Foster care, externalizing disorders, and antipsychotic use among Medicaid-enrolled youths.

Abstract

OBJECTIVES:

The authors investigated the extent to which clinical diagnoses of externalizing disorders explain higher rates of antipsychotic use by foster care youths.

METHODS:

Medicaid claims data from 44 states for 2009 for youths in foster care (N=301,894) and those not in foster care (N=5,092,574) were analyzed, excluding those with schizophrenia, bipolar disorder, autism, and major depressive disorder. Logistic regressions assessed the relationship between foster care, externalizing disorders, and antipsychotic use.

RESULTS:

Foster care youths had higher rates of externalizing disorders than the comparison group (attention-deficit hyperactivity disorder, 17.3% versus 6.5%; disruptive behavior disorder, 7.2% versus 2.5%; conduct disorder, 2.3% versus .5%) and greater antipsychotic use (7.4% versus 1.4%). Foster care remained a significant predictor of antipsychotic use after control for demographic and diagnostic covariates, including externalizing disorders (adjusted odds ratio=2.59, 95% confidence interval=2.54-2.63).

CONCLUSIONS:

High rates of externalizing disorder diagnoses only partially explained elevated levels of antipsychotic use in this vulnerable population.

• Authors: Lauren Vanderwerker, Ayse Akincigil, Mark Olfson, Tobias Gerhard, Sheree Neese-Todd, Stephen Crystal
• Journal: Psychiatric services (Washington, D.C.) (Psychiatr Serv) Vol. 65 Issue 10 Pg. 1281-4 (Oct 2014) ISSN: 1557-9700 [Electronic] United States
• PMID: 25124057 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Antipsychotic Agents

Topics

• Adolescent
• Antipsychotic Agents (therapeutic use)
• Attention Deficit Disorder with Hyperactivity (drug therapy, psychology)
• Child
• Child, Preschool
• Conduct Disorder (drug therapy, psychology)
• Female
• Foster Home Care (psychology, statistics & numerical data)
• Humans
• Infant
• Infant, Newborn
• Male
• Medicaid
• United States