Racial and Ethnic Disparities in Treatment of Youth With Bipolar Disorders.

Objective: Little is known about racial/ethnic disparities in the treatment of pediatric bipolar disorder. This study examined racial and ethnic differences in prescription fill patterns and receipt of recommended treatment among Medicaid-enrolled youth.

Method: A retrospective longitudinal cohort study using Medicaid claims data from 36 states was conducted for youth 10 to 17 years of age with a "new episode" of bipolar disorder from January 1, 2017, through December 31, 2018 (N = 16,807). Measures related to receipt of guideline-concordant care included filled prescription of a mood stabilizer or antipsychotic, any antidepressant monotherapy, and any psychotherapy visit within 90 days of the new episode of bipolar disorder. We used generalized linear mixed models to examine differences by race/ethnicity in guideline-concordant treatment patterns.

Results: Approximately two-fifths (39.5%) of the cohort filled prescriptions for the recommended treatment of mood stabilizers or antipsychotic medication and about one-half (47.6%) received psychotherapy within 90 days of the first diagnosis during the 365-day follow-up period. Less than one-fifth (17.5%) of youth received antidepressant monotherapy. After controlling for demographic, clinical, and contextual factors, both Hispanic (adjusted odds ratio [AOR] = 0.70, 95% CI = 0.64-0.77) and non-Hispanic Black youth (AOR = 0.58, 95% CI = 0.53-0.63) had lower odds of filling a mood stabilizer or antipsychotic prescription compared to non-Hispanic White youth. Non-Hispanic Black youth also had lower odds of antidepressant monotherapy (AOR = 0.57, 95% CI = 0.50-0.64) or receiving psychotherapy (AOR = 0.89, 95% CI = 0.81-0.97) than non-Hispanic White youth.

Conclusion: Racial/ethnic differences in guideline-concordant treatment for youth with bipolar disorder underscore the need to identify barriers to recommended care for minoritized youth.