Racial Disparities in Psychotropic Medication Use Before a Diagnosis of Schizophrenia and Major Depressive Disorder Among Youths and Young Adults

ABSTRACT Objective To assess Black–White differences in psychotropic medication use during the year before an incident diagnosis of schizophrenia or major depressive disorder (MDD) among youths and young adults, and secondarily to compare prescribing patterns by diagnosis: Methods Retrospective cohort study using administrative claims from a publicly funded behavioural health system (2017–2022). Incident schizophrenia or MDD was identified using ICD‐10 codes. Medication fills in the 12 months pre‐diagnosis were assessed by race. Multivariable logistic regression estimated adjusted odds ratios (ORs) for medication use, controlling for demographic and socioeconomic factors. Results The cohort included 787 individuals with schizophrenia and 5917 with MDD. In the year before diagnosis, Black youths and young adults had lower odds than White youths and young adults of receiving several psychotropic classes. In schizophrenia, Black patients had lower odds of any antipsychotic use (OR = 0.47, 95% CI: 0.35, 0.64), driven by lower odds of second‐generation antipsychotic (SGA) use (OR = 0.43, 95% CI: 0.32, 0.59). First‐generation antipsychotic use did not differ by race. Among SGA users, days' supply was similar by race. In MDD, Black patients had lower adjusted odds of antidepressant and benzodiazepine use. Compared with MDD, schizophrenia was associated with higher odds of antipsychotic and mood stabilizer use pre‐diagnosis. Conclusions Racial disparities in treatment exposure are evident prior to diagnosis, particularly for SGAs before schizophrenia, suggesting inequities in early pathways to care. Strategies to improve equitable access to timely evaluation and evidence‐based treatment are needed.