Pediatric PTSD treatment patterns: Insights from a large retrospective study

Background: Post-traumatic stress disorder (PTSD) is a severe psychiatric condition associated with significant impairments in daily functioning. Although psychotherapy is the recommended first-line treatment, off-label psychotropic medications are frequently used. This study examined national treatment patterns and disparities in pediatric PTSD care using a large, diverse dataset.

Methods: We conducted a retrospective analysis of pediatric patients (ages 6–18) diagnosed with PTSD (ICD-10: F43.1; N = 61,516) from the TriNetX Research Network. Treatment patterns were analyzed across demographic and clinical variables. Odds ratios (ORs), hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated.

Results: The average age at diagnosis was 11.2 years (SD = 3.67), with females comprising 58.3% of the cohort. Mood disorders (59.2%), ADHD, and anxiety disorders were common comorbidities. Antidepressants were prescribed to 51.4% of patients, most commonly sertraline and fluoxetine. Antipsychotics were used in 30.5% of cases, but only 19.2% had prior psychotherapy. Overall psychotherapy utilization was 35.5%. Black and Hispanic youth were less likely to receive most psychotropics, and Black youth had lower odds of receiving psychotherapy (OR: 0.85, 95% CI: 0.81–0.89), though antipsychotic use did not differ significantly. After controlling for confounders, greater clinical severity was associated with increased antipsychotic use (aHR: 2.79, 95% CI: 2.68–2.90).

Conclusions: This study highlights substantial variability in pediatric PTSD care, including frequent psychotropic use, often preceding psychotherapy, and significant racial and ethnic disparities. These findings emphasize the need for standardized protocols, better access to evidence-based care, and targeted strategies to reduce inequities.