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Abstract

Objectives

The authors investigated the extent to which clinical diagnoses of externalizing disorders explain higher rates of antipsychotic use by foster care youths.

Methods

Medicaid claims data from 44 states for 2009 for youths in foster care (N=301,894) and those not in foster care (N=5,092,574) were analyzed, excluding those with schizophrenia, bipolar disorder, autism, and major depressive disorder. Logistic regressions assessed the relationship between foster care, externalizing disorders, and antipsychotic use.

Results

Foster care youths had higher rates of externalizing disorders than the comparison group (attention-deficit hyperactivity disorder, 17.3% versus 6.5%; disruptive behavior disorder, 7.2% versus 2.5%; conduct disorder, 2.3% versus .5%) and greater antipsychotic use (7.4% versus 1.4%). Foster care remained a significant predictor of antipsychotic use after control for demographic and diagnostic covariates, including externalizing disorders (adjusted odds ratio=2.59, 95% confidence interval=2.54–2.63).

Conclusions

High rates of externalizing disorder diagnoses only partially explained elevated levels of antipsychotic use in this vulnerable population.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services

Cover: Shamrock Ranch, by Peter Hurd, 1962. Watercolor, 12 × 16 inches. New Mexico Museum of Art, Santa Fe. Gift of the family of Edythe C. Mattone, 2005.

Psychiatric Services
Pages: 1281 - 1284
PubMed: 25124057

History

Published online: 1 October 2014
Published in print: October 2014

Authors

Details

Lauren Vanderwerker, Ph.D.
When this work was done Dr. Vanderwerker was with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, where Dr. Akincigil, Dr. Gerhard, and Dr. Crystal are on the faculty and Ms. Neese-Todd is on the research staff. Dr. Akicigil and Dr. Crystal are also with the School of Social Work and Dr. Gerhard is with the Ernest Mario School of Pharmacy, Rutgers University. Dr. Olfson is with the New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City. Dr. Vanderwerker is now with The Hilltop Institute, University of Maryland Baltimore County, Baltimore (e-mail: [email protected]).
Ayse Akincigil, Ph.D.
When this work was done Dr. Vanderwerker was with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, where Dr. Akincigil, Dr. Gerhard, and Dr. Crystal are on the faculty and Ms. Neese-Todd is on the research staff. Dr. Akicigil and Dr. Crystal are also with the School of Social Work and Dr. Gerhard is with the Ernest Mario School of Pharmacy, Rutgers University. Dr. Olfson is with the New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City. Dr. Vanderwerker is now with The Hilltop Institute, University of Maryland Baltimore County, Baltimore (e-mail: [email protected]).
Mark Olfson, M.D., M.P.H.
When this work was done Dr. Vanderwerker was with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, where Dr. Akincigil, Dr. Gerhard, and Dr. Crystal are on the faculty and Ms. Neese-Todd is on the research staff. Dr. Akicigil and Dr. Crystal are also with the School of Social Work and Dr. Gerhard is with the Ernest Mario School of Pharmacy, Rutgers University. Dr. Olfson is with the New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City. Dr. Vanderwerker is now with The Hilltop Institute, University of Maryland Baltimore County, Baltimore (e-mail: [email protected]).
Tobias Gerhard, Ph.D.
When this work was done Dr. Vanderwerker was with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, where Dr. Akincigil, Dr. Gerhard, and Dr. Crystal are on the faculty and Ms. Neese-Todd is on the research staff. Dr. Akicigil and Dr. Crystal are also with the School of Social Work and Dr. Gerhard is with the Ernest Mario School of Pharmacy, Rutgers University. Dr. Olfson is with the New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City. Dr. Vanderwerker is now with The Hilltop Institute, University of Maryland Baltimore County, Baltimore (e-mail: [email protected]).
Sheree Neese-Todd, M.A.
When this work was done Dr. Vanderwerker was with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, where Dr. Akincigil, Dr. Gerhard, and Dr. Crystal are on the faculty and Ms. Neese-Todd is on the research staff. Dr. Akicigil and Dr. Crystal are also with the School of Social Work and Dr. Gerhard is with the Ernest Mario School of Pharmacy, Rutgers University. Dr. Olfson is with the New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City. Dr. Vanderwerker is now with The Hilltop Institute, University of Maryland Baltimore County, Baltimore (e-mail: [email protected]).
Stephen Crystal, Ph.D.
When this work was done Dr. Vanderwerker was with the Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, New Jersey, where Dr. Akincigil, Dr. Gerhard, and Dr. Crystal are on the faculty and Ms. Neese-Todd is on the research staff. Dr. Akicigil and Dr. Crystal are also with the School of Social Work and Dr. Gerhard is with the Ernest Mario School of Pharmacy, Rutgers University. Dr. Olfson is with the New York State Psychiatric Institute and Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City. Dr. Vanderwerker is now with The Hilltop Institute, University of Maryland Baltimore County, Baltimore (e-mail: [email protected]).

Funding Information

Agency for Healthcare Research and Quality10.13039/100000133: HS017918
: R18HS019937
National Institute of Mental Health10.13039/100000025: MH-16242

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