总消费量包括抗抑郁药、抗精神病药、镇静剂、镇静剂或催眠药以及情绪稳定剂的销售额。每个国家或地区（8 个中低收入国家、19 个中高收入国家和 38 个高收入国家）的人口估计均基于联合国《2019 年世界人口展望》报告。精神药物的平均年销售趋势，表示为每天每 1000 名居民的限定日剂量 (DDD)，使用根据收入水平和地区调整的随机效应模型进行估算。

发现

精神药物销售额从 2008 年的每 1000 名居民每天 28·54 DDD 增加到 2019 年的每 1000 名居民每天 34·77 DDD，相当于 4·08% (95% CI 2·96–5·21) 相对平均值每年增加。与中高收入国家（每 1000 名居民每天 1·94 DDD）相比，高收入国家的绝对年增长率更高（每 1000 名居民每天 3·31 DDD，95% CI 3·01–3·61）天，1·45–2·44）和中低收入国家（每天每 1000 名居民 0·88 DDD，0·62–1·13；p<0·0001）。2008 年至 2019 年精神药物销售额的相对平均年增长率在中高收入国家 (7·88%, 95% CI 6·99–8·77) 高于中低收入国家 (2· 90%, 2·40–3·39) 和高收入国家 (1·02%, 0·80–1·24)。2019年，精神药物的区域消费差异很大，北美报告的所有精神药物类别的销售额最高（每天每 1000 名居民 167·54 DDD），亚洲报告的销售额最低（每天每 1000 名居民 5·59 DDD） . 2019 年有 17 个国家的精神药物消费量非常低，包括高收入国家和精神障碍患病率高的国家。

解释

精神药物的消费量在过去 12 年中有所增长，虽然绝对增长率最高的是高收入国家，但相对增长率最高的是中等收入国家，尤其是中高收入国家。各国精神药物消费的差异只能部分由地理位置和收入来解释。在消费量极低的国家，需要做出更大的努力来增加精神药物的供应，这可能是由于经济或文化原因，以及缺乏开出精神药物处方的训练有素的保健专业人员。

资金

没有任何。