Trends in Antipsychotic Medication Use in Young Privately Insured Children

被引:33
作者
Bushnell, Greta A. [1 ,2 ]
Crystal, Stephen [5 ]
Olfson, Mark [3 ,4 ]
机构
[1] Rutgers Sch Publ Hlth, Piscataway, NJ USA
[2] Rutgers Ctr Pharmacoepidemiol & Treatment Sci, New Brunswick, NJ USA
[3] Columbia Univ, Vagelos Coll Phys & Surg, Mailman Sch Publ Hlth, New York, NY USA
[4] New York State Psychiat Inst & Hosp, New York, NY 10032 USA
[5] Rutgers State Univ, Inst Hlth Hlth Care Policy & Aging Res, New Brunswick, NJ USA
基金
美国医疗保健研究与质量局; 美国国家卫生研究院;
关键词
antipsychotic agents; child; trends; off-label use; drug utilization; PSYCHIATRIC-DISORDERS; PEDIATRIC USE; ATYPICAL ANTIPSYCHOTICS; MALADAPTIVE AGGRESSION; PRACTICE PARAMETER; DRUG USE; YOUTH; ADOLESCENTS; IMPACT; STIMULANTS;
D O I
10.1016/j.jaac.2020.09.023
中图分类号
B844 [发展心理学(人类心理学)];
学科分类号
040202 ;
摘要
Objective: To estimate trends of annual antipsychotic medication use by privately insured young children (aged 2-7 years) in the United States, and to describe the clinical and treatment characteristics of these children. Method: The study population included young children from a nationwide commercial claims database (2007-2017). We estimated annual antipsychotic use by age and sex, defined as the number of children dispensed an antipsychotic per year divided by the number enrolled. We described clinical diagnoses and mental health service use in those with prescription antipsychotic use in 2009 and 2017. Results: Annual antipsychotic use in young children was 0.27% in 2007, peaked at 0.29% in 2009, and statistically significantly declined to 0.17% by 2017 (linear trend: -0.017% per year, 95% CI: -0.018 to -0.016). Antipsychotic use was higher in boys than in girls. A greater proportion of antipsychotic users received a mental disorder diagnosis in 2017 (89%) than in 2009 (86%, p < .01). The most common clinical diagnoses in antipsychotic users, under a hierarchical classification, were pervasive developmental disorder (2009 = 27%, 2017 = 38%, p < .01), conduct or disruptive behavior disorder (2009 = 15%, 2017 = 21%, p < .01), and attention-deficit/hyperactivity disorder (2009 = 24%, 2017 = 18%, p < .01). Among 2017 antipsychotic users, 32% had 4+ psychotherapy claims, 43% had a psychiatrist visit, and the majority used another psychotropic medication, most commonly a stimulant (boys = 57%, girls = 50%). Conclusion: In privately insured young children, antipsychotic use declined from 2009 to 2017, with shifts toward indications with some supporting evidence. Nevertheless, a majority of use remains off label and for conditions lacking effectiveness and safety data. Improving antipsychotic prescribing in young children remains a challenge.
引用
收藏
页码:877 / 886
页数:10
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