Comparison of foster children and non-foster children with respect to prevalence and treatment patterns of mental disorders in the Texas Medicaid System

Studies conducted in several states have shown higher prevalence of mental disorders in foster children compared to the general population. Because states have flexibility regarding policy on how services are delivered to foster children, potential exists for interstate differences in foster populations. The objectives of this study were to compare prevalence rates of four common mental disorders (ADHD, bipolar disorder, depression, and PTSD) among foster and non-foster children eligible for Texas Medicaid, and to compare treatment modalities for new cases of depression in the same population. This retrospective database study used Texas Medicaid data from fiscal years 2003 through 2005. A binomial logistic regression model was used to determine the effects of foster status on prevalence rates of these disorders. A multinomial logistic regression model was used to determine the relationship between foster status and treatment modalities for new cases of depression. Significantly higher prevalence rates of the four diagnoses were observed in foster children for all three study years. Prevalence rates of each disorder were: ADHD (19.1-20.3/1,000 [non-foster] and 214.8-236.2/1,000 [foster]); bipolar disorder (1.8-2.8/1,000 [non-foster] and 107.0-138.5/1,000 [foster]); depression (7.6-7.7/1,000 [non-foster] and 221.1-267.8/1,000 [foster]); PTSD (1.1-1.2/1,000 [non-foster] and 87.7-100.2/1,000 [foster]). After adjusting for age, gender, and ethnicity, foster children had significantly greater odds of being diagnosed with ADHD (odds ratio [OR] = 10.73-12.14, p<0.001), bipolar disorder (OR = 38.50-41.01, p<0.001), depression (OR = 32.83-42.04; p<0.001) and PTSD (OR = 60.06-75.02, p<0.001) than non-foster children across all three study years. Among new cases of depression, foster children were significantly more likely to be treated with pharmacotherapy alone, psychotherapy alone, and combination therapy than non-foster children when compared to no treatment (OR = 1.15-2.40, p≤0.047). 47.0% of foster children and 56.9% of non-foster children received no treatment. Prevalence rates of four psychiatric disorders were significantly higher among foster children, confirming findings from previous studies. For depression, foster children were more likely to be receiving pharmacologic and/or non-pharmacologic treatment compared to no treatment than non-foster children. In both groups, there was a very high rate of children with depression who received no treatment.