Prescribed use of anxiolytics, hypnotics, sedatives, and antidepressants in adolescents in Spain: a comprehensive exploratory analysis of gender inequalities

Purpose This study aims to examine the magnitude and trends of gender inequalities in AHS and antidepressant use, the role of medicalization, and the intersection with other axes of inequality among the adolescent population in Spain. Methods A cross-sectional analysis of the Spanish Primary Care Clinical Database (BDCAP) was conducted in the population aged 10–18 years in 2023 (n = 1,197,508), along with a temporal trend analysis for the period 2018–2023. Prevalences were calculated for girls and boys, and gender differences were estimated using prevalence ratios (PR) from age-adjusted robust Poisson regression models. Analyses were stratified by age, income, and place of birth. To assess gender inequalities in medicalization, models were additionally adjusted for mental health diagnoses and healthcare visits. Results Girls were more likely to use prescribed AHS and antidepressants than boys, and this gender gap widened between 2018 and 2023. After additional adjustments, the probability of AHS and antidepressant use remained significantly higher among girls (PR_AHS = 1.45 [1.43–1.47] and PR_antidepressants = 1.93 [1.90–1.97]). Gender differences emerged around age 13 and peaked at ages 17–18. No consistent pattern was observed for income level and place of birth. Conclusion The findings highlight persistent gender inequalities in adolescent psychotropic drug use linked to processes of medicalization and broader structural conditions. Addressing these disparities requires coordinated intersectoral interventions and structural transformations beyond the healthcare system alone.