Initiation of new psychotropic prescriptions without a psychiatric diagnosis among US adults: Rates, correlates, and national trends from 2006 to 2015

OBJECTIVES: To estimate rates and national trends of initiation of new psychotropic medications without a psychiatric diagnosis and to identify demographic and clinical correlates independently associated with such use among US adults in outpatient settings.

DATA SOURCE: Data were gathered from the 2006-2015 National Ambulatory Medical Care Survey (NAMCS), a nationally representative sample of office-based U.S. outpatient care. The sample was limited to adults aged 18 or older who received a new psychotropic drug prescription (n = 8618 unweighted).

STUDY DESIGN: Using a repeated cross-sectional design with survey sampling techniques, we estimated prescription initiation rates and national trends. Multivariable-adjusted logistic regression analysis was used to identify correlates independently associated with initiation of new psychotropic prescriptions without a psychiatric diagnosis.

DATA COLLECTION/EXTRACTION METHODS: Data were publicly available, and we extracted them from the Centers for Disease Control and Prevention website.

PRINCIPAL FINDINGS: Altogether, at 60.4% of visits at which a new psychotropic prescription was initiated, no psychiatric diagnosis was recorded for the visit. Overall, the rate increased from 59.1% in 2006-2007 to 67.7% in 2008-2009 and then decreased to 52.0% in 2014-2015. Visits to psychiatrists were associated with very low odds of having no psychiatric diagnosis when compared to primary care visits (OR = 0.02; 95% CI, 0.01-0.04). Visits to non-psychiatric specialists showed 6.90 times greater odds of not having a psychiatric diagnosis when compared to primary care visits (95% CI, 5.38-8.86).

CONCLUSION: New psychotropic medications are commonly initiated without any psychiatric diagnosis, especially by non-psychiatrist physicians. Non-psychiatrists should document relevant diagnoses more vigilantly to prevent potentially inappropriate use or misuse.