Psychotropic polypharmacy among youths with serious emotional and behavioral disorders receiving coordinated care services

Benjamin Wu, Eric J. Bruns, Ming Hui Tai, Bethany R. Lee, Ramesh Raghavan, Susan DosReis

    Research output: Contribution to journalArticle

    Abstract

    Objective: The study examined differences in psychotropic polypharmacy among youths with serious emotional and behavioral disorders who received coordinated care services (CCS) that used a wraparound model and a matched sample of youths who received traditional services. Methods: A quasi-experimental design compared psychotropic polypharmacy one year before and one year after discharge from CCS. The cohort was youths with serious emotional and behavioral disorders who were enrolled in CCS from December 2009 through May 2014. The comparison group was youths with serious emotional and behavioral disorders who received outpatient mental health services during the same time. Administrative data from Medicaid, child welfare, and juvenile justice services were used. A difference-in-difference analysis with propensity score matching evaluated the CCS intervention by time effect on psychotropic polypharmacy. Results: In both groups, most youths were male, black, and 10–18 years old, with attention-deficit hyperactivity disorder (54%255%), mood disorder (39%242%), depression (26%227%), and bipolar disorder (25%226%). About half of each group was taking an antipsychotic. The percentage reduction in polypharmacy from one year before CCS enrollment to one year after discharge was 28% for the CCS group and 29% for the non-CCS group, a nonsignificant difference. CCS youths excluded from the analysis had more complex mental health needs and a greater change in polypharmacy than the CCS youths who were included in the analytic sample. Conclusions: Mental health care coordination had limited impact in reducing psychotropic polypharmacy for youths with less complex mental health needs. Further research is needed to evaluate the effect on psychotropic polypharmacy among youths with the greatest mental health needs.

    Original languageEnglish (US)
    Pages (from-to)716-722
    Number of pages7
    JournalPsychiatric Services
    Volume69
    Issue number6
    DOIs
    StatePublished - Jun 1 2018

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    Polypharmacy
    Mental Health
    Propensity Score
    Medicaid
    Social Justice
    Mental Health Services
    Attention Deficit Disorder with Hyperactivity
    Ambulatory Care
    Mood Disorders
    Bipolar Disorder
    Child Welfare
    Antipsychotic Agents
    Research Design
    Depression
    Delivery of Health Care

    ASJC Scopus subject areas

    • Psychiatry and Mental health

    Cite this

    Psychotropic polypharmacy among youths with serious emotional and behavioral disorders receiving coordinated care services. / Wu, Benjamin; Bruns, Eric J.; Tai, Ming Hui; Lee, Bethany R.; Raghavan, Ramesh; DosReis, Susan.

    In: Psychiatric Services, Vol. 69, No. 6, 01.06.2018, p. 716-722.

    Research output: Contribution to journalArticle

    Wu, Benjamin ; Bruns, Eric J. ; Tai, Ming Hui ; Lee, Bethany R. ; Raghavan, Ramesh ; DosReis, Susan. / Psychotropic polypharmacy among youths with serious emotional and behavioral disorders receiving coordinated care services. In: Psychiatric Services. 2018 ; Vol. 69, No. 6. pp. 716-722.
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    abstract = "Objective: The study examined differences in psychotropic polypharmacy among youths with serious emotional and behavioral disorders who received coordinated care services (CCS) that used a wraparound model and a matched sample of youths who received traditional services. Methods: A quasi-experimental design compared psychotropic polypharmacy one year before and one year after discharge from CCS. The cohort was youths with serious emotional and behavioral disorders who were enrolled in CCS from December 2009 through May 2014. The comparison group was youths with serious emotional and behavioral disorders who received outpatient mental health services during the same time. Administrative data from Medicaid, child welfare, and juvenile justice services were used. A difference-in-difference analysis with propensity score matching evaluated the CCS intervention by time effect on psychotropic polypharmacy. Results: In both groups, most youths were male, black, and 10–18 years old, with attention-deficit hyperactivity disorder (54{\%}255{\%}), mood disorder (39{\%}242{\%}), depression (26{\%}227{\%}), and bipolar disorder (25{\%}226{\%}). About half of each group was taking an antipsychotic. The percentage reduction in polypharmacy from one year before CCS enrollment to one year after discharge was 28{\%} for the CCS group and 29{\%} for the non-CCS group, a nonsignificant difference. CCS youths excluded from the analysis had more complex mental health needs and a greater change in polypharmacy than the CCS youths who were included in the analytic sample. Conclusions: Mental health care coordination had limited impact in reducing psychotropic polypharmacy for youths with less complex mental health needs. Further research is needed to evaluate the effect on psychotropic polypharmacy among youths with the greatest mental health needs.",
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