Objective: To investigate racial disparities in the first-time prescription of mood stabilizers for first-episode mania in nonpsychotic, hospitalized patients with bipolar I disorder, specifically comparing the rates of lithium and valproic acid prescription between non-Hispanic Black and non-Hispanic White patients.
Methods: A retrospective cohort study was conducted using the TriNetX database. We included eligible hospitalized non Hispanic Black and non-Hispanic White patients newly diagnosed with bipolar I disorder without psychotic features between January 1, 2014, and December 31, 2023. Propensity score matching was employed to create balanced comparison populations of non-Hispanic Black and non-Hispanic White patients, controlling for factors that may influence medication selection. A measure of association analysis was performed to calculate and compare the fraction of patients with either lithium or valproic acid use in both cohorts. Odds ratios were assessed.
Results: The study included 1,582 patients (N = 791 per cohort). After propensity matching, baseline characteristics were well balanced. Lithium was prescribed to 24% of White patients compared to 15% of Black patients (odds ratio [OR] 1.82, 95% CI, 1.41–2.35, P < .05). Conversely, valproic acid was prescribed to 20% of Black patients compared to 12% of White patients (OR 0.53 95% CI, 0.40–0.71, P < .05).
Conclusions: Significant disparities in the prescription rates of valproic acid and lithium were observed, with Black patients more likely to receive valproic acid and less likely to receive lithium compared to their White counterparts. Efforts to address these inequities should involve addressing structural, patient-related, and clinician-related factors that may contribute to our findings.
J Clin Psychiatry 2025;86(1):24m15524
Author affiliations are listed at the end of this article.
Continue Reading...
Members enjoy unlimited free PDF downloads as part of their subscription! Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.
Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97–170. CrossRef
Tchikrizov V, Ladner ME, Caples FV, et al. Health disparities in the treatment of bipolar disorder. Personalized Med Psychiatry. 2023;37–38:100101. PubMedCrossRef
Depp C, Ojeda VD, Mastin W, et al. Trends in use of antipsychotics and mood stabilizers among Medicaid beneficiaries with bipolar disorder, 2001–2004. Psychiatr Serv. 2008;59(10):1169–1174. PubMedCrossRef
Gonzalez Arnold J, Salcedo S, Ketter TA, et al. An exploratory study of responses to low-dose lithium in African Americans and Hispanics. J Affect Disord. 2015;178:224–228. PubMedCrossRef
Busch AB, Frank RG, Sachs G, et al. Bipolar-I patient characteristics associated with differences in antimanic medication prescribing. Psychopharmacol Bull. 2009;42(1):35–49. PubMed
Akinhanmi M, El-Amin S, Balls-Berry JE, et al. Decreased core symptoms of mania and utilization of lithium/mood stabilizing anticonvulsants in U.S. bipolar I patients of African vs European ancestry. J Affect Disord. 2020;260:361–365. PubMedCrossRef
Haukoos JS, Lewis RJ. The propensity score. JAMA. 2015;314(15):1637–1638. CrossRef
Amutah C, Greenidge K, Mante A, et al. Misrepresenting race - the role of medical schools in propagating physician bias. N Engl J Med. 2021;384(9):872–878. PubMedCrossRef
Moore C, Coates E, Watson A, et al. “It’s important to work with people that look like me”: black patients’ preferences for patient-provider race concordance. J Racial Ethn Health Disparities. 2023;10(5):2552–2564.
Ruiz-White I, Kramer L, Philips L, et al. Racial and ethnic disparities in physical and mental health care and clinical trials. J Clin Psychiatry. 2023;84(4):23ah14887. PubMedCrossRef