Krantz Landon B, Froehlich Tanya E, Beck Andrew F, Becker Stephen P, MacDougall Melinda C, Ehrlich Shelley, Anyigbo Chidiogo U, Eggers Samuel, Brinkman William B
Division of General and Community Pediatrics (LB Krantz, AF Beck, MC MacDougall, CU Anyigbo, S Eggers, and WB Brinkman), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics (LB Krantz, TE Froehlich, AF Beck, S Ehrlich, CU Anyigbo, and WB Brinkman), University of Cincinnati College of Medicine, Cincinnati, Ohio.
Department of Pediatrics (LB Krantz, TE Froehlich, AF Beck, S Ehrlich, CU Anyigbo, and WB Brinkman), University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Developmental and Behavioral Pediatrics (TE Froehlich and SP Becker), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Acad Pediatr. 2025 Jun 6;25(7):102863. doi: 10.1016/j.acap.2025.102863.
To examine whether higher attention-deficit/hyperactivity disorder (ADHD) medication coverage was associated with lower depressive symptoms among adolescents who live in underresourced neighborhoods and/or identify as a member of a minoritized group.
In this retrospective cohort study, adolescents aged 12 to 18 years with ADHD completed a depression screener at their annual well visit. Patients were seen at a primary care office that predominantly serves minoritized, Medicaid-insured youth from underresourced neighborhoods. We calculated ADHD medication coverage as the percentage of days in which medication was available in the prior 36 months based on prescriptions in the electronic health record (range 0%-100%). Zero-inflated negative binomial regression models assessed whether medication coverage was associated with differences in total depression scores, measured by the Patient Health Questionnaire.
We included 2569 adolescents (66.6% male, 70.9% Black, 86.6% Medicaid-insured) with 4145 well visits. Medication coverage was poor (mean = 18.5% days covered, standard deviation = 26.8%). Higher medication coverage was not associated with lower depression scores in the overall sample. However, after excluding patients with 0% medication coverage, there was a significant association between higher coverage and lower depression scores. Depression symptom scores were higher in patients with mental/behavioral health comorbidities, those of female sex, and those living in neighborhoods with lower opportunity scores.
Greater ADHD medication coverage was associated with a small, yet potentially clinically significant decrease in depression symptoms in our sample, underscoring the need to investigate the protective effect of ADHD medication on depression in more diverse populations.
研究在资源匮乏社区居住和/或属于少数族裔群体的青少年中，更高的注意力缺陷多动障碍（ADHD）药物覆盖范围是否与更低的抑郁症状相关。
在这项回顾性队列研究中，患有ADHD的12至18岁青少年在年度健康检查时完成了抑郁筛查。患者在一家主要为来自资源匮乏社区的少数族裔、参加医疗补助保险的青少年提供服务的初级保健诊所就诊。我们根据电子健康记录中的处方，将ADHD药物覆盖范围计算为前36个月内有药物可用的天数百分比（范围为0%-100%）。零膨胀负二项回归模型评估药物覆盖范围是否与通过患者健康问卷测量的总抑郁评分差异相关。
我们纳入了2569名青少年（66.6%为男性，70.9%为黑人，86.6%参加医疗补助保险），进行了4145次健康检查。药物覆盖情况较差（平均覆盖天数=18.5%，标准差=26.8%）。在总体样本中，更高的药物覆盖范围与更低的抑郁评分无关。然而，在排除药物覆盖范围为0%的患者后，更高的覆盖范围与更低的抑郁评分之间存在显著关联。患有精神/行为健康合并症的患者、女性患者以及居住在机会评分较低社区的患者的抑郁症状评分更高。
在我们的样本中，更高的ADHD药物覆盖范围与抑郁症状的小幅但可能具有临床意义的降低相关，这突出了在更多样化人群中研究ADHD药物对抑郁的保护作用的必要性。
