医疗补助计划覆盖的青少年中的寄养照料、外化性障碍及抗精神病药物使用情况
Foster care, externalizing disorders, and antipsychotic use among Medicaid-enrolled youths.
作者信息
Vanderwerker Lauren, Akincigil Ayse, Olfson Mark, Gerhard Tobias, Neese-Todd Sheree, Crystal Stephen
出版信息
Psychiatr Serv. 2014 Oct;65(10):1281-4. doi: 10.1176/appi.ps.201300455.
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.
目的
作者调查了外化性障碍的临床诊断在多大程度上解释了寄养青少年使用抗精神病药物的较高比例。
方法
分析了来自44个州的2009年医疗补助索赔数据，涉及寄养青少年（N = 301,894）和非寄养青少年（N = 5,092,574），排除了患有精神分裂症、双相情感障碍、自闭症和重度抑郁症的青少年。逻辑回归分析评估了寄养、外化性障碍和抗精神病药物使用之间的关系。
结果
寄养青少年的外化性障碍发生率高于对照组（注意缺陷多动障碍，17.3%对6.5%；破坏性行为障碍，7.2%对2.5%；品行障碍，2.3%对0.5%），且抗精神病药物使用率更高（7.4%对1.4%）。在控制了人口统计学和诊断协变量（包括外化性障碍）后，寄养仍然是抗精神病药物使用的显著预测因素（调整后的优势比 = 2.59，95%置信区间 = 2.54 - 2.63）。
结论
外化性障碍诊断的高比例仅部分解释了这一弱势群体中抗精神病药物使用水平的升高。
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