Objective
This study uses Veterans Health Administration (VHA) pharmacy and encounter claims
to evaluate the use of psychotropic medications without a psychiatric diagnosis across
age groups.
Methods
National VHA administrative data for fiscal year 2010 (FY2010) were used to identify
all veterans who filled a prescription for at least one psychotropic medication from
VHA (N = 1.85 million). Bivariate and multivariate analyses were used to compare the
proportion of these veterans without any psychiatric diagnosis, across age groups,
adjusting for possible medical indications. Analyses were repeated for six different
classes of psychotropic medications and comparing mental health utilizers and non–mental
health utilizers. Comparisons were made to prescribing of HIV and diabetes medications
without an indicated diagnosis.
Results
Of all VHA patients prescribed a psychotropic medication in FY2010, 30% had no psychiatric
diagnosis, with highest proportions among veterans ages 65–85. This practice was most
frequent among nonmental health utilizers and far more prevalent for psychotropic
medications than for HIV or diabetes medications. Logistic regression analysis found
that age greater than 65 was the strongest predictor of being prescribed a psychotropic
without a psychiatric diagnosis. Adjustment for possible medical use of psychotropics
and overall medical comorbidity did not substantially alter these trends.
Conclusion
Older veterans, especially those not using specialty mental healthcare, are more likely
to be prescribed psychotropic medications in the absence of a psychiatric diagnosis,
perhaps representing unnecessary use, under-diagnosis of mental illness, or incomplete
documentation.
Key Words
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Article info
Publication history
Published online: October 28, 2013
Accepted:
October 9,
2013
Received in revised form:
October 4,
2013
Received:
July 10,
2013
Identification
Copyright
Published by Elsevier Inc.
