Qatar EHR study maps pediatric psychotropic prescribing and potential polypharmacy, 2019-2022

Between 2019 and 2022, public-sector health records in Qatar captured 2,941 psychotropic prescriptions for 2,221 children and adolescents aged 0 to 17 years, and a retrospective analysis of those records has now revealed how medication classes shifted over the period and how often young patients had more than one class of psychotropic medication recorded. The study, published in Frontiers in Psychiatry, drew on the integrated electronic health record system shared by Hamad Medical Corporation and the Primary Health Care Corporation, the two principal public healthcare providers that together serve approximately 90 percent of Qatar’s national population.

The researchers classified every eligible prescription into one of five study-defined categories: antidepressants, antipsychotics, anxiolytics, mood stabilizers, or attention-deficit/hyperactivity disorder (ADHD) medications. The composition of prescribing changed markedly over the four years. ADHD medications accounted for 28.7 percent of recorded psychotropic prescriptions in 2019 but only 13.7 percent in 2022, while the anxiolytic category rose from 26.0 percent to 37.5 percent over the same interval. The antidepressant share peaked at 26.5 percent in 2021. These percentages describe the composition of prescription records rather than the prevalence of treatment among children in the population.

Prescribing also differed sharply by age. Among infants younger than one year, every eligible prescription fell into the study-defined anxiolytic category, and that category accounted for 93.3 percent of prescriptions among children aged 1 to 4 years. ADHD medications were the most common class among prescriptions for children aged 5 to 11 years, at 40.4 percent, followed by anxiolytics at 28.9 percent and antipsychotics at 19.8 percent. Among adolescents aged 12 to 17 years, antidepressants and antipsychotics dominated, accounting for 33.9 percent and 32.4 percent of prescriptions respectively, while ADHD medications represented 14.6 percent and anxiolytics 11.5 percent. Gender differences were also evident: ADHD medications made up a larger share of prescriptions among males than females, 26.5 percent versus 9.9 percent, whereas antidepressants accounted for a larger share among females, 26.4 percent versus 13.7 percent.

Diagnostic context added an important layer of interpretation. ADHD medications accounted for 89.2 percent of prescription records linked to an ADHD diagnosis, antidepressants accounted for 86.2 percent of depression-linked records and 77.5 percent of anxiety disorder-linked records, and antipsychotics accounted for 75.7 percent of autism spectrum disorder-linked prescriptions. Notably, among seizure disorder-linked prescriptions, 79.7 percent were assigned to the anxiolytic category and 18.6 percent to the mood-stabilizer category, reflecting the fact that some medications in these categories, such as certain antiepileptic agents and benzodiazepines, may be prescribed for neurological rather than primary psychiatric indications. The study’s authors emphasized that medication-category labels should not be read as confirmation of a psychiatric treatment purpose.

The central safety-focused outcome was a prescription-based measure the investigators called potential cross-class polypharmacy: the recording of medications from two or more distinct study classes for the same patient at any point during 2019 to 2022. Of the 2,221 unique patients, 322 met this criterion, corresponding to 14.5 percent, and the proportion climbed with age, from 1.99 percent among children aged 1 to 4 years and 12.39 percent among those aged 5 to 11 years to 21.62 percent among adolescents aged 12 to 17 years. No infants younger than one year met the criterion. In a gender-adjusted model restricted to patients aged 1 to 17 years, each additional year of age was associated with higher odds of meeting the criterion, with an adjusted odds ratio of 1.13 and a 95 percent confidence interval of 1.10 to 1.16.

The researchers were careful to stress that this measure does not establish that patients actually took multiple medications at the same time. The available data extract contained dispensing dates and quantities but lacked sufficient information to reconstruct continuous exposure duration, so a 30- or 60-day overlap threshold could not be applied, and sequential prescribing, switching between medications, and genuinely concurrent treatment could not be reliably distinguished. The first observed medication class was also not assumed to represent treatment initiation, because prescribing before 2019 was unavailable. In a sensitivity analysis that excluded the 694 patients with a prescription-linked diagnosis of seizure disorder or cerebral palsy, the proportion meeting the criterion rose slightly to 16.96 percent, or 259 of 1,527 patients, and the principal recorded medication pairs were unchanged.

Among the 322 patients meeting the potential-polypharmacy criterion, the most frequent recorded class-level pair was antidepressant-antipsychotic, observed in 140 patients, or 43.5 percent, followed by ADHD medication-antipsychotic in 75 patients, or 23.3 percent. Other frequently recorded pairs included anxiolytic-mood stabilizer in 16.8 percent, antidepressant-anxiolytic in 12.4 percent, and antipsychotic-anxiolytic in 12.1 percent. Because patients with three or more recorded classes could contribute multiple pairs, these percentages were not mutually exclusive. At the level of individual drugs, the most frequent recorded pair was methylphenidate-risperidone, seen in 41 patients, or 12.7 percent, followed by fluoxetine-olanzapine at 9.0 percent, fluoxetine-risperidone and aripiprazole-risperidone at 8.7 percent each, and risperidone-sertraline at 7.5 percent. Risperidone appeared repeatedly across the common combinations, a pattern the authors highlighted as a potential surveillance priority given that antipsychotics in children and adolescents are associated with metabolic, cardiovascular, neurological, endocrine, and sedative adverse effects.

Several patient-level associations accompanied these patterns. The distribution of first observed medication class was associated with age group and gender, and age was positively correlated with the number of distinct medication classes recorded during the study period, with a Spearman rank correlation of 0.192. Patients whose first observed class was an antipsychotic or an antidepressant had the highest proportions meeting the potential-polypharmacy criterion, at 23.6 percent and 23.0 percent respectively, compared with 6.7 percent among those whose first observed class was an anxiolytic. The unadjusted proportion meeting the criterion was higher among females than males, 16.33 percent versus 13.16 percent, but after adjustment for age group this gender association was no longer statistically significant, with an adjusted odds ratio of 1.13 and a confidence interval of 0.89 to 1.45.

The study’s limitations are substantial and were laid out explicitly by the authors. The findings concern prescriptions recorded in Qatar’s public healthcare systems and may not capture private-sector prescribing or treatment received elsewhere. Prescription-linked diagnoses do not necessarily establish the indication for individual medications, and residual indication misclassification remains possible even after the neurological-diagnosis sensitivity analysis. The regression models included only age and gender, so residual confounding by diagnosis, severity, prescriber specialty, and other unmeasured factors is likely, and the descriptive temporal analyses cannot establish that pandemic-related disruption caused the observed prescribing patterns. The study design does not permit causal inference, and the results may not generalize to private-sector settings or other health systems.

Despite these caveats, the study fills a documented gap, since real-world evidence on pediatric psychotropic prescribing in Gulf health systems has remained limited. The authors framed the observed patterns as identifying potential medication-safety surveillance priorities, particularly among adolescents and patients with antipsychotic-containing medication histories, rather than as evidence of inappropriate prescribing or medication-related harm. They suggested that patients with multiple recorded psychotropic medication classes could be considered for structured medication review to clarify whether prescribing represents concurrent use or sequential therapy, and that confirmed antipsychotic-containing combinations may warrant specialist review where clinically appropriate. Future research, they concluded, should incorporate exposure duration, verified indications, and clinical outcomes to distinguish concurrent treatment from sequential prescribing and to evaluate whether medication-review interventions deliver measurable benefit.

Subject of Research: Pediatric psychotropic prescribing and potential polypharmacy in Qatar's public electronic health records, 2019-2022

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

Article References: Abo El-Ella, D. M., Dhieb, D., Kanan, Y., Hamad, S., & Bastaki, K. (2026). Pediatric psychotropic prescribing and polypharmacy, 2019-2022: a retrospective electronic health record study in Qatar. Frontiers in Psychiatry, 17, Article 1944247. https://doi.org/10.3389/fpsyt.2026.1944247

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1944247

Keywords: pediatric psychopharmacology, polypharmacy, electronic health records, Qatar, antipsychotics, antidepressants, ADHD medications, anxiolytics, medication safety, adolescent psychiatry, retrospective study, prescribing patterns