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Background/Aim: Only a few psychotropic medications are approved for the treatment of mental disorders in children and adolescents. The appropriate use of a medication requires both a valid indication and the correct age. The aim of this study is to describe changes in the prevalence of psychiatric diagnoses and prescriptions among young girls in connection with the COVID-19 pandemic, and to attempt to place these within a broader historical context and identify underlying trends.

Methods: We analyzed prescription and validated diagnosis (ICD-10) data of 12–17-year-old adolescents (N= 3.352.291) from a large German statutory health insurance (AOK). To capture changes in connection with the pandemic, we defined three time periods (prepandemic, pandemic, postpandemic), determined prescription and diagnosis prevalence in the corresponding periods and compared them.

Results: Among young girls, a significant increase in depressive disorders (F32: +29.7%) and obsessive-compulsive disorders (F42: + 42.7%), – but above all, a significant increase in anxiety disorders (F40: +78%) – was observed during the study period. Diagnoses such as somatoform disorders, on the other hand, decreased (F45: -26.7%). The most commonly prescribed psychotropic medications in girls were antidepressants (primarily SSRIs), stimulants (primarily methylphenidate), and antipsychotics (primarily quetiapine).

Discussion/Conclusion: A significant increase in mood disorders and anxiety disorders among adolescents has been reported worldwide. In Germany, in 1998, somatoform disorders were the most commonly diagnosed condition on medical certificates among young women aged 18–24, accounting for about one-third of cases [1]. However, the prevalence of somatoform disorders has been declining for years [2]. This can be interpreted positively as an indication of more precise diagnosis. On the other hand, it is also striking that diagnoses are increasingly being made for conditions for which approved medications are available, at least by adulthood. The increase in ADHD diagnoses among girls is also worth noting here. In our study, we found only modest increases following the pandemic (+1.6%). However, a recently published study by the DAK in 2024 found a 21% increase in ADHD diagnoses among girls compared to 2023. The gender ratio for new cases in 2024 is thus 2:1 (in 2024, 22.4 boys and 11.3 girls per 1,000 children and adolescents received an ADHD diagnosis for the first time) [3]. In our data, ADHD is the psychiatric diagnosis most frequently associated with a prescription for psychopharmacological medication. In summarizing medication trends for young women over the past two or three decades in this area, we note that, in addition to antidepressant effects, the primary goal has been a sedative effect – an effect achieved in 1998 through benzodiazepines and tricyclic antidepressants, whereas today melatonin, quetiapine, and methylphenidate are the drugs of choice.

Overall, a higher prevalence of more precise diagnosed mental disorders can be assumed, which are treated on an indication-specific basis and increasingly with medication. The advantages and disadvantages of these changes are discussed. More specific diagnoses may have replaced earlier more or less provisional diagnoses. On the other hand, it is also conceivable that diagnoses are made based on the available range of approved medications.

Literatur

[1] Hach I, Rentsch A, Ruhl UE, Becker ES, Türke V, Margraf J, Kirch W. Drug use patterns in young German women and association with mental disorders. Ann Pharmacother. 2004 Sep;38(9):1529-34. DOI: 10.1345/aph.1D527
[2] Kohring C, Hartmann M, Holstiege J, Müller D. Inzidenztrends für 37 psychische Störungen bei Erwachsenen in der ambulanten Versorgung – Entwicklungen zwischen 2015 und 2022 mit Fokus auf Schizophrenie, Depressionen, tabakbezogenen und somatoformen Störungen sowie Schlaf- und Persönlichkeitsstörungen. Versorgungsatlas-Bericht Nr. 24/06. Berlin: Zentralinstitut für die kassenärztliche Versorgung in Deutschland (Zi); 2024. DOI: 10.20364/VA-24.06
[3] DAK-Gesundheit. DAK Kinder- und Jugendreport 2026: Aufmerksamkeitsdefizit und Hyperaktivitätsstörung (ADHS). 2026. Available from: https://www.dak.de/dak/unternehmen/reporte-forschung/kjr-2026-adhs-bei-kindern-und-jugendlichen_221514