Age at Emergence of Gender Inequalities in Psychotropic Use in Adolescence: A Longitudinal Study

Background

While magnitude and trends of gender inequalities in psychotropic medication use in adolescents are well documented, longitudinal evidence on the timing of their emergence remains limited, despite its importance for preventing the gender gap. This study aims to longitudinally analyse the specific age at which gender inequalities in psychotropic use emerge among adolescents in Spain, and how it varies by socioeconomic status.

Methods

We conducted a longitudinal study using Spanish primary care electronic health records (BDCAP), including adolescents aged 9–18 years followed between 2018-2024 (n = 174,336). The age at first prescription of anxiolytics, hypnotics and sedatives (AHS) and antidepressants was analysed using sex-stratified Kaplan–Meier survival analysis, and age-specific hazard ratios were estimated using Cox proportional models with a sex-by-age interaction. Additionally, an interaction analysis combining sex and income level was performed.

Results

Girls showed a significantly higher risk of initiating psychotropic use from age 12 onwards for both AHS (HR = 1.24 [1.12–1.38]) and antidepressants (HR = 1.58 [1.29–1.93]), with the largest differences observed at age 14 (AHS HR = 2.14 [1.99–2.42]; antidepressants HR = 3.06 [2.70–3.48]). From age 13, cumulative incidence was higher in girls, reaching 12.2% for AHS and 6.8% for antidepressants by age 18, compared with 8.2% and 2.8% in boys. Inequalities in AHS emerge one year earlier in low-income adolescents, but this effect does not occur for antidepressant use.

Conclusions

Gender differences in prescribed psychotropic medication use among adolescents in Spain emerge at age 12, and the intersection of gender and socioeconomic status may influence the timing of initiation, particularly for AHS. Studying the emergence of gender inequalities in psychotropic use among adolescents enables the development of early interventions to prevent a widening gender gap in mental health, which may persist throughout life.

Key messages

• Early adolescence -12 years old- marks the onset of the gender gap in psychotropic use and mental health in Spain.

• Gender inequality in the age of psychotropic use initiation is influenced by socioeconomic status, emphasizing the need for an intersectional approach in adolescent mental health care.