The Relationship between Mental Health Diagnosis and Treatment with Second-Generation Antipsychotics over Time: A National Study of U.S. Medicaid-Enrolled Children

Authors

  • Meredith Matone M.H.S.,

    1. PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
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  • Russell Localio Ph.D.,

    1. Department of Biostatistics and Epidemiology, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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  • Yuan-Shung Huang M.S.,

    1. Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
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  • Susan dosReis Ph.D.,

    1. Department of PharmaceuticalHealth Services Research, University of Maryland School of Pharmacy, Baltimore, MD
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  • Chris Feudtner M.D., Ph.D., M.P.H.,

    1. PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
    2. Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
    3. Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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  • David Rubin M.D., M.S.C.E.

    Corresponding author
    1. Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
    2. Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
    • PolicyLab, The Children's Hospital of Philadelphia, Philadelphia, PA
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Address correspondence to David Rubin, M.D., M.S.C.E., CHOP North - Room 1533, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; e-mail: Rubin@email.chop.edu.

Abstract

Objective

To describe the relationship between mental health diagnosis and treatment with antipsychotics among U.S. Medicaid-enrolled children over time.

Data Sources/Study Setting

Medicaid Analytic Extract (MAX) files for 50 states and the District of Columbia from 2002 to 2007.

Study Design

Repeated cross-sectional design. Using logistic regression, outcomes of mental health diagnosis and filled prescriptions for antipsychotics were standardized across demographic and service use characteristics and reported as probabilities across age groups over time.

Data Collection

Center for Medicaid Services data extracted by means of age, ICD-9 codes, service use intensity, and National Drug Classification codes.

Principal Findings

Antipsychotic use increased by 62 percent, reaching 354,000 youth by 2007 (2.4 percent). Although youth with bipolar disorder, schizophrenia, and autism proportionally were more likely to receive antipsychotics, youth with attention deficit hyperactivity disorder (ADHD) and those with three or more mental health diagnoses were the largest consumers of antipsychotics over time; by 2007, youth with ADHD accounted for 50 percent of total antipsychotic use; 1 in 7 antipsychotic users were youth with ADHD as their only diagnosis.

Conclusions

In the context of safety concerns, disproportionate antipsychotic use among youth with nonapproved indications illustrates the need for more generalized efficacy data in pediatric populations.

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