Psychotropic Medication Patterns in Medicaid-Insured Youth Based on Clinician-Reported Maltreatment Status

The main objective of this study is to explore the relationship of psychotropic medication use patterns and clinician-reported maltreatment status in Medicaid-insured youth. This cross-sectional study analyzed computerized outpatient claims for youth aged 2-17 years who were continuously enrolled for ≥10 months in a mid-Atlantic state Medicaid program in 2006. Bivariate analyses and multivariable logistic modeling were employed to assess patterns of any psychotropic drug use, and specifically for antipsychotics, antidepressants, and stimulants by clinician-reported maltreatment status and according to other study covariates. Child maltreatment status was assessed using ICD-9 codes for maltreatment. Other covariates included age group, gender, race/ethnicity, region, Medicaid-eligibility categories, and clinician-reported psychiatric diagnostic groups. Among 274,490 youth, 901 had a clinician-reported child maltreatment indicator for a prevalence of 3.3 per 1,000. These youth were more likely to be older, female, African American, and Medicaid eligible by foster care or disability. Youth with clinician-reported maltreatment compared to youth without identified maltreatment had a significantly higher prevalence of antipsychotic use (14.1 vs. 3.4 %), antidepressant use (12.1 vs. 3.4 %) and stimulant use (15.8 vs. 7.8 %). After adjusting for the study covariates, the odds of antipsychotic use (2.6 [2.0, 3.2]), antidepressant use (2.0 [1.6, 2.6]), and any psychotropic use (1.5 [1.3, 1.9]) were comparatively higher among youth with clinician-reported maltreatment. By contrast, the adjusted-odds of stimulant use was comparable between the groups. The findings from this exploratory study from one state's Medicaid outpatient data suggest that youth with maltreatment indicators have an increased likelihood of antipsychotic and antidepressant medication dispensings.