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The articles in this landmark issue range across the world, from the Netherlands to Korea to the United States to China to Wales. They take as their subjects often-overlooked and at-risk patient populations, such as American Indian youth in foster care and Medicaid-insured youth under the care of nurse practitioners. I strongly encourage you to read through this issue carefully, looking for the insight you might bring not only to your own research or practice but also to your community and the mental healthcare system at large.
I draw your attention to a few examples of the forward-looking and comprehensive work inside. Yang et al. use claims data to analyze more than a million psychotropic prescriptions dispensed to Medicaid-insured youth aged 2–17 years, with the goal of understanding differences in prescribing practice between physicians and nurse practitioners (NPs). The authors find that both psychiatric and non-psychiatric NPs are making a rapidly growing share of prescriptions in this population, and that NPs are more likely to be the only treatment provider in simple cases. As long as this collaboration is effective and understood, Yang et al. conclude, it is a welcome capacity builder. “Building effective care collaboration among clinicians from various provider types and specialties is crucial to accommodate a growing demand for mental health services,” they write, “especially given the critical shortage of pediatric mental health providers.”
Glesener et al. look at prescribing practices for children in foster care in Minnesota. They find that 26% receive psychotropic medication, consistent with previous research showing high prescribing rates in this population. The authors also find racial discrepancies, with American Indian and African American children significantly less likely to receive medication. Finally, the authors note that “increased time since placement into foster care was also significantly associated with increased dispensing rates.”
Sultan et al. investigate national patterns in the United States concerning stimulant, antidepressant, and antipsychotic medications. Their analysis bolsters anecdotal experience, in that stimulant and antidepressant use mirrors the extent and prevalence of attention-deficit/hyperactivity disorder, depression, and anxiety—but antipsychotic prescribing follows no such pattern, reflecting “the heterogeneity of disorders and conditions treated with this medication class.”
Finally, Brophy et al. undertake an analysis of detailed medical and education records of almost 1.5 million Welsh children over 16 years, with a sobering conclusion concerning antipsychotics. “This research finds antipsychotics are prescribed mainly for children with learning difficulty,” the authors write, “and in this population there are higher rates of adverse events, they are used at a younger age, and for a longer time period.”
I hope you benefit from this collection of timely articles.