Table 2.
Prescribing Cautions and Patient Characteristics of Children and Adolescents Initiating Prescription Benzodiazepine Treatment
| Variable | Total N=85,550 |
Children, 3–12 years N=24,504 |
Adolescents, 13–17 years N=61,046 |
Child vs adolescent |
|---|---|---|---|---|
| % | % | % | Crude PR (95% CI) | |
| Prescribing cautions, prior year (unless specified) | ||||
| Drug-related disorder | 2.8 | 0.5 | 3.8 | 0.12 (0.10, 0.15) |
| Alcohol-related disorder | 0.8 | 0.1 | 1.1 | 0.08 (0.05, 0.12) |
| Suicidality (recorded self-harm, suicidal ideation) | 3.7 | 0.7 | 4.9 | 0.15 (0.13, 0.17) |
| Poisoning | 2.2 | 1.0 | 2.7 | 0.37 (0.32, 0.42) |
| Sleep apnea; hyposomnia | 1.8 | 2.8 | 1.4 | 2.03 (1.84, 2.24) |
| Respiratory failure; hypoxemia (excludes day of BZD start) | 1.2 | 2.4 | 0.7 | 3.29 (2.91, 3.72) |
| Any diagnosis above | 9.8 | 6.7 | 11.0 | 0.61 (0.58, 0.64) |
| Opioid prescription | ||||
| Dispensed day of BZD start | 16.9 | 17.9 | 16.5 | 1.08 (1.05, 1.12) |
| Dispensed in prior 30 days or day of BZD start | 21.5 | 22.1 | 21.2 | 1.04 (1.01, 1.07) |
| >10 days supplied | 4.4 | 5.3 | 4.1 | 1.28 (1.20, 1.37) |
| Provider contact, prior 30 days | ||||
| Mental health professional | 25.5 | 18.2 | 28.4 | 0.64 (0.62, 0.66) |
| Psychiatrist | 18.0 | 12.3 | 20.3 | 0.61 (0.58, 0.63) |
| Psychologist; therapist (supportive); psychiatric nurse | 13.9 | 9.9 | 15.5 | 0.64 (0.61, 0.67) |
| General provider | 50.4 | 49.6 | 50.8 | 0.98 (0.96, 0.99) |
| Pediatrician | 24.6 | 33.1 | 21.3 | 1.55 (1.52, 1.59) |
| Family practice | 17.4 | 10.5 | 20.1 | 0.52 (0.50, 0.54) |
| Internal medicinea | 12.3 | 10.8 | 12.8 | 0.84 (0.81, 0.88) |
| Nurse practitioner; physician’s assistant | 3.6 | 3.4 | 3.6 | 0.96 (0.88, 1.03) |
| Specialist | 30.1 | 37.5 | 27.1 | 1.38 (1.35, 1.41) |
| Neurology | 7.6 | 11.6 | 6.0 | 1.94 (1.85, 2.03) |
| Surgery, radiology, anesthesiology | 24.0 | 28.2 | 22.3 | 1.26 (1.23, 1.30) |
| Pediatrician specialty, other | 8.0 | 11.9 | 6.5 | 1.83 (1.75, 1.92) |
| None of above | 24.9 | 26.7 | 24.2 | 1.10 (1.07, 1.13) |
| Psychotropic prescription, prior 30 daysb | ||||
| SSRI | 25.2 | 14.1 | 29.7 | 0.48 (0.46, 0.49) |
| Other antidepressant | 7.4 | 3.3 | 9.1 | 0.36 (0.34, 0.39) |
| Stimulant | 9.2 | 9.6 | 9.1 | 1.06 (1.02, 1.11) |
| Antipsychotic | 8.2 | 7.4 | 8.5 | 0.87 (0.82, 0.91) |
| Clonidine/guanfacine | 3.8 | 6.7 | 2.6 | 2.54 (2.37, 2.72) |
| Additional characteristics | ||||
| Any mental health diagnosis, prior 30 days | 48.2 | 36.3 | 53.0 | 0.68 (0.67, 0.70) |
| ADHD diagnosis, prior year | 15.9 | 17.4 | 15.3 | 1.13 (1.09, 1.17) |
| Inpatient admission, prior 30 days | ||||
| Psychiatric related | 4.1 | 2.7 | 4.7 | 0.57 (0.53, 0.62) |
| Non-psychiatric related | 9.7 | 15.1 | 7.5 | 2.02 (1.94, 2.10) |
| Discharged on BZD start date | 7.5 | 10.0 | 6.5 | 1.56 (1.48, 1.63) |
| Complex chronic condition, prior year inpatient diagnosesc | 9.4 | 14.6 | 7.4 | 1.97 (1.89, 2.06) |
| Neuromuscular, neurological | 3.5 | 7.5 | 1.9 | 3.92 (3.65, 4.21) |
| Other congenital or genetic defect | 3.2 | 3.8 | 3.0 | 1.25 (1.15, 1.35) |
| Malignancy | 2.0 | 3.7 | 1.3 | 2.80 (2.55, 3.08) |
| Cardiovascular | 1.6 | 2.0 | 1.4 | 1.38 (1.23, 1.54) |
a
Internal medicine and medical doctor not classified under another specialty.
b
Hypnotic, z-drug (children=0.2%, adolescents=1.1%), Hydroxyzine (children=1.8%, adolescents=2.2%); Multiple psychotropic classes: antidepressant + antipsychotic (children=2.9%, adolescents=4.9%); antidepressant + stimulant (children=3.0%, adolescents=4.2%), antidepressant + another class (children=6.4%, adolescents=10.0%).
c
Most common categories displayed (>1% of initiators).
BZD, benzodiazepine; PR, prevalence ratio; SSRI, selective serotonin reuptake inhibitor; ADHD, attention-deficit hyperactivity disorder.