Trends in antipsychotic drug use by very young, privately insured children.
OBJECTIVE
This study describes recent trends and patterns in antipsychotic treatment of privately insured children aged 2 through 5 years.


METHODS
A trend analysis is presented of antipsychotic medication use (1999-2001 versus 2007) stratified by patient characteristics. Data are analyzed from a large administrative database of privately insured individuals. Participants were privately insured children, aged 2 through 5 years, with 12 months of continuous service enrollment in 1999-2001 (N = 400,196) or 2007 (N = 755,793). The main outcomes are annualized rates of antipsychotic use and adjusted rate ratios (ARR) of year effect on rate of antipsychotic use adjusted for age, sex, and treated mental disorder.


RESULTS
The annualized rate of any antipsychotic use per 1,000 children increased from 0.78 (95% confidence interval [CI] 0.69-0.88) (1999-2001) to 1.59 (95% CI 1.50-1.68) (2007) (ARR 1.76, 95% CI 1.56-2.00). Significant increases in antipsychotic drug use were evident for boys (ARR 1.66, 95% CI 1.44-1.90) and girls (ARR 2.26, 95% CI 1.70-3.01) and for children diagnosed with several different psychiatric disorders. Among antipsychotic-treated children in the 2007 sample, pervasive developmental disorder or mental retardation (28.2%), attention deficit/hyperactivity disorder (ADHD) (23.7%), and disruptive behavior disorder (12.9%) were the most common clinical diagnoses. Fewer than one-half of antipsychotic-treated young children received a mental health assessment (40.8%), a psychotherapy visit (41.4%), or a visit with a psychiatrist (42.6%) during the year of antipsychotic use.


CONCLUSIONS
Despite increasing rates of antipsychotic use by very young children, provision of formal mental health services remains sparse. These service patterns highlight a critical need to improve the availability of specialized and well integrated mental health care for very young children with serious mental health problems.
Olfson
Mark
M
Columbia University and the New York State Psychiatric Institute, New York, NY, USA. mo49@columbia.edu
Crystal
Stephen
S
Huang
Cecilia
C
Gerhard
Tobias
T
D000367:Age Factors; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D002659:Child Development Disorders, Pervasive / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D002675:Child, Preschool; D015331:Cohort Studies; D004363:Drug Utilization / Q000639:trends; D005260:Female; D005544:Forecasting; D006301:Health Services Needs and Demand / Q000639:trends; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data; D008607:Intellectual Disability / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D008605:Mental Health Services / Q000639:trends; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use; D012017:Referral and Consultation / Q000639:trends; D012737:Sex Factors; D014481:United States
D014150:Antipsychotic Agents; D011619:Psychotropic Drugs