Psychotropic medication consumption before and after onset of COVID-19 pandemic in 91 countries and regions: a time-series analysis

Background: The availability of psychotropic medications serves as a key indicator of global mental health status, underscoring the critical importance of continued monitoring. However, comprehensive studies assessing the global effect of the COVID-19 pandemic on such trends remain lacking. This study aimed to describe psychotropic consumption trends before and after the onset of the COVID-19 pandemic and investigate the pandemic's short- and long-term effects on psychotropic consumption across 91 countries and regions. Methods: This study used country-level sales data of psychotropic medications between Q1, 2012, and Q2, 2023 of 91 countries and regions from the IQVIA-Multinational Integrated Data Analysis System. Average annual sales trends were estimated and expressed as defined daily dose per 1000 inhabitants per day (DDD/TID) at the overall level and stratified by medication class and country income level. Relative average annual changes were assessed for the periods 2017-2019 and 2020-2022 both overall and within specific medication classes and income groups. The pandemic's short- and long-term effects on psychotropic medication sales were examined through interrupted time series analyses using quarterly data, conducted for each country and at overall level. Findings: Globally, the total consumption of psychotropic medications increased from 34.12 DDD/TID in 2020 to 36.15 DDD/TID in 2022, corresponding to a relative average increase of 2.94% 95% CI 0.97, 4.94 annually. The estimated relative change during 2020-2022 were 1.82% 1.02, 2.64 in Lower-Middle-Income-Countries (LMICs), 6.77% -0.39, 14.45 in Upper-Middle-Income-Countries (UMICs), and 2.48% 0.72, 4.27 in High-Income-Countries (HICs). Overall psychotropic consumption showed an initial surge in Q1 2020 (level change: 1.94 DDD/TID 1.67, 2.21), followed by a rapid decline during Q2 2020 (level change: -1.03 -1.52, -0.54). Most HICs exhibited a similar pattern. Following the pandemic onset, there was an increasing trend in overall psychotropic consumption (trend change: 0.13 0.07, 0.19). 70 of 91 countries showed an increasing slope change. Interpretation: Psychotropic medication consumption increased globally after the onset of the COVID-19 pandemic. During the pandemic, consumption rates in LMICs and UMICs appeared to slow down, however, patterns of change in psychotropic medication consumption following onset of the pandemic vary on a country level. To address these disparities, strategies for equitable psychotropic medication distribution and enhanced mental health care access in LMICs and UMICs are needed to improve global mental health. Funding: None.