Of more than 7,700 youths with a new episode of PTSD in 2012, about 60% received psychotherapy, about 6% received pharmacotherapy and more than one-third received neither therapy nor medication, according to retrospective study findings.
“To date, little is known about the prevalence of psychotropic prescribing for PTSD among children and adolescents in the United States. If common, this practice would be concerning, given that it is associated with significant side effects and limited efficacy, hardly a favorable risk-benefit ratio,” Rene Soria-Saucedo, MD, PhD, from the department of health policy and management, Boston University School of Public Health, and colleagues wrote. “Similarly, little is known about the factors associated with the use of pharmacotherapy for PTSD among youths.”
Researchers conducted a retrospective cohort analysis using medical and pharmacy claims data from a nationally representative sample of privately insured Americans to examine which characteristics of youths with PTSD were tied to receiving prescriptions for antidepressants, antipsychotics or benzodiazepines. They included children and teens aged 6 to 18 years who received a new diagnosis of PTSD between Jan. 1 and Dec. 31, 2012.
Of 7,726 pediatric patients with PTSD included in this study, 5.9% received pharmacotherapy, 59% received psychotherapy alone, 2.7% received combination treatment and 35.2% received neither psychotherapy nor pharmacotherapy. Among youth with PTSD who received pharmacotherapy, 71.3% took antidepressants, 21.6% took antipsychotics and 7.1% took benzodiazepines.
Youths receiving pharmacotherapy group were more likely to be older, to be female, live in the South, live in rural areas and be treated by mental health providers. Children received antipsychotics more often than antidepressants or benzodiazepines (27.6% vs. 17.7% and 6.3%). Teenagers accounted for almost all benzodiazepine users (93.8%). Females accounted for about 75% of benzodiazepine and antidepressant users and 59.2% of antipsychotic users.
Provider specialty had the strongest tie to antidepressant use (OR = 3.13) and history of hospitalization was the strongest predictor of antipsychotic use (OR = 2.99). Providers in the Northeastern and Western region were less likely to prescribe antidepressants and antipsychotics than those in the South.
“Even though less than 10% of youths used off-label pharmaceuticals, quality-of-care concerns remain valid,” the authors wrote. “Further research is needed to understand the rationale behind the prescription of pharmacotherapy for PTSD among children and develop initiatives to expand psychotherapy access, especially in the primary care setting.” – by Savannah Demko
Disclosure: The authors report no relevant financial disclosures.