Trends in and Perceptions of the Utilization of Psychotropic Medications Among Foster Youth Transitioning to Adulthood

Background:  Since the 1990s, the rate at which psychotropic medications are prescribed to children in the U.S. has markedly increased (Brenner et al., 2014).  Particularly high prescription rates among foster youth have heightened concern from researchers, and have led to increased guidance from and oversight by government.  Most research has focused on school-age children, and less is known about psychotropic medication use among older adolescents in foster care (Brown et al., 2015).  This study examines the prevalence rates and experiences of psychotropic medication use over time among transition-age foster youth, and examines differences in medication use by type of behavioral health problems.

Methods:  This study draws on data collected from CalYOUTH participants who were interviewed at ages 17 (n=727) and 19 (n=611).  In both waves, information was gathered on current behavioral health disorders, psychotropic medication use in the past year, and youths’ perceptions about the effects and benefits of medications. The Mini International Neuropsychiatric Interview (MINI) was used to screen for the following behavioral health problems: depression, mania, social phobia, PTSD, psychoticism, and alcohol use and substance use disorders.  Several survey items asked about youths’ experiences with medication use, (e.g., “my medicine gives me bad side effects”). First, the overall prevalence rate of psychotropic medication use was compared between ages 17 and 19.  Second, we examined prevalence rates of medication use by specific behavioral health disorders, and whether rates differed over time.  Lastly, among youth who used psychotropic medications, respondents’ self-reported ratings of medication effects were evaluated at both ages using three categories (agree, neutral, disagree). Group differences were assessed using paired t-tests (appropriate for a design-based variance estimate).  Survey weights accounted for sampling design and nonresponse.

Results:  The overall rate of psychotropic medication use significantly declined from age 17 (27%) to age 19 (15%) (p<.001).  Among youths with behavioral health disorders, rates of medication use were generally lower at age 19 than at 17.  The largest drops in medication use occurred among respondents who screened positive for a manic episode (46% to 20%, p<.05) and concurrent mental health and substance use disorders (54% to 28%, p<.001).  Among youth who used psychotropic medications, over one-third reported bad side effects of their medications (43% at 17; 36% at 19).  Most youths reported the positive or neutral view that benefits of their medications outweighed the disadvantages (70% at 17; 74% at 19).

Conclusions:  We found a notable decline in the rate of psychotropic medication use from ages 17 to 19 in general, as well as among foster youth with some behavioral health disorders.  Findings about youths’ experiences with medications suggest that most youths had a favorable or neutral view of their medication’s benefits, which did not differ over time.  Further research is needed to explore barriers to treatment access encountered by older foster youth, changes in their personal preferences about using psychotropic medications, and potential roles of child welfare professionals in working with young people transitioning to adulthood from foster care.