Are Racial/Ethnic Differences in Youth Psychotropic Drug Use Due to Overuse of Whites or Underuse of Racial/Ethnic Minorities

Background: Approximately one-quarter of youth diagnosed with mental illness receive a psychotropic drug. White youth are twice as likely to take mood stabilizers and antipsychotics as black and Hispanic youth, and four times as likely to have stimulant or antidepressant prescriptions. Psychotropic drugs are proven to be effective in the treatment of psychiatric disorders and, combined with appropriate therapy, can have long-lasting beneficial effects. On the other hand, children’s usage of psychotropic drugs can cause severe side effects. The present study assesses racial/ethnic disparities in rates of psychotropic drug use among those with and without need for these medications.

Data: We analyzed 65,401 youth age 5-17 respondents from the 2004-2010 Medical Expenditure Panel Surveys (MEPS). We assessed disparities for any psychotropic drug use, polypharmacy (two or more psychotropic medications), antidepressants, antipsychotics, and stimulants for youth with and without need for these medications. We defined psychotropic drug categories using Multum classification codes available in the MEPS and a follow-up check on un-categorized drug names. We consider youth with Columbia Impairment Scale (CIS) score > 16 or parent-reported fair or poor mental health to have a need for psychotropic drug use. Need for antidepressants, stimulants, and antipsychotics were assessed based on relevant conditions identified by ICD-9 codes linked to treatment in the MEPS.

Methods: We estimated logit regression models, separately analyzing overuse (no identified need for care and use) and underuse (identified need for care but no use) for any psychotropic drug, polypharmacy, antidepressants, stimulants, and atypical antipsychotics. Our independent variable of interest is an indicator of race/ethnicity (Black, Hispanic with white as referent).  We adjusted for family income, region, urbanicity, insurance coverage, parent-assessed mental health and physical health, gender, CIS, and age. As a secondary analysis, we decomposed the overall disparity in psychotropic drug use, using a predictive margins approach to compare model-based predictions of appropriate use, overuse, and underuse.

Results: Blacks and Hispanics were significantly less likely to overuse any psychotropic drug use, multiple psychotropic drugs, antidepressants, and atypical antipsychotics compared to whites. There were no differences in overuse of stimulants.  Blacks were more likely to underuse any psychotropic drug than whites, but were less likely to underuse antidepressants and stimulants.  Hispanics were less likely to underuse all psychotropic drugs except for antipsychotics.

Conclusions: Preliminary results suggest that disparities in psychotropic drug use are predominantly driven by overuse among white youth rather than underuse by racial/ethnic minority youth. The exception is Black-white disparities in any psychotropic drug use which are driven both by underuse by Blacks and overuse by Whites.  The results, coupled with risk warnings on psychotropic drugs for youth, suggest a need to improve vigilance to improve the appropriateness of psychotropic drug prescription for all racial/ethnic groups, and a reduction of overuse among white youth.