Identifying cross-cultural variations in psychostimulant use for attention deficit hyperactivity disorder using linked data

Ghosh, Manonita; Holman, C. DʼArcy J.; Preen, David B.

doi:10.1186/s13034-017-0152-9

Cited by 8 publications

(9 citation statements)

References 30 publications

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“…Further research examining the association between household size and mental health outcomes is needed. In addition, our finding of an inverse association between stimulant dispensing and the proportion of the population that are not Canadian citizens is similar to prior research demonstrating less use of these drugs among immigrants [ 60 – 63 ]. Whether this reflects less access to diagnostic testing and treatment, implicit bias on the part of health-care providers or teachers, cultural responses to health and illness or a combination of the above requires further study.…”

Section: Discussionsupporting

confidence: 88%

Geographic variation and sociodemographic correlates of prescription psychotropic drug use among children and youth in Ontario, Canada: a population-based study

et al. 2023

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Background Population-based research examining geographic variability in psychotropic medication dispensing to children and youth and the sociodemographic correlates of such variation is lacking. Variation in psychotropic use could reflect disparities in access to non-pharmacologic interventions and identify potentially concerning use patterns. Methods We conducted a population-based study of all Ontario residents aged 0 to 24 years who were dispensed a benzodiazepine, stimulant, antipsychotic or antidepressant between January 1, 2018, and December 31, 2018. We conducted small-area variation analyses and identified determinants of dispensing using negative binomial generalized estimating equation models. Results The age- and sex-standardized rate of psychotropic dispensing to children and youth was 76.8 (range 41.7 to 144.4) prescriptions per 1000 population, with large variation in psychotropic dispensing across Ontario’s census divisions. Males had higher antipsychotic [rate ratio (RR) 1.40; 95% confidence interval (CI) 1.36 to 1.44) and stimulant (RR 1.75; 95% CI 1.70 to 1.80) dispensing rates relative to females, with less use of benzodiazepines (RR 0.85; 95% CI 0.83 to 0.88) and antidepressants (RR 0.81; 95% CI 0.80 to 0.82). Lower antipsychotic dispensing was observed in the highest income neighbourhoods (RR 0.72; 95% CI 0.70 to 0.75) relative to the lowest. Benzodiazepine (RR 1.12; 95% CI 1.01 to 1.24) and stimulant (RR 1.11; 95% CI 1.01 to 1.23) dispensing increased with the density of mental health services in census divisions, whereas antipsychotic use decreased (RR 0.82; 95% CI 0.73 to 0.91). The regional density of child and adolescent psychiatrists and developmental pediatricians (RR 1.00; 95% CI 0.99 to 1.01) was not associated with psychotropic dispensing. Conclusion We found significant variation in psychotropic dispensing among young Ontarians. Targeted investment in regions with long wait times for publicly-funded non-pharmacological interventions and novel collaborative service models may minimize variability and promote best practices in using psychotropics among children and youth.

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Section: Discussionsupporting

confidence: 88%

Geographic variation and sociodemographic correlates of prescription psychotropic drug use among children and youth in Ontario, Canada: a population-based study

et al. 2023

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“…Treatment adherence is defined by the World Health Organization as ''the degree to which the person's behavior corresponds with the agreed recommendations from a health care provider'' (Dobbels, van Damme-Lombaert, Vanhaecke, & De Geest, 2005). Several studies in this field have concluded that after consulting a mental health care service, ethnic minority children were less likely to use ADHD-related medications after their diagnosis and had a higher drop-out rate from psychological or psychopharmacological treatment (e.g., Coker et al, 2016;dosReis et al, 2003;Ghosh et al, 2017;Ji et al, 2018;Morgan et al, 2013). For instance, Cummings et al (2017) have recently reported that African American and Hispanic youth (6-12 years) were more likely than White youth to receive combined treatment for ADHD but were also more likely to discontinue medication and disengage from treatment (Cummings et al, 2017).…”

Section: Cultural Diversity In Treatment Variablesmentioning

confidence: 99%

Challenges in ADHD care for ethnic minority children: A review of the current literature

Slobodin

Masalha

2020

Transcult Psychiatry

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While attention deficit hyperactivity disorder (ADHD) has been extensively studied in the past decades, the role of social and cultural practices in its assessment, diagnosis, and treatment has been often overlooked. This selective review provides an overview of research that explores social and cultural influences on help-seeking behavior in ethnic minority children with ADHD. Studies were selected that address cultural diversity in three areas of ADHD help-seeking: problem recognition, access to mental health services, and treatment. Special attention was given to studies of treatment selection and adherence in minority groups. Findings suggested that cultural disparities in ADHD care among ethnic minority children occur in the early stages of problem recognition, through service selection, and in the quality of treatment. Ethnic minority children were less likely than their nonminority counterparts to be diagnosed with ADHD and its comorbid conditions and less likely to be prescribed and adhere to stimulant drug treatment. These differences reflect cultural diversity in norms and attitudes towards mental health issues (e.g., fear of social stigma) as well as limited access to qualified health care. Paradoxically, cultural, racial, and language bias may also lead to the overidentification of ethnic minority children as disabled and to higher ratings of ADHD symptoms. This review highlights the importance of sociocultural factors in understanding developmental psychopathology and help-seeking behavior. In addition, it further supports calls for increasing cultural competence in communications during clinical assessment, diagnosis, and treatment in minority communities. Clinical, theoretical, and methodological considerations for future research are discussed.

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“…While the two studies cannot be compared directly, both of them suggested a lower initiation of ADHD medication within the immigrant population. Immigrants in general might be prone to underutilizing psychiatric health care ( 41–44 ), but other factors such as cultural beliefs and attitudes toward behavioral symptoms and medication of ADHD ( 45 , 46 ), health literacy ( 47 ), language problems, or occupation might also contribute to less frequent medication initiation. A study among children, who were born between 1995 and 2004 in Sweden, found that children who had only foreign-born parents were less likely to use medication compared with children who had at least one Swedish-born parent, suggesting that ADHD medication use might be influenced by cultural factors ( 46 ).…”

Section: Discussionmentioning

confidence: 99%

The role of sociodemographic and clinical factors in the initiation and discontinuation of attention deficit hyperactivity disorder medication among young adults in Sweden

et al. 2023

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IntroductionLong-term medication use is a recommended treatment for attention-deficit/hyperactivity disorder (ADHD), however, discontinuation is common. Non-medical factors which might influence initiation and discontinuation are understudied. Therefore, we investigated how different sociodemographic factors and comorbidities were associated with the initiation and discontinuation of ADHD medication use among young adults.Methods and resultsWe conducted a population-based prospective cohort study using individually linked administrative register data, in which we included all individuals residing in Sweden, between the age of 19 and 29 who were first diagnosed with ADHD between January 2006 and December 2016 (n = 59224). ADHD medication initiation was defined as the first prescription of ADHD medication in the period from 3 months before to 6 months after the cohort entry date. Those who initiated ADHD medication were followed up for medication use until discontinuation, death/emigration, or until 2019. Logistic and Cox regression models were used to investigate the associations between sociodemographics, health-related predictors and initiation, as well as discontinuation. Overall, 48.7% of the 41399 individuals initiated ADHD medication, most often methylphenidate (87%). Among the initiators, 15462 (77%) discontinued medication use during the follow-up (median time: 150 days). After mutually adjusting all other predictors, initiation was positively associated with older age, male sex, higher level of education, and negatively associated with living at home with parents, immigrant status, being unemployed during the year before inclusion, being on disability pension, having autism, substance use, schizophrenia-spectrum disorders, other mental disability/developmental disorders, cardiovascular diseases or previous accidents. Discontinuation was positively associated with being born abroad, living in big cities, being unemployed during the year before inclusion, having cancer, and negatively associated with a higher educational level, having depression, anxiety or stress-related disorder, autism spectrum disorder or diabetes.ConclusionBesides medical factors, sociodemographics, such as educational attainment and immigrant status might also play a role in the initiation and discontinuation of ADHD medication use among young adults newly diagnosed with ADHD.

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Identifying cross-cultural variations in psychostimulant use for attention deficit hyperactivity disorder using linked data

Cited by 8 publications

References 30 publications

Geographic variation and sociodemographic correlates of prescription psychotropic drug use among children and youth in Ontario, Canada: a population-based study

Geographic variation and sociodemographic correlates of prescription psychotropic drug use among children and youth in Ontario, Canada: a population-based study

Challenges in ADHD care for ethnic minority children: A review of the current literature

The role of sociodemographic and clinical factors in the initiation and discontinuation of attention deficit hyperactivity disorder medication among young adults in Sweden

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