Variation in psychiatric diagnoses and use of psychotropic medication among children, adolescents, and young adults in Denmark

@misc{sonne2026variation,
  title = {{Variation in psychiatric diagnoses and use of psychotropic medication among children, adolescents, and young adults in Denmark}},
  author = {H. Sonne and H. Kildegaard and M. Bech and R. Wesselhoeft and A. S. K. Hansen and A. G. Ording and A. Pottegaard},
  howpublished = {medRxiv},
  year = {2026},
  month = oct,
  doi = {10.64898/2026.10.19.26365872},
  url = {https://www.medrxiv.org/content/10.64898/2026.10.19.26365872v1},
  note = {CC BY-NC-ND},
}

TY  - UNPB
TI  - Variation in psychiatric diagnoses and use of psychotropic medication among children, adolescents, and young adults in Denmark
AU  - H. Sonne
AU  - H. Kildegaard
AU  - M. Bech
AU  - R. Wesselhoeft
AU  - A. S. K. Hansen
AU  - A. G. Ording
AU  - A. Pottegaard
PY  - 2026
DA  - 2026/10/19
PB  - medRxiv
DO  - 10.64898/2026.10.19.26365872
UR  - https://www.medrxiv.org/content/10.64898/2026.10.19.26365872v1
AB  - BackgroundPsychiatric diagnoses and psychotropic medication use among children, adolescents, and young adults have increased in high-income countries, with concerns about geographic variation. We described national trends and geographic variation in Denmark from 2010 to 2025 and developed an interactive online tool to explore these patterns.  MethodsWe conducted a nationwide, descriptive, repeated cross-sectional register-based study of all Danish residents aged 0-24 years in 2010-2025 (n=2,930,744), using the Danish National Patient Registry and the Danish National Prescription Registry. We estimated annual incidence, prevalence, and, for selected diagnoses, lifetime prevalence, by age and sex, and age- and sex-standardised rates across regions, health councils, and municipalities. We assessed geographic variation using deviations from national means, coefficients of variation, Gini coefficients, and funnel plots.  FindingsPsychiatric diagnoses and psychotropic medication use increased from 2010 to 2025. The annual prevalence of attention-deficit hyperactivity disorder (ADHD) increased from 0{middle dot}41 to 2{middle dot}3 per 100 individuals, autism spectrum disorders from 0{middle dot}20 to 1{middle dot}2, and melatonin use from 0{middle dot}14 to 3{middle dot}0. ADHD and autism spectrum disorders were more prevalent among boys and anxiety disorders among girls. Sertraline use was also more prevalent among girls. Geographic variation was observed across diagnoses and psychotropic medications at regional, health council, and municipal levels. For example, lifetime prevalence of autism ranged from 1{middle dot}3 to 5{middle dot}9 per 100 across municipalities, and in 2025 regional coefficients of variation ranged from 0{middle dot}11 (sertraline) to 0{middle dot}41 (atomoxetine). Results can be explored in the interactive online tool (https://bupstat.sdu.dk/?lang=en).  InterpretationPsychiatric diagnoses and psychotropic medication use increased among Danish children, adolescents, and young adults, with marked geographic variation. Descriptive data cannot establish the causes of this variation, but the findings identify areas for further review and support continued monitoring.  FundingBest for Us project (www.bedstforos.dk), funded by the Novo Nordisk Foundation (NNF24SA0093635) and the Obel Family Foundation (69348).  Research in contextO_ST_ABSEvidence before this studyC_ST_ABSWe searched PubMed on 25 September 2026 without date or language restrictions, using two search strings (Appendix Text 1). One search string combined search terms for psychiatric disorders and psychotropic medications, children, adolescents, and young adults, and geographic variation. The other search string combined similar population and condition terms with time trends and Denmark or other Nordic countries. We supplemented these with reference lists of key publications, health atlas websites, and national reports. Existing evidence shows substantial increases in psychiatric diagnoses and psychotropic medication use among children and adolescents in high-income countries over the past two decades, with particularly marked rises in attention-deficit hyperactivity disorder (ADHD), autism spectrum disorders, and use of ADHD medications, antidepressants, and melatonin. Studies show considerable geographic variation in diagnostic and prescribing practices that differences in underlying morbidity cannot fully account for. Other countries have produced health atlases examining geographic variation in child and adolescent mental healthcare. However, no comparable nationwide analysis covering both psychiatric diagnoses and psychotropic medication use across multiple geographic levels has previously been conducted in Denmark. The identified studies were predominantly observational and register-based. Nationwide health registries provide high-quality data, but the observational nature limits causal inference about the mechanisms underlying the observed variation.  Added value of this studyThis study provides the first nationwide, comprehensive mapping of both psychiatric diagnoses and psychotropic medication use among Danish children, adolescents, and young adults over a 16-year period. By applying standardised measures of geographic variation, including coefficients of variation, Lorenz curves, and Gini coefficients, across a broad range of diagnostic categories and medication groups simultaneously, this study extends previous Danish and Nordic work. The accompanying interactive online tool enables dynamic exploration of temporal and geographic patterns and supports ongoing monitoring and dissemination of findings beyond the research community.  Implications of all the available evidenceThe substantial geographic variation observed across diagnostic and prescribing practices, combined with the rising prevalence of psychiatric diagnoses and psychotropic medication use, highlights the need for continued monitoring of child and adolescent mental healthcare in Denmark. The findings provide a foundation for targeted quality-improvement initiatives, resource planning, and closer alignment of diagnostic and prescribing practice at the regional and municipal levels. Future research should examine the mechanisms underlying geographic variation, including the role of access to services, local clinical cultures, and socioeconomic factors, and evaluate the impact of initiatives to reduce unwarranted variation.
ER  -