Antidepressant treatment of Medicaid-insured youth with a cancer diagnosis

Objectives The primary purpose of this study was to determine whether youth with a clinical diagnosis of cancer are subsequently more likely to be prescribed antidepressants than their counterparts without cancer in a multi-state Medicaid-enrolled population. Methods Data on youth, ages 2-17 years, who were continuously enrolled in Medicaid for 3 or more months during 2000-2001 (n=2435391), were extracted from administrative claims files of seven state Medicaid programmes. All youth with a cancer diagnosis were selected and, for each, 10 youth matched for age (±1 year), gender and race/ethnicity who did not have a cancer diagnosis were randomly selected as a comparison group. Antidepressant use in the subsequent 3-24 months following the index cancer diagnosis was compared to antidepressant use in the comparison group in the same time frame, adjusting for psychiatric diagnoses. Key findings Youth with cancer were predominantly male (60.8%), 5-14 years of age (67.9%) and white (51.7%). Antidepressant use (unadjusted) in the cancer group (8.8%) was higher than in the comparison group (5.2%). Adjusting for comorbid psychiatric diagnosis, Cox proportional hazards analysis indicated that antidepressant use was nearly twice as likely (hazard ratio=1.97, 95% confidence interval=1.57-2.46) in cancer-diagnosed youth as in a comparable group of youth without cancer. Conclusions A two-fold greater use of antidepressants following a cancer diagnosis in youth compared to their Medicaid-insured counterparts without cancer suggests a need for additional evaluation of the benefits and risks of antidepressants, particularly selective serotonin-reuptake inhibitors, in a population likely to require complex medication treatments.