Psychotropic Drug Use and Negative Effects of Psychotropic Drugs Among Older Foster Youth: The Influence of Youths' Gender, Race, Sexual Orientation, and Placement

Background: Observers have drawn attention to the use of psychotropic medications with children in foster care, noting that they are used at rates higher than in the general population, in some cases in inappropriate ways (Leslie et al, 2010; Raghavan et al, 2005). California enacted legislation in 1999 to create court oversight of use of psychotropic medication by foster children. The US Congress has also mandated that states adopt protocols for the appropriate use and monitoring of psychotropic medications administered to children in care. This study assesses the extent to which youths’ gender, race/ethnicity, sexual orientation, and placement type are associated with 1) their use of psychotropic medications and 2) negative effects of psychotropic medications, controlling for the presence of mental health disorders.

Methods:  The study population consisted of 727 foster youth approaching the transition to adulthood in California. Study data come from the Baseline Youth Survey of the CalYOUTH Study, conducted in 2013 when the participating youth were an average of 17 years old.  Dependent variables were 1) a dichotomous measure of whether youth reported that they had received medication for their emotions in the past year and 2) a dichotomous measure of whether youth who had received such medication disagreed with the statement that the “good things about the medication outweigh the bad.”  Independent variables included: youths’ gender, race/ethnicity, and sexual orientation (“100% heterosexual” versus all other sexual orientations); youths’ current placement type (nonrelative foster home; relative foster home, group care; independent living; other); and presence of one or more current mental health diagnoses (self-report MINI-Kid diagnoses: depression or dysthymia; oppositional defiant disorder or conduct disorder; ADHD; PTSD, and psychotic disorders). Logistic regression models assessed whether youth and placement characteristics were associated with self-reported use of psychotropic medications and negative effects of such medications, controlling for the presence of a mental health disorder. 

Results:  Not surprisingly, self-reported symptoms consistent with a mental health disorder increased the estimated odds of psychotropic drug receipt (OR ≈ 2.8; p < .001).  Youths’ sex, race, and sexual orientation were not associated with use of such medications, but current placement in group care (OR ≈ 3.6; p < .001) or independent living settings (OR ≈ 3.5; p < .05) increased the estimated odds of receiving drugs compared to placement in nonrelative foster care.  Interestingly, conditioned on receipt of psychotropic medications, the presence of a mental health disorder was not associated with self-reported negative effects of psychotropic medications. Youth living in kinship foster care were less likely than those in other settings to report negative side effects of medications they had received (OR ≈ .13; p < .05). 

Conclusions: Encouragingly, this study finds no evidence that youths’ demographic characteristics are associated with use or negative effects of psychotropic drugs after controlling for self-reported mental health. However, the association between placement type and receipt of medication after controlling for mental health disorders calls for further research into how youth in some settings, particularly group care, come to receive psychotropic medications (Breland-Noble et al, 2004).