Examining psychotropic medication use among youth in the U.S. by race/ethnicity and psychological impairment.

OBJECTIVE: Clinical practice guidelines underscore the need for careful evaluation of the risk-benefit ratio of psychotropic medications treating mental health disorders among youth. While it is well known that racial/ethnic disparities exist in psychotropic medication use, little is known about whether these differences are driven by over-prescribing among white youth, under-prescribing among minority youth, or both. To build evidence in this area, this study examined racial/ethnic differences in the prescription of psychotropic medications among youth with and without psychological impairment. METHODS: Secondary data on two-year medication use from the 2004-2011 Medical Expenditure Panel Surveys were analyzed. We capitalized on two-year panel data, creating variables that allow for differential sequencing of psychological impairment and medication prescription (e.g., impairment in year 1 or year 2, and a psychotropic medication fill in year 2). Statistical differences were determined using unadjusted rate comparisons and logistic regression models, after adjustment for socio-contextual and health status characteristics. RESULTS: Compared to Black and Latino youth with psychological impairment, White youth were more likely to be prescribed psychotropic medications when impaired. Among youth never having psychological impairment, White youth were also more likely to be prescribed medications compared to their racial/ethnic minority counterparts. CONCLUSIONS: Differences in rates of medication use among youth with and without impairment suggest poor medication targeting across racial/ethnic groups. These results, combined with recent psychotropic medication risk warnings and concerns over increases in psychotropic medication use among youth, suggest that a continued emphasis on accurate targeting of prescribing patterns is needed across racial/ethnic groups.

Effectiveness of the Engagement and Counseling for Latinos (ECLA) intervention in low-income Latinos.

BACKGROUND: Persistent disparities in access and quality of mental health care for Latinos indicate a need for evidence-based, culturally adapted, and outside-the-clinic-walls treatments. OBJECTIVE: Evaluate treatment effectiveness of telephone (ECLA-T) or face-to-face (ECLA-F) delivery of a 6-8 session cognitive behavioral therapy and care management intervention for low-income Latinos, as compared to usual care for depression. DESIGN: Multisite randomized controlled trial. SETTING: Eight community health clinics in Boston, Massachusetts and San Juan, Puerto Rico. PARTICIPANTS: 257 Latino patients recruited from primary care between May 2011 and September 2012. MAIN OUTCOME MEASURES: The primary outcome was severity of depression, assessed with the Patient Health Questionnaire-9 and the Hopkins Symptom Checklist-20. The secondary outcome was functioning over the previous 30 days, measured using the World Health Organization Disability Assessment Schedule (WHO-DAS 2.0). RESULTS: Both telephone and face-to-face versions of the Engagement and Counseling for Latinos (ECLA) were more effective than usual care. The effect sizes of both intervention conditions on Patient Health Questionnaire-9 were moderate when combined data from both sites are analyzed (0.56 and 0.64 for face-to-face and telephone, respectively). Similarly, effect sizes of ECLA-F and ECLA-T on the Hopkins Symptom Checklist were quite large in the Boston site (0.64 and 0.73. respectively) but not in Puerto Rico (0.10 and 0.03). CONCLUSIONS AND RELEVANCE: The intervention appears to help Latino patients reduce depressive symptoms and improve functioning. Of particular importance is the higher treatment initiation for the telephone versus face-to-face intervention (89.7% vs. 78.8%), which suggests that telephone-based care may improve access and quality of care.

Trends in smoking among adults with mental illness and association between mental health treatment and smoking cessation.

IMPORTANCE: Significant progress has been made in reducing the prevalence of tobacco use in the United States. However, tobacco cessation efforts have focused on the general population rather than individuals with mental illness, who demonstrate greater rates of tobacco use and nicotine dependence. OBJECTIVES: To assess whether declines in tobacco use have been realized among individuals with mental illness and examine the association between mental health treatment and smoking cessation. DESIGN, SETTING, AND PARTICIPANTS: Use of nationally representative surveys of noninstitutionalized US residents to compare trends in smoking rates between adults with and without mental illness and across multiple disorders (2004-2011 Medical Expenditure Panel Survey [MEPS]) and to compare rates of smoking cessation among adults with mental illness who did and did not receive mental health treatment (2009-2011 National Survey of Drug Use and Health [NSDUH]).The MEPS sample included 32,156 respondents with mental illness (operationalized as reporting severe psychological distress, probable depression, or receiving treatment for mental illness) and 133,113 without mental illness. The NSDUH sample included 14,057 lifetime smokers with mental illness. MAIN OUTCOMES AND MEASURES: Current smoking status (primary analysis; MEPS sample) and smoking cessation, operationalized as a lifetime smoker who did not smoke in the last 30 days (secondary analysis; NSDUH sample). RESULTS: Adjusted smoking rates declined significantly among individuals without mental illness (19.2% [95% CI, 18.7-19.7%] to 16.5% [95% CI, 16.0%-17.0%]; P < .001) but changed only slightly among those with mental illness (25.3% [95% CI, 24.2%-26.3%] to 24.9% [95% CI, 23.8%- 26.0%]; P = .50), a significant difference in difference of 2.3% (95% CI, 0.7%-3.9%) (P = .005). Individuals with mental illness who received mental health treatment within the previous year were more likely to have quit smoking (37.2% [95% CI, 35.1%-39.4%]) than those not receiving treatment (33.1% [95% CI, 31.5%-34.7%]) (P = .005). CONCLUSIONS AND RELEVANCE: Between 2004 and 2011, the decline in smoking among individuals with mental illness was significantly less than among those without mental illness, although quit rates were greater among those receiving mental health treatment. This suggests that tobacco control policies and cessation interventions targeting the general population have not worked as effectively for persons with mental illness.