Diagnostic Patterns and Racial/Ethnic Differences in Antipsychotic Prescribing Among Privately Insured Youth

This study examined antipsychotic prescribing patterns with respect to mental health diagnoses and racial/ethnic differences among privately insured youth. We leveraged 2009-2021 data from Optum's de-identified Clinformatics^® Data Mart Database, derived from a database of administrative claims for members of large commercial and Medicare Advantage healthcare insurance plans. There were 46,372 new antipsychotic users between 6-17 years old. For each antipsychotic user, we identified a non-user with the same age, sex, and year of enrollment. We first examined sociodemographic and mental health characteristics of antipsychotic users. We then compared the odds of being an antipsychotic user across different racial/ethnic groups. Comparisons were repeated in subgroups of youth diagnosed with attention-deficit/hyperactivity disorder (ADHD), depressive disorders, and disruptive behavior disorders to examine racial/ethnic differences within common, off-label diagnoses. At least 61% of antipsychotic users had no recorded FDA-approved diagnoses. Depressive disorders and ADHD appeared most frequently, in 46% and 40% of antipsychotic users, respectively. Across the full sample, racial/ethnic minority youth had approximately 25-60% lower odds of antipsychotic use compared with White youth. However, racial/ethnic differences were greatly reduced or eliminated within groups of youth with ADHD, depressive disorders, and disruptive behavior disorders. These findings suggest most privately insured antipsychotic users lack recorded diagnoses for which antipsychotic use in youth is FDA-approved or has established guidelines. Furthermore, it is possible that observed differences in antipsychotic use among racial/ethnic minoritized groups can be attributed at least in part to disparities upstream of initial diagnoses.