Table 2.
Selecteda characteristics of children initiating anti-anxiety medication and factors associated with initiating with SSRI+another anti-anxiety medication vs. SSRI alone and with non-SSRI anti-anxiety medication vs. SSRI alone
| Initial anti-anxiety treatment group |
||||||
|---|---|---|---|---|---|---|
| Children initiating anti- anxiety medication (N=84,500) No.(%) |
SSRI alone (N=53,009) No.(%) |
SSRI + another anti-anxiety medication (N=5,863) |
Non-SSRI anti-anxiety medication (N=25,628) |
|||
| Patient characteristic | No.(%) | Vs. SSRI alone Multivariable RR(95% CI)a |
No.(%) | Vs. SSRI alone Multivariable RR(95% CI)a |
||
| Female | 49,255 (58) | 31,688 (60) | 3,771 (64) | REF | 13,796 (54) | REF |
| Male | 35,245 (42) | 21,321 (40) | 2,092 (36) | 1.0(0.9-1.0) | 11,832 (46) | 1.1(1.1-1.1) |
| Age, median(IQR) | 14 (11-16) | 14 (11-16) | 15 (13-16) | 14 (10-16) | ||
| 3-5 years | 1,449 (2) | 696 (1) | 25 (<1) | 0.4(0.2-0.5) | 728 (3) | 1.4(1.3-1.5) |
| 6-9 years | 12,377 (15) | 7,782 (15) | 332 (6) | 0.4(0.4-0.5) | 4,263 (17) | 1.0(1.0-1.1) |
| 10-13 years | 21,997 (26) | 14,525 (27) | 1,269 (22) | 0.8(0.7-0.8) | 6,203 (24) | 0.9(0.9-1.0) |
| 14-17 years | 48,677 (58) | 30,006 (57) | 4,237 (72) | REF | 14,434 (56) | REF |
| Anxiety disorder, index diagnosis | ||||||
| Unspecified | 42,652 (50) | 26,037 (49) | 2,417 (41) | REF | 14,198 (55) | REF |
| Generalized anxiety disorder | 20,508 (24) | 13,812 (26) | 1,417 (24) | 1.1(1.0-1.2) | 5,279 (21) | 0.8(0.8-0.8) |
| OCD | 6,194 (7) | 4,773 (9) | 353 (6) | 0.9(0.8-1.0) | 1,068 (4) | 0.5(0.5-0.6) |
| Panic disorder | 4,294 (5) | 1,967 (4) | 507 (9) | 2.0(1.9-2.2) | 1,820 (7) | 1.3(1.3-1.4) |
| PTSD | 3,531 (4) | 1,683 (3) | 492 (8) | 1.5(1.4-1.7) | 1,356 (5) | 1.2(1.1-1.2) |
| Social phobia | 1,972 (2) | 1,465 (3) | 156 (3) | 1.0(0.9-1.2) | 351 (1) | 0.6(0.6-0.7) |
| Otherc | 3,530 (4) | 1,993 (4) | 279 (5) | 1.6(1.4-1.7) | 1,258 (5) | 1.1(1.0-1.1) |
| Multiple | 1,819 (2) | 1,279 (2) | 242 (4) | 1.6(1.5-1.9) | 298 (1) | 0.6(0.6-0.7) |
| Provider type, index anxiety diagnosis | ||||||
| Psychiatry | 20,514 (24) | 14,114 (27) | 1,674 (29) | REF | 4,726 (18) | REF |
| Psychologist; Therapist | 10,124 (12) | 5,761 (11) | 444 (8) | 0.7(0.7-0.8) | 3,919 (15) | 1.6(1.6-1.7) |
| Family practice | 11,136 (13) | 7,004 (13) | 788 (13) | 0.9(0.8-0.9) | 3,344 (13) | 1.0(1.0-1.1) |
| Pediatrics | 13,565 (16) | 9,574 (18) | 502 (9) | 0.5(0.5-0.6) | 3,489 (14) | 0.9(0.8-0.9) |
| Other | 20,980 (25) | 12,109 (23) | 1,768 (30) | 1.0(0.9-1.0) | 7,103 (28) | 1.3(1.2-1.3) |
| Unknown | 8,181 (10) | 4,447 (8) | 687 (12) | 1.0(0.9-1.1) | 3,047 (12) | 1.3(1.3-1.4) |
| Psychiatric co-morbidity detailsd | ||||||
| Any recent non-anxiety psychiatric diagnosisb | 38,363 (45) | 23,841 (45) | 3,188 (54) | − | 11,334 (44) | − |
| Depression diagnosis (REF=no diagnosis)b | ||||||
| Recent diagnosis | 18,875 (22) | 13,163 (25) | 2,231 (38) | 1.1(1.0-1.2) | 3,481 (14) | 0.6(0.6-0.6) |
| Prior diagnosis, no recent diagnosis | 3,275 (4) | 2,017 (4) | 201 (3) | 0.9(0.8-1.1) | 1,057 (4) | 0.9(0.9-1.0) |
| Attention deficit disorder (REF=no diagnosis)b | ||||||
| Recent diagnosis | 10,191 (12) | 5,139 (10) | 428 (7) | 1.0(0.9-1.2) | 4,624 (18) | 1.5(1.5-1.6) |
| Prior diagnosis, no recent diagnosis | 4,877 (6) | 2,911 (5) | 236 (4) | 1.1(0.9-1.2) | 1,730 (7) | 1.2(1.1-1.2) |
| Other episodic mood disorder | 4,073 (5) | 2,036 (4) | 455 (8) | 1.2(1.1-1.3) | 1,582 (6) | 1.3(1.2-1.3) |
| Bipolar disorder | 1,479 (2) | 466 (1) | 164 (3) | 1.6(1.4-1.8) | 849 (3) | 1.8(1.7-1.9) |
| Index anxiety diagnosis in inpatient setting | 4,313 (5) | 1,981 (4) | 938 (16) | 2.1(1.9-2.3) | 1,394 (5) | 1.2(1.1-1.2) |
| Mental health diagnostic/evaluation visit | 45,051 (53) | 29,917 (56) | 3,294 (56) | 1.1(1.0-1.1) | 11,840 (46) | 0.8(0.8-0.8) |
IQR: Interquartile range, REF: Referent category
Multivariable RRs are from the full model that includes all variables in supplemental eTable 1; the multivariable RRs (95% CI) for the comparison between SSRI + another anti-anxiety medication vs. non-SSRI anti-anxiety medication are available in supplemental eTable 1; ‘Any recent non-anxiety psychiatric diagnosis’ was not entered into the full multivariable model as specific indicators for psychiatric disorders were used instead
Recent=0–30 days before anti-anxiety medication initiation, prior=31–365 days before anti-anxiety medication initiation
Anxiety disorders with <1000 children: other anxiety, separation anxiety, selective mutism, anxiety due to medical condition, agoraphobia, other/specific phobia
Definitions: depression (ICD-9: 296.2x, 296.3x, 300.4x, 309.1x, 311.x), attention deficit disorder (ICD-9: 314.0x), other episodic mood disorder (ICD-9: 296.9x), bipolar disorder/cyclothymic (ICD-9: 296.0x, 296.4x, 296.5x, 296.6x, 296.7x, 296.8x, 301.13)