Черные подростки и молодые взрослые реже получают психотропные препараты до постановки диагноза шизофрении или депрессии

Black youths and young adults are less likely than White youths and young adults to receive psychotropic medications before being diagnosed with schizophrenia or major depressive disorder (MDD), according to study findings published in Early Intervention in Psychiatry. Racial disparities in behavioral health care have previously been documented among young patients with psychotic disorders, including differences in access to treatment and the duration of untreated psychosis. However, less is known about whether differences in medication use are already present before a psychiatric diagnosis is established. Researchers conducted a retrospective cohort study to assess racial differences in psychotropic medication use during the year before an incident diagnosis for schizophrenia or MDD among youths and young adults. Additionally, researchers compared medication use between patients who were subsequently diagnosed with schizophrenia vs MDD. Addressing systemic inequities in early mental health care, improving access to specialized services, and promoting equitable prescribing practices may help reduce these disparities and strengthen early intervention efforts. Using data from the Department of Human Services (DHS), Allegheny County, Pennsylvania, researchers selected eligible participants aged 10 to 35 years and who had an incident diagnosis of schizophrenia or MDD. Researchers defined incident schizophrenia and major depression as more than 1 inpatient or 2 outpatient claims or more than 30 days with a primary diagnosis based on the International Classification of Diseases, Tenth Edition ( ICD-10 ) codes.  Researchers also defined the index date to be the first inpatient or second qualifying outpatient visit. Prescription fills during the 12 months preceding diagnosis were evaluated across multiple medication classes, including antipsychotics, antidepressants, benzodiazepines, antianxiety medications, anticonvulsants, lithium, attention-deficit/hyperactivity disorder (ADHD) medications, and medications for narcolepsy or sleep disorders. A total of 6509 patients were included in the analysis. The study participants were then separated by race into Black (n=2522; mean age at diagnosis, 20.54 years; 70.54% women) and White (n=3987; mean age at diagnosis, 20.31 years; 65.11% women) cohorts. A total of 5741 patients (36.5% were Black patients) had a diagnosis for MDD, while 768 patients (55.2% were Black patients) had a diagnosis for schizophrenia. Black vs White patients who had higher mean Area Deprivation Index scores (7.64 vs 6.31, respectively; P <.001), indicating greater neighborhood socioeconomic disadvantage. Researchers found that schizophrenia represented 16.81% of diagnoses among Black patients vs 8.63% among White patients, while MDD represented 83.19% vs 91.37% of diagnoses, respectively ( P <.001). Among patients with schizophrenia, Black vs White patients had 53% lower adjusted odds for receiving an antipsychotic during the year before diagnosis (odds ratio [OR], 0.47; 95% CI, 0.35-0.64). Black patients also had 67% lower odds for receiving antidepressants (OR, 0.33; 95% CI, 0.24-0.45). Differences in antipsychotic use were primarily observed with second-generation antipsychotics (SGAs). At least 1 SGA prescription was filled by 34.20% of Black patients vs 55.52% of White patients with schizophrenia ( P <.001). After adjustment, Black vs White patients had lower odds for receiving an SGA (OR, 0.43; 95% CI, 0.32-0.59). In contrast, first-generation antipsychotic (FGA) use did not significantly differ by race. Racial differences in medication use were also observed among patients with MDD. Black vs White patients had lower adjusted odds for antidepressant use (OR, 0.45; 95% CI, 0.40-0.51) and benzodiazepine use (OR, 0.41; 95% CI, 0.32-0.54). When medication patterns were compared by eventual diagnosis, patients with schizophrenia vs MDD had greater adjusted odds for receiving antipsychotics (OR, 9.06; 95% CI, 7.52-10.92), lithium (OR, 7.72; 95% CI, 4.92-12.14), and antidepressant use (OR, 1.22; 95% CI, 1.03-1.44) during the year before diagnosis. Patients with schizophrenia vs MDD also had higher unadjusted proportions of use for anticonvulsants (14.27% vs 8.06%, respectively), benzodiazepines (9.61% vs 4.15%, respectively), and attention deficit/hyperactivity disorder (ADHD) medications (10.05% vs 6.67%, respectively; all P <.001). Study limitations include the use of administrative claims, which lack clinical details like symptom severity and medication adherence; the data missed factors influencing prescribing, such as formulary restrictions; and a lack of diagnostic changes over time or nonpharmacologic treatments. “Addressing systemic inequities in early mental health care, improving access to specialized services, and promoting equitable prescribing practices may help reduce these disparities and strengthen early intervention efforts,” the study authors concluded. References: Suh K, Mayanil T, Ko PJ, Yang J, Jhon P, Chengappa KNR. Racial disparities in psychotropic medication use before a diagnosis of schizophrenia and major depressive disorder among youths and young adults. Early Interv Psychiatry. 2026;20(8):e70232. doi:10.1111/eip.70232