Pediatric psychotropic prescribing and polypharmacy, 2019-2022: a retrospective electronic health record study in Qatar

Background Real-world evidence on pediatric psychotropic prescribing and polypharmacy in Gulf health systems remains limited. Characterizing medication-class patterns and multi-class prescribing is essential for medication safety surveillance in children and adolescents. This study examined psychotropic prescribing, potential polypharmacy, and recorded medication combinations among children and adolescents using public-sector electronic health records in Qatar. Methods A retrospective observational study used electronic health record data from Hamad Medical Corporation and the Primary Health Care Corporation, Qatar’s principal public healthcare providers, from January 2019 to December 2022. Children and adolescents aged 0–17 years with at least one psychotropic prescription were included. Medications were classified as antidepressants, antipsychotics, anxiolytics, mood stabilizers, or attention-deficit/hyperactivity disorder (ADHD) medications. Potential cross-class polypharmacy was assessed as the recording of two or more medication classes per patient during the study period; available duration information did not permit confirmation of concurrent exposure. Logistic regression examined patient-level associations with this outcome. Results The dataset included 2,941 eligible prescription records corresponding to 2,221 unique patients. The proportion of prescriptions for ADHD medications decreased from 28.7% in 2019 to 13.7% in 2022, whereas the proportion assigned to anxiolytics increased from 26.0% to 37.5%. ADHD medications predominated among prescriptions for children aged 5–11 years, while antidepressants and antipsychotics predominated among those for adolescents aged 12–17 years. The potential-polypharmacy criterion was met by 322 patients (14.5%), reaching 21.6% among adolescents. In a gender-adjusted model restricted to patients aged 1–17 years, each additional year of age was associated with higher odds of meeting the criterion (adjusted OR 1.13, 95% CI 1.10-1.16). After excluding patients with prescription-linked seizure disorder or cerebral palsy, the corresponding proportion was 16.96% (259/1,527). Among patients meeting the criterion, antidepressant-antipsychotic and ADHD medication-antipsychotic pairs were most frequent; methylphenidate-risperidone was the most common recorded individual-drug pair. Conclusions This study characterizes pediatric psychotropic prescribing and potential polypharmacy in Qatar’s public healthcare records and helps address the limited regional evidence from Gulf health systems. The observed patterns identify potential medication-safety surveillance priorities, particularly among adolescents and patients with antipsychotic-containing medication histories. Further assessment incorporating exposure duration and clinical outcomes is needed to establish concurrency and clinical significance.