Antipsychotic Use Declined From 2009 to 2017 in Privately Insured Children

Antipsychotic use declined from 2009 to 2017 in privately insured children, according to results of a study published in the Journal of the American Academy of Child & Adolescent Psychiatry.

Despite a lack of evidence for effectiveness in the treatment of several conditions for which they are prescribed, antipsychotic medications were increasingly prescribed for youth from the late 1990s into the early 2000s. Though antipsychotic medication use declined in privately insured children after several states increased regulations surrounding atypical antipsychotic prescribing to children enrolled in Medicaid in 2014, the direction of these trends on very young, privately insured children as of 2017 has not yet been determined.

To evaluate trends in the use of antipsychotic medication among children aged 2-7 years from 2007 to 2017, data from a database covering individuals with employer-sponsored insurance and their dependents were analyzed. Children who filled ≥1 antipsychotic prescription during the calendar year were considered antipsychotic users.

Antipsychotic use peaked in 2009 at 0.29%, decreasing significantly the following year (P <.01) and continuing to decrease through 2017 (P <.01). Boys aged 2-3 years had the greatest relative decrease in antipsychotic use (P <.01). A significant increase was observed in the proportion of children with antipsychotic use who had ≥1 visit with a healthcare provider in 2017 compared with 2009 (P <.01). In addition, a significant increase was observed in the proportion of children with antipsychotic use who received a mental disorder diagnosis in 2017 compared with 2009 (P <.01). A significant decrease was observed in the proportion of children initiating antipsychotic medication for ADHD, depression, anxiety, adjustment disorder, unspecified mood disorder or “other” mental disorders in 2017 compared with 2009 (P <.01).

Limitations to this study include the focus on privately insured children with prescription drug coverage, which prevents applying these findings to uninsured children or children insured through Medicaid. Demographic data was also unavailable, limiting the ability to investigate differences among races and ethnicities. Future studies with demographic data, regional data, and data differentiating between new and continuing antipsychotic use are warranted.

The results of this study indicated that antipsychotic prescribing rates in privately insured children aged 2-7 years significantly declined from 2007 to 2017, peaking in 2009. This decline, paired with the increase in mental disorder diagnoses and visits to healthcare providers may indicate a trend towards more cautious prescribing.

Reference

Bushnell GA, Crystal S, Olfson M. Trends in antipsychotic medication use in young privately insured children. [published online October 20, 2020]. J Am Acad Child Adolesc Psychiatry. doi: 10.1016/j.jaac.2020.09.023