Characteristics and predictors of off‐label use of antipsychotics in general population sample

Objective Increasing number of people have been prescribed antipsychotics (APs) off‐label in recent decades. This study aimed to identify the characteristics and predictors of receiving prescription of antipsychotics off‐label. Methods The study sample was part of the Northern Finland Birth Cohort 1966 (n = 7071). Data included questionnaires and national register data. Information on prescribed medications was extracted from the national register. The sample was divided into three groups: Persons who had been prescribed APs off‐label (n = 137), individuals with non‐psychotic mental disorders without APs off label (n = 1478) and individuals who had been diagnosed with psychosis or bipolar disorder and who had been prescribed APs (n = 151). We compared sociodemographic, lifestyle and clinical characteristics between the off‐label and the comparison groups using logistic regression. Results The most common diagnoses in the off‐label group were depression (n = 96, 70.1%) and anxiety (n = 55, 40.1%). Compared with individuals with non‐psychotic mental disorders who were not prescribed APs off‐label, individuals with prescribed off‐label APs had a lower level of education, lower socioeconomic status, were less often married, had a higher level of somatic and psychiatric morbidity, were more often smokers and more often had a substance abuse disorder and heavy alcohol consumption. When comparing the off‐label group to individuals with psychosis or bipolar disorder who used APs, there were less differences, though individuals with psychosis or bipolar disorder had more markers of morbidity and a lower level of education. Conclusion Individuals who had been prescribed APs off label had a higher level of mental and somatic morbidity and poorer socioeconomic status than individuals with non‐psychotic mental disorders who did not use APs.