Looking at mental health utilization and Medicaid

Dinci Pennap, PhD

A recent study reveals that one-fifth of a Medicaid-insured birth cohort received a mental health diagnosis before age 8 years, and 10% received at least 1 medication as a result of their diagnosis.

The report, which assessed medical claims data for more than 35,000 children covered by Medicaid in a Mid-Atlantic state, was published in JAMA Pediatrics¹ and led by Dinci Pennap, PhD, of the University of Maryland Department of Pharmaceutical Health Services Research, Baltimore, and her colleagues. The research team’s goal was to quantify the extent to which children received mental health care and related medications.

“Our findings highlight substantial mental health service utilization in the medical claims data of a vulnerable and economically disadvantaged pediatric population,” Pennap says. “Whether or not there is under- or overutilization is dependent on the ‘true’ incidence of mental health problems in this publicly insured population.”

Of the children aged 8 years and younger who were studied as part of the report, 20% received a psychiatric diagnosis and 58% of those were behavioral in nature. The most common diagnoses uncovered were attention-deficit/hyperactivity disorder (ADHD) at 44% and another 32% were learning disorders. Of the children diagnosed, 10% were prescribed psychotropic medications. Most of them-81%-were given just a single prescription, but 16% were prescribed 2 medications and 4% received 3 or more prescriptions for 60 or more days.

Additionally, 75% of the children prescribed medications for a mental health condition were given a stimulant, 32% were given an alpha-agonist, and 20% received an anxiolytic or hypnotic medication, according to the data. The research team also found that at age 7 years, half or more of the children in the study who had received mental health medications had more than 200 days of annual drug exposure overall. Most (in the year they turned 3 years old) received prescriptions for at least 60 days, the team says.

In terms of first mental health diagnosis, 22% of girls were diagnosed with adjustment disorders compared with 15% of boys, and 7% of girls were diagnosed with anxiety disorders compared with 4% of boys, the researchers note. Boys, however, were more likely to be diagnosed with ADHD at 30% of the study group, compared with 22% of girls.

“We hope that our findings regarding early medication exposure and prolonged medication use will spark a dialogue around clinical monitoring and health outcomes research among pediatric psychotropic medication users,” Pennap says. “The bulk of pediatric mental health visits are to pediatricians. The importance of clinical monitoring in follow-up visits after psychotropic medication initiation cannot be overemphasized.”

When asked whether the study investigated safety or appropriate usage of mental health services in the population, Pennap says the study did not address safety or appropriate use, but reveals trends that could be compared with other populations.

“While our study findings are not sufficient to determine under- or overutilization in this birth cohort, studies comparing psychotropic medication utilization among publicly insured youths in the United States and select European countries suggest far greater utilization in the US pediatric populations compared to their European counterparts,” Pennap says. “Yet, there is little evidence that greater use reflects appropriate beneficial care.”

Pennap says she hopes the study will be used to help inform policy and regulatory decisions to improve clinical monitoring and establish protocols for follow-up care for early mental health services, particularly among publicly-insured children.

References:

1. Pennap D, Zito JM, Santosh PJ, Tom SE, Onukwugha E, Magder LS. Patterns of early mental health diagnosis and medication treatment in a Medicaid-insured birth cohort. JAMA Pediatrics. 2018;172(6):576-584.