Author's School

Brown School of Social Work

Author's Department/Program

Social Work

Language

English (en)

Date of Award

5-30-2012

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Chair and Committee

Curtis McMillen

Abstract

Problem: The use of psychotropic medications among foster youth has received growing national attention due to high rates of use and concerns about the appropriateness of prescribing. Understanding medication use in older foster youth is of heightened concern as these youth are preparing to transition out of the state custody and assume the management of their mental health care. While it has been established that rates of medication use are high among this population, little is known about the demographic and clinical factors associated with high rates of medication use and what patterns of use look like over time.

Methods: This study used data from a sample of 404 foster youths in Missouri from 2001-2005 to examine situations associated with medication use at age 17, then characterize patterns of use over the subsequent year for those who remained in state custody: n=294). Data were collected through structured interviews with youths including interviewer derived diagnoses using the Diagnostic Interview Schedule. Analyses focused specifically on examining racial differences between white youths and youths of color. A proposed model of pathways to medication use was tested using multi-group structural equation modeling, patterns of medication use were examined, and youths were classified into medication use subgroups using latent growth mixture modeling.

Results: While rates of medication use were significantly different between white youths and youths of color, the strength of the relationship between mental health problems and psychotropic medication use was not significantly different. White youths were more likely to be taking medications in conjunction with outpatient therapy, while youths of color were more likely to be connected with mental health treatment through the psychiatric hospital or emergency room. No racial differences were identified in the types of psychotropic medications youths were taking, however, youths of color were more likely to discontinue medications over the study year. Four medication use subgroups were identified - a low/no use group: 74%), a medium stable medication use group: 14%), a declining use group: 4%), and a high stable use group: 9%). Youths in the declining and high stable use groups were not significantly different from one another at age 17 and were most likely to be taking antipsychotic medications in addition to antidepressant medications. Youths in the medium use group were primarily taking antidepressant medications and had lower rates of comorbid behavioral disorders than youths in the highest use group.

Conclusion: These results suggest need to further examine racial differences in mental health treatment overall but did not point to racial disparities in medication use. High rates of antidepressant use suggest the potential to reduce medication use through evidence based treatments targeting depression and anxiety. Additional information is needed to better understand the underlying needs that are generating medication use, particularly polypharmacy, in order to develop alternative responses. Youths that took the highest number of medications also presented indicators of complex needs. Targeted interventions to assess and clarify the mental health problems of these youths could improve the quality of their treatment and prevent abrupt discontinuation as they leave state care.

Comments

Permanent URL: http://dx.doi.org/K7BZ646M

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