Studies showing that more and more children are using psychiatric medications have generated reactions--some would say overreactions--with ritualistic sameness. A researcher, after examining a data set maintained by a regulatory body, government health care program, or private HMO or insurance carrier, determines that the number of children currently on psychiatric medications is greater now than it was a few years ago. When news media report those results, they suggest that the increase bodes ill for the nation's kids, even though the study itself draws no such conclusions.
In June, for instance, a New York Times article reporting on one such study intoned that it was "likely to inflame a continuing debate about the risks of using psychiatric medication in children." But should it?
Ultimately, mental health professionals agree that more research could help ensure that children's illnesses are properly diagnosed and that the right medications are given to the right kids. But if the studies that measure utilization rates without relating those numbers to outcomes make it appear as if there is overuse of psychiatric medications, do they play a constructive role in developing mental health care goals? Or might research funds, already in tight supply, be better devoted to clinical outcomes studies?
"On the basis of current trends in practice, one can't make judgments about the quality, the effectiveness, or the safety of care," says Mark Olfson, MD, a professor of clinical psychiatry at the New York State Psychiatric Institute of the Columbia University Medical Center in New York City, whose study showing a significant increase in prescriptions of antipsychotic medications for children and adolescents generated the New York Times article. But he insists that knowing the number of children using the drugs helps researchers better understand what they need to learn about safety, efficacy, and effectiveness.
When the Journal of the American Medical Association published a study in February 20001 that reported prescription trends for psychotropic medications among preschoolers, articles in the media generated an apoplectic reaction. (See Psychiatric Times, May 2000
.) Reacting to the outcry, then First Lady Hillary Clinton convened a White House conference to consider the study's implications, although critics claimed that this action related more to election year politics than genuine concern.
Today, the questions those early studies raised about whether children with mental illnesses received correct diagnoses and proper treatment--including medications--are well known, though still largely unanswered. So do the utilization studies still make sense when resources might be better spent on outcome studies and clinical research, especially when their release is often accompanied by distorted reports in the news media?
Despite the usefulness of epidemiologic research, Olfson acknowledges that the attention these studies receive in the media can sometimes have an unanticipated impact. "I am aware that at times the press exaggerates and sometimes even distorts these findings in ways that do not serve the public interest," Olfson said. "For instance, relatively little attention is given to the problem of untreated psychiatric disorders in the community. Studies concerning unmet need for treatment do not tend to garner the attention I feel they deserve. At the same time, I think it's important to have an understanding of current treatment patterns. If we're to make well-informed decisions about mental health care policy, we need to understand who is receiving what treatments."