Association Between Neighborhood Context and Psychotropic Polypharmacy Use Among High-Need Children

Area of Science:

• Pediatric Healthcare Research
• Social Determinants of Health
• Health Services Research

Background:

• Children with high needs often receive complex care, including psychotropic medications and psychotherapy.
• Understanding how neighborhood context influences treatment is crucial for equitable care delivery.

Purpose of the Study:

• To investigate the association between neighborhood context and psychotropic polypharmacy and psychotherapy utilization in high-need children.
• To identify disparities in treatment based on neighborhood characteristics, race, and ethnicity.

Main Methods:

• A cross-sectional study analyzed electronic health records of 4,017 children (ages 2-17) from 2015-2019.
• Psychotropic polypharmacy was defined as concurrent use of ≥2 drug classes for ≥60 days; psychotherapy included any therapy or adaptive behavior treatment.
• Neighborhood context was measured using the Child Opportunity Index; multilevel models assessed associations with treatment outcomes.

Main Results:

• Moderate and high child opportunity were associated with increased odds of polypharmacy and psychotherapy, respectively.
• Black race and Hispanic ethnicity were linked to lower odds of psychotropic polypharmacy compared to White race.
• Associations remained significant after adjusting for clinical factors.

Conclusions:

• Neighborhood factors, including the Child Opportunity Index, race, and ethnicity, significantly influence treatment outcomes for high-need children.
• Findings suggest structural disparities and systemic racism may affect access to and utilization of mental health services.
• Further research is needed to address these access and equity concerns.