The RCPsych Article of the Month for March is from BJPsych Open and is entitled ‘Social gradients in the receipt of medication for attention-deficit hyperactivity disorder in children and young people in Sheffield’ by Samuel Nunn.

When I was studying for a Masters in Public Health, I was fascinated by research about the relationship between inequality and health. Step into A&E any day of the week and you’ll see a skewed representation of rich and poor, both in terms of what people present with and their frequency of attendance. Look at life expectancy (or healthy life expectancy) and you’ll see that the UK is not an equal country – each of our chances of living long and healthy lives is affected by our socio-economic position, which is to do with our level of access to various forms of wealth; monetary, social, time, or physical. All this thinking about inequality and health gave structure to ideas I’d formed from anecdotal observations working in healthcare: coming from a deprived background in the UK means that the odds are stacked against you. Returning to healthcare a bit more educated about these issues changed my practice.

Our study shows that there is a social gradient in children and young people’s receipt of medication for ADHD in the UK, which won’t come as a surprise to lots of clinicians working in the field. For me, the study raises many more questions. Some of these questions are academic, and are probably answerable by empirical research; such as how the social gradient affects long term outcomes for children and young people, and what we could do to smooth out or eradicate the social gradient? Other questions are political or philosophical, such as what political and societal structures are responsible for the social gradient, and what should we do about it, if anything? I find the latter set of questions harder to approach, more contentious to discuss, and more enchanting than the former.

I think there is a need to set academic research in the context of the politics of the society we live in, especially when venturing in to a topic as politically charged as inequality. Some issues we can solve with new technology, or knowledge; others require a shift in political attitudes and ideas. As scientists and researchers, I wonder if we can bridge the gap between these. I believe that the existence of a social gradient in receipt of medication for ADHD has implications for clinicians and for policymakers, and I hope that the article stimulates thought and conversation about both the subject matter, and about the broader ideological discussions that our findings prompt us to engage in.

Why I chose this article:
“It is a pleasure to recognize “Social gradients in the receipt of medication for attention-deficit hyperactivity disorder in children and young people in Sheffield” as the article of the month. Utilizing the Index of Multiple Deprivations, Nunn et al. noted that with increased deprivation there is an increased odds ratio in receiving medications for the treatment of ADHD (one decile increase in the IMD, or less deprivation, was associated with a 10% lower odds ratio). While this finding has been previously reported in Scandinavia, this is the first UK study to replicate the impact of deprivation and a social gradient on the receipt of ADHD medication. As a cross-sectional study, causality is not considered though further studies addressing this should be considered. The authors correctly concluded that this existence of a social gradient, which should be considered for other medical and psychiatric diagnoses, impacts not only patients and healthcare professionals but also policy makers, public health professionals, social services, and politicians. BJPsych Open looks forward to further research from this group on this important topic and an ongoing dialogue of social gradients in mental health.”

Kenneth R. Kaufman, Editor-in-Chief, BJPsych Open

View the Press Release for this article here

View the RCPsych Article of the Month Collection here.

Find out more about the RCPsych Publications by visiting the RCPsych Hub!