(196) So Many Countries, So Many Customs: A Register-Based Analysis of Conduct Disorder Prevalence and Treatment Patterns in Four Western Countries

Sunday, August 28, 2022

8:00 AM – 1:45 PM CEST

Location: Hall C

Publication Number: 1241

Presenting Author(s)

Mette Bliddal, PhD
– Associate professor, University of Southern Denmark, University of Southern Denmark, Odense C, Syddanmark, Denmark

Co-Author(s)

Christian Bachmann
– Department of Child and Adolescent Psychiatry, LVR-Klinikum Düsseldorf/Heinrich-Heine University Düsseldorf, Bergische Landstrasse 2, Düsseldorf 40629, Germany, Germany
Susan DosReis, FISPE
– Professor, Pharmaceutical Health Services Research, School of Pharmacy, Baltimore, Maryland, United States
Ingvild Odsbu
– Researcher, Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Oslo, Norway
Oliver Scholle, PhD
– Postdoctoral research fellow, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
Svetlana Skurtveit
– Department of Mental Disorders, Norwegian Institute of Public Health, Norway, Oslo, Norway
Annika Vivirito
– InGef - Institute for Applied Health Research Berlin, Berlin, Germany, Germany
Rikke Wesselhoeft, MD
– Associate Professor, Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, University of Southern Denmark, Odense C, Syddanmark, Denmark
Stephen scott
– Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK, United Kingdom

Background: Conduct disorders (CD) are common among children and adolescents and place a high burden on health systems and society. Regarding the management of CD, there is a broad international consensus favouring timely diagnosis and non-pharmacological treatment in outpatient settings. However, there is some evidence that CD often go underdiagnosed and when diagnosed, little is known on treatment initiatives.

Objectives: We aimed to compare across four Western countries (Denmark, Germany, Norway, and US) the prevalence of CD, antipsychotic treatment, psychiatric hospitalizations, psychiatric comorbidity, and speciality of the diagnosing physician.

Methods: In this cross-sectional observational study, we used administrative data to identify children and adolescents (aged 0-19 years) with an ICD-10 diagnosis code for CD (F91, F90.1, or F92) at any point in calendar year 2018. Prevalence was determined within each country’s study population. We calculated the prevalence of psychiatric comorbidity and psychotropic treatment, and quantified the prevalence and duration of psychiatric hospitalization for each country.

Results: CD prevalence differed 31-fold between countries, ranging from 0.1% (Denmark) to 3.1% (Germany). Nearly three in four diagnoses were assigned to males in all countries (range: 68–73%). The proportion of CD patients with antipsychotic medication ranged from 4.0% (Germany) to 12.2% (US). Attention-deficit/hyperactivity disorder was the most common comorbidity in all countries, ranging from 48% (Germany) to 70% (Denmark). Psychiatric hospitalisation prevalence ranged from 1.2% (Norway) to 12.5% (Germany). Among children and adolescents with CD, the duration of hospitalisation ranged from a low in Norway of 226.8 days/1,000 children/adolescents to a high in Germany of 5378.0 days/1,000. The average hospital stay duration ranged from 2.7 days (US) to 22.3 days (Germany). The most frequent diagnosing physicians were primary care physicians in the US (37%) and Germany (63%) followed by specialist physicians (24 and 13%, respectively; data not available for Denmark and Norway).

Conclusions: Prevalence of CD in children and adolescents differ largely between the four Western countries. Despite variability across countries, there is consistent data to suggest a high proportion of psychiatric comorbidity with CD. Variability in antipsychotic use and hospitalisation warrant further study to ensure alignment with international consensus on CD management.