Racial differences in the use of adjunctive psychotropic medications for patients with schizophrenia.
BACKGROUND
Antidepressants, mood stabilizers and anxiolytics are frequently used in addition to antipsychotic medications in order to control ancillary symptom complexes among patients with schizophrenia. Although extensive data has demonstrated racial disparities in diagnostic and treatment patterns for schizophrenia, little is known about racial differences in the use of adjunctive medications. Since these adjunctive medications may significantly improve clinical outcomes, further investigation is warranted.


OBJECTIVE
The purpose of this study was to determine the rates at which adjunctive antidepressants, mood stabilizers and anxiolytics were prescribed to black patients and white patients with schizophrenia. The authors hypothesized that black patients would be less likely to receive any adjunctive medication as compared to white patients.


METHODS
This cross-sectional study utilized data from an academic medical center in Rochester, New York. Three multivariate logistic regression were performed to model the likelihood of receiving each of the three types of adjunctive medication. The primary independent variable was race, and the models also controlled for clinical and sociodemographic factors such as diagnosis, age, gender, living situation, and insurance status.


RESULTS
Of the 456 patients included in the study, 37% received an antidepressant, 33% received a mood stabilizer and 23% received an anxiolytic. All patients received an antipsychotic medication. In each multivariate model, race was significantly associated with likelihood of receiving the adjunctive medication (p<.01 for all). None of the covariates was consistently associated with receipt of an adjunctive medication.


CONCLUSIONS
Even after controlling for potentially confounding clinical and sociodemographic factors, race was strongly associated with receipt of adjunctive medications. This finding is consistent with previous work demonstrating racial disparities in the treatment and management of schizophrenia. The cross-sectional study design, however, limits the conclusions that can be drawn from this study, as length-time bias may have led to a misrepresentation of how many patients receive adjunctive medications. Caution should be observed in interpreting our results and replication is necessary.


CONCLUSIONS
Differences in the use of adjunctive medications may be due to true differences in the frequency of ancillary symptom complexes. Previous work, however, suggests that differences are more likely to be due to underdiagnosis of affective or anxiety symptoms among black patients. Among patients with recognized ancillary symptoms complexes, black patients may also be less likely than white patients to receive treatment. This may be due to racial differences in accessibility of mental health care, physician perceptions of patients, and patient beliefs and preferences. In future work, use of standardized diagnostic tools may help to determine actual rates of ancillary symptom complexes and to identify racial variations. Additionally, further research is needed to clarify the underlying biases and behaviors that affect use of adjunctive medications among patients with schizophrenia in whom ancillary symptom complexes have been identified.
Mallinger
Julie B
JB
MPH, University of Rochester, Department of Community & Preventive Medicine, Rochester, NY, USA. julie_mallinger@yahoo.com
Lamberti
Steven J
SJ
D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D003710:Demography; D004358:Drug Therapy / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012559:Schizophrenia / Q000188:drug therapy* / Q000208:ethnology*
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D011619:Psychotropic Drugs