title: Examining psychotropic medication use among youth in the U.S. by race/ethnicity and psychological impairment.
abstract: Clinical practice guidelines underscore the need for careful evaluation of the risk-benefit ratio of psychotropic medications treating mental health disorders among youth. While it is well known that racial/ethnic disparities exist in psychotropic medication use, little is known about whether these differences are driven by over-prescribing among white youth, under-prescribing among minority youth, or both. To build evidence in this area, this study examined racial/ethnic differences in the prescription of psychotropic medications among youth with and without psychological impairment.
  
  
  
  Secondary data on two-year medication use from the 2004-2011 Medical Expenditure Panel Surveys were analyzed. We capitalized on two-year panel data, creating variables that allow for differential sequencing of psychological impairment and medication prescription (e.g., impairment in year 1 or year 2, and a psychotropic medication fill in year 2). Statistical differences were determined using unadjusted rate comparisons and logistic regression models, after adjustment for socio-contextual and health status characteristics.
  
  
  
  Compared to Black and Latino youth with psychological impairment, White youth were more likely to be prescribed psychotropic medications when impaired. Among youth never having psychological impairment, White youth were also more likely to be prescribed medications compared to their racial/ethnic minority counterparts.
  
  
  
  Differences in rates of medication use among youth with and without impairment suggest poor medication targeting across racial/ethnic groups. These results, combined with recent psychotropic medication risk warnings and concerns over increases in psychotropic medication use among youth, suggest that a continued emphasis on accurate targeting of prescribing patterns is needed across racial/ethnic groups.
authors.affiliation: Health Equity Research Lab/Center for Multicultural Mental Health Research, Cambridge Health Alliance, United States; Department of Psychiatry, Harvard Medical School, United States. Electronic address: bcook@cha.harvard.edu.
authors.forename: Benjamin Lê
authors.initials: BL
authors.lastname: Cook
authors.affiliation: Health Equity Research Lab/Center for Multicultural Mental Health Research, Cambridge Health Alliance, United States; Department of Psychiatry, Harvard Medical School, United States. Electronic address: ncarson@cha.harvard.edu.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Carson
authors.affiliation: RTI International, United States. Electronic address: nilayykafali@gmail.com.
authors.forename: E Nilay
authors.initials: EN
authors.lastname: Kafali
authors.affiliation: Heller School for Social Policy and Management, United States. Electronic address: annievalentine@yahoo.com.
authors.forename: Anne
authors.initials: A
authors.lastname: Valentine
authors.affiliation: UMD School of Pharmacy, United States. Electronic address: jdrueda@umaryland.edu.
authors.forename: Juan David
authors.initials: JD
authors.lastname: Rueda
authors.affiliation: Swarthmore College, United States. Electronic address: scoeodess@swarthmore.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Coe-Odess
authors.affiliation: Yale School of Public Health, United States. Electronic address: Susan.busch@yale.edu.
authors.forename: Susan
authors.initials: S
authors.lastname: Busch
mesh_terms: D000293:Adolescent; D001741:Black or African American / Q000208:ethnology / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy* / Q000208:ethnology*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D014481:United States / Q000208:ethnology; D044465:White People / Q000208:ethnology / Q000706:statistics & numerical data*
chemical_list: D011619:Psychotropic Drugs
keywords: Psychopharmacology; Racial/ethnic disparities; Youth