Patterns of psychotropic medication use among young people living in out-of-home care: A scoping review and meta-analysis of international literature.

Young people in out-of-home care experience complex mental health needs and may be prescribed psychotropic medications at a greater rate than those not living in care. The aim of this scoping review was to synthesise international literature to (1) understand the prevalence of psychotropic medication use among young people in out-of-home care and (2) identify the factors associated with a greater likelihood of prescribing and/or use. This scoping review was conducted according to the Joanna Briggs Institute (JBI) methodological guidance. Five electronic databases were searched for relevant literature published from inception to September 2024. Synthesising the literature involved a mixed-method approach, utilising a proportional meta-analysis, narrative synthesis and content analysis. Sixty-one studies were eligible for inclusion. Meta-analysis calculated the pooled prevalence of any psychotropic medication as 42.16% (95% confidence interval [CI]: 31.76-52.93%). Pooled prevalence estimates for individual subclasses were 25.60% for stimulants (16.82-35.51%), 21.33% for antipsychotics (12.42-31.87%), 16.36% for antidepressants (10.35-23.42%), 8.57% for mood stabilisers (4.61-13.58%) and 2.24% for anxiolytics (1.12-3.72%). The most commonly examined predisposing factors suggested differences in prescribing practices associated with demographic characteristics such as age, sex and ethnicity. Psychotropic medication management in out-of-home care is complex; however, further research on the international prescribing practices outside the United States is needed. Improved cross-system coordination, caregiver support, meaningful youth involvement and trauma-informed, person-centred approaches to mental health care in out-of-home care are essential to ensure safe, effective and equitable psychotropic medication use.