Antipsychotic prescribing for behavioral disorders in US youth: Physician specialty, insurance coverage, and complex regimens

Mehmet Burcu, Daniel J. Safer, Julie M. Zito

Research output: Contribution to journalArticlepeer-review


Purpose: To assess antipsychotic prescribing patterns according to insurance coverage type and physician specialty in the outpatient treatment of behavioral disorders (BD) in US youth. Methods: We used 2003-2010 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data to compare antipsychotic prescribing in the outpatient treatment of BD in youth (6-19years) according to insurance coverage (public vs. private) and physician specialty (psychiatrist vs. non-psychiatrist) using population-weighted Chi-square and multivariable analyses. Also, we examined co-prescribing of antipsychotics with other psychotropic medication classes. Subgroup analyses were conducted in BD visits with no other clinician-reported psychiatric diagnosis (non-comorbid BD visits). Results: A large majority (71.0%) of BD visits were provided by non-psychiatrists. However, psychiatrists prescribed antipsychotics far more frequently than non-psychiatrists (24.2% vs. 4.6%; adjusted odds ratio (AOR)=5.1 [95% confidence interval (CI), 2.8-9.2]) in total BD visits as well as in non-comorbid BD visits (18.6% vs. 3.6%; AOR=5.8 [95% CI, 3.2-10.5]). Antipsychotic prescribing was nearly two-fold greater in visits by publicly insured 6-12year olds (11.3% vs. 5.8%; AOR=1.9 [95% CI, 1.1-3.5]) and 13-19year olds (16.2% vs. 8.9%; AOR=2.0 [95% CI, 1.1-3.6]) compared with their privately insured counterparts. In more than one-third of antipsychotic-prescribed BD visits, antipsychotics were prescribed concomitantly with ≥2 psychotropic medication classes regardless of age group, insurance coverage, or even in the absence of psychiatric comorbidities. Conclusion: In outpatient visits by youth for BD, antipsychotics were primarily prescribed by psychiatrists, concomitantly, and for the publicly insured. These treatment patterns merit further investigation.

Original languageEnglish (US)
Pages (from-to)26-34
Number of pages9
JournalPharmacoepidemiology and Drug Safety
Issue number1
StatePublished - Jan 1 2016


  • Antipsychotic medications
  • Behavioral disorders
  • Concomitant medications
  • Insurance coverage
  • Pharmacoepidemiology
  • Physician specialty
  • Youth

ASJC Scopus subject areas

  • Epidemiology
  • Pharmacology (medical)

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