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Black Children Less Likely to Receive Adequate Medication for Psychiatric Disorders

Black children are more likely to receive inadequate pharmacotherapy for their mental health conditions than children in other racial groups, a study in Psychiatric Services in Advance has found. The study also suggests that children who have anxiety are more likely to receive inadequate pharmacotherapy than children who have other mental illnesses.

Andrea S. Young, Ph.D., of Johns Hopkins University School of Medicine and colleagues analyzed data from 601 children aged six to 12 years who had visited one of nine outpatient mental health clinics and participated in the Longitudinal Assessment of Manic Symptoms study. The children and their parents were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia and the Service Assessment for Children and Adolescents to assess the child’s psychiatric symptoms and lifetime mental health services use, respectively. The children’s global functioning was assessed via the Children’s Global Assessment Scale, and mental health service use data were collected by using the Service Assessment for Children and Adolescents.

A child psychiatrist and a child psychologist reviewed the children’s current and past psychiatric diagnoses, medications taken, psychotherapy received, psychiatric inpatient admissions, number of sessions, and duration of each intervention. They independently rated the children’s current pharmacologic and psychotherapy interventions as standard of care, adequate, inadequate, inappropriate, or treatment pending. Treatment ratings were then collapsed into two groups: inadequate (combining inadequate, inappropriate, and treatment pending ratings) and adequate (combining adequate and standard-of-care ratings). Due to limited information about the patients’ experience with psychotherapy, Young and colleagues limited their analyses to medication adequacy.

Overall, only 51% of the children were receiving adequate pharmacotherapy for their mental health conditions. Compared with White children, Black children had 1.84 times the odds of receiving inadequate pharmacotherapy. Black children also had 1.91 times the odds of receiving inadequate pharmacotherapy compared with the combined race group (which included American Indian/Alaska Native, Asian, biracial/multiracial children, and children whose parents chose not to disclose their children’s race).

Young and colleagues also found that children who had anxiety disorders had 1.55 times the odds of receiving inadequate pharmacotherapy compared with children who had other mental disorders. However, children whose caregivers had at least a bachelor’s degree were more likely to receive adequate pharmacotherapy compared with children whose parents had a high school education, general equivalency diploma, or less than a high school education.

“The findings highlight the need for further investigation into the contributors to racial disparities in receiving adequate mental health care and to develop strategies for improving children’s access to mental health care,” Young and colleagues wrote. “The results also underscore a need both for systemic change to reduce barriers and for providers to practice cultural humility in their clinical work.”

For related information, see the Psychiatric Services article “Understanding Racial-Ethnic Disparities in Wraparound Care for Youths With Emotional and Behavioral Disorders.”