Identifying Predictive Factors for Psychotropic Use in Youths With PTSD

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Of 7726 youths included in the study, 59.0% received psychotherapy alone, 5.9% received pharmacotherapy, and 35.2% received neither psychotherapy nor pharmacotherapy.
Of 7726 youths included in the study, 59.0% received psychotherapy alone, 5.9% received pharmacotherapy, and 35.2% received neither psychotherapy nor pharmacotherapy.

Less than 60% of youths received first-line psychotherapy treatment following an episode of post-traumatic stress disorder (PTSD), according to a cohort study published in Psychiatric Services in Advance. Psychotropic medication use was associated with more severe symptomatology, although more than a third of patients did not receive either treatment.

A retrospective cohort of privately insured children and adolescents with new episode PTSD was extracted from medical and pharmacy claims from 2011 to 2012. Multivariate logistic regression was used to identify the relationship between certain sociodemographic and medical characteristics and the mode of treatment received. Treatment categories included psychotherapy and pharmacotherapy, with the latter including treatment with antidepressants, antipsychotics, and benzodiazepines. 

Of 7726 youths included in the study, 4556 (59.0%) received psychotherapy alone, 453 (5.9%) received pharmacotherapy, and 2717 (35.2%) received neither psychotherapy nor pharmacotherapy. Just 209 participants (2.7%) received both psychotherapy and pharmacotherapy treatment. In patients receiving pharmacotherapy, 71.3% used antidepressants, 21.6% used antipsychotics, and 7.1% used benzodiazepines. Youths receiving pharmacotherapy were typically older than youths without medication prescriptions, and more likely to be female, live in the South, reside in rural areas, and be treated by mental health providers. Previous hospitalization (odds ratio [OR], 2.99; 95% confidence interval [CI], 1.67-5.35; P <.05) and psychiatric comorbidities (OR, 2.27; 95% CI, 1.29-3.98; P <.05) predicted antipsychotic use specifically; provider specialty (OR, 3.13; 95% CI, 1.80-5.43; P <.001) and general medical comorbidities (OR, 2.34; 95% CI, 1.82-3.01; P <.001) predicted antidepressant use. Capitated insurance was associated with antidepressant use, while non-capitated insurance was associated with antipsychotic use.

These data suggest that psychotherapy is underutilized as treatment in youths with PTSD, and that many youths with PTSD do not receive any form of care. Pharmacotherapy was typically associated with more “severe and complex” presentations of the disorder, although future research is necessary to identify the most efficacious modes of treatment for PTSD in this age demographic.

Reference

Soria-Saucedo R, Chung JH, Walter H, Soley-Bori M, Kazis LE. Factors that predict the use of psychotropics among children and adolescents with PTSD: evidence from private insurance claims [published online July 2, 2018]. Psychiatr Serv. doi:10.1176/appi.ps.201700167

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