title: Disparities in Psychiatric Diagnosis and Treatment for Youth with Systemic Lupus Erythematosus: Analysis of a National US Medicaid Sample.
abstract: To estimate the national prevalence and racial/ethnic differences in psychiatric diagnoses and pharmacologic treatment in a US Medicaid beneficiary population of youth with systemic lupus erythematosus (SLE).
  
  
  
  We included youth aged 10 to 18 years with a diagnosis of SLE (defined as ≥ 3 outpatient visit claims with an International Classification of Diseases, 9th ed. code of 710.0, each > 30 days apart) in the US Medicaid Analytic Extract database from 2006 and 2007. This database contains all inpatient and outpatient Medicaid claims from 49 states and the District of Columbia. We calculated the prevalence of psychiatric diagnoses and treatment, and used logistic regression to compare depression and anxiety diagnoses, antidepressant, and anxiolytic use among racial/ethnic groups.
  
  
  
  Of 970 youth with SLE, 15% were white, 42% were African American, 27% were Latino, and 16% were of other races/ethnicities. Diagnoses of depression were present for 19%, anxiety for 7%, acute stress/adjustment for 6%, and other psychiatric disorders for 18%. Twenty percent were prescribed antidepressants, 7% were prescribed anxiolytics, 6% were prescribed antipsychotics, and 5% were prescribed stimulants. In adjusted analyses, African Americans were less likely than whites to be diagnosed with depression (OR 0.56, 95% CI 0.34-0.90) or anxiety (OR 0.49, 95% CI 0.25-0.98), or to be prescribed anxiolytics (OR 0.23, 95% CI 0.11-0.48).
  
  
  
  We present population-level estimates showing high psychiatric morbidity in youth with SLE, but less prevalent diagnosis and treatment in African Americans. Mental health interventions should address potential racial/ethnic disparities in care.
authors.affiliation: From the Division of Rheumatology, and the Center for Pediatric Clinical Effectiveness, and the PolicyLab, Children's Hospital of Philadelphia; Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.M. Knight, MD, MSCE, Attending Physician, Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia, and Faculty, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, and Faculty, PolicyLab, The Children's Hospital of Philadelphia, and Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; M. Xie, MS, Center for Mental Health Policy and Services Research, University of Pennsylvania; D.S. Mandell, ScD, Director, Center for Mental Health Policy and Services Research, University of Pennsylvania, and Associate Director, Center for Autism Research, The Children's Hospital of Philadelphia, and Associate Professor of Psychiatry and Pediatrics, Perelman School of Medicine at the University of Pennsylvania. knightan@email.chop.edu.
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Knight
authors.affiliation: From the Division of Rheumatology, and the Center for Pediatric Clinical Effectiveness, and the PolicyLab, Children's Hospital of Philadelphia; Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.M. Knight, MD, MSCE, Attending Physician, Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia, and Faculty, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, and Faculty, PolicyLab, The Children's Hospital of Philadelphia, and Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; M. Xie, MS, Center for Mental Health Policy and Services Research, University of Pennsylvania; D.S. Mandell, ScD, Director, Center for Mental Health Policy and Services Research, University of Pennsylvania, and Associate Director, Center for Autism Research, The Children's Hospital of Philadelphia, and Associate Professor of Psychiatry and Pediatrics, Perelman School of Medicine at the University of Pennsylvania.
authors.forename: Ming
authors.initials: M
authors.lastname: Xie
authors.affiliation: From the Division of Rheumatology, and the Center for Pediatric Clinical Effectiveness, and the PolicyLab, Children's Hospital of Philadelphia; Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania, USA.A.M. Knight, MD, MSCE, Attending Physician, Division of Pediatric Rheumatology, The Children's Hospital of Philadelphia, and Faculty, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, and Faculty, PolicyLab, The Children's Hospital of Philadelphia, and Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania; M. Xie, MS, Center for Mental Health Policy and Services Research, University of Pennsylvania; D.S. Mandell, ScD, Director, Center for Mental Health Policy and Services Research, University of Pennsylvania, and Associate Director, Center for Autism Research, The Children's Hospital of Philadelphia, and Associate Professor of Psychiatry and Pediatrics, Perelman School of Medicine at the University of Pennsylvania.
authors.forename: David S
authors.initials: DS
authors.lastname: Mandell
mesh_terms: D000293:Adolescent; D001741:Black or African American; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002648:Child; D015897:Comorbidity; D005260:Female; D054625:Healthcare Disparities; D006630:Hispanic or Latino; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008484:Medicaid; D001523:Mental Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D015995:Prevalence; D014481:United States; D044465:White People
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D014150:Antipsychotic Agents
keywords: DEPRESSION; HEALTHCARE DISPARITIES; MENTAL DISORDERS; PEDIATRIC SYSTEMIC LUPUS ERYTHEMATOSUS