27 - Use of Psychotropic Medications among Adolescents and Young Adults in the United States, 2000-2019

Publication Number: 3024.27

Lauren E. Wisk, University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA, United States; Chu J. Zhuang, University of California, Los Angeles David Geffen School of Medicine, Santa Monica, CA, United States; Kristen Choi, UCLA Joe C. Wen School of Nursing, Los Angeles, CA, United States; Susan Ettner, University of California, Los Angeles David Geffen School of Medicine, Culver City, CA, United States; Bonnie Zima, Child Psychiatry, UCLA-Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, United States

Background: US health officials have suggested that psychotropic medication overuse in youth, specifically stimulants and selective serotonin reuptake inhibitors (SSRIs), has contributed to an increase in violent incidents, due in part to purported over-prescribing.

Objective: We sought to describe the prevalence and patterning of stimulant and SSRI use among U.S. adolescents and young adults to evaluate evidence for overprescribing and differential access.

Design/Methods: Data are from the nationally representative Medical Expenditure Panel Survey, which provides two calendar years of healthcare utilization and survey data on non-institutionalized individuals. 56,973 person-years for respondents aged 12-26 who were interviewed between 2000-2019 were identified. Existing algorithms were applied to identify receipt of any stimulant or SSRI medications during the observation window and we evaluated the association with sociodemographic characteristics (Table). The Child and Adolescent Mental Health Disorders Classification System (CAMHD) was used to classify mental, behavioral and developmental health conditions using ICD-9/10 diagnostic codes. Analyses reflect the multi-stage probability-based sampling design of the MEPS.

Results: 7.62% and 8.03% of youth used any stimulant or SSRI medications, respectively. 39.1% of SSRI prescriptions were accompanied by a diagnosis of anxiety, 78.3% with depression, 31.9% with obsessive compulsive disorder; 46.2% of SSRI prescriptions were to individuals with more than one CAMHD diagnosis. 82.5% of stimulant prescriptions were accompanied by a diagnosis of ADHD and 17.3% to individuals with more than one CAMHD diagnosis. Prevalence of stimulant or SSRI use among those without a CAMHD diagnosis was rare (both < 0.5%). Annual use prevalence of use increased between 2000 and 2019 for both drugs, accompanied by a rise in condition prevalence and expanded FDA approvals also seen over this period. While SSRI use increased with age (4.9% among ages 12-14 vs 9.9% among ages 24-26, p<.001), stimulant use decreased with age (14.8% among ages 12-14 vs 3.0% among ages 24-26, p<.001). Differences in use of these medications were also seen by sex, ethnicity, race, education, insurance, and region of residence.

Conclusion(s): Use of these medications overall was low ( < 10% of youth) and aligned with indicators of having a qualifying behavioral health diagnosis. We find evidence of disparities by socioeconomic status, highlighting equity concerns. Future work will evaluate the use of medications in conjunction with therapy versus alone.

Psychotropic medication use by sociodemographic characteristics among youth ages 12-26 in the US (2000-2019)
Meds-Table.pdfTable shows the prevalence of sociodemographic characteristics in the sample (%, total column; eg 14.9% of the sample is Hispanic) and the prevalence of any SSRI or stimulant use by each sociodemographic characteristic (eg 5.4% of Hispanic youth report any SSRI use). All comparisons of medication use by sociodemographics are statistically significant at p<0.001.