Anxiety-related Pediatric Primary Care Visits Rose 300% Over Decade in Massachusetts.
Anxiety-related Pediatric Primary Care Visits Rose 300% Over Decade in Massachusetts
A new study found that children’s visits to the doctor for all mental health conditions increased from 2014 to 2023 in the commonwealth. Visits related to anxiety represented the largest increase, and ADHD was the most common condition addressed during these visits.
The mental health of children and adolescents has been a growing public health priority, particularly over the last decade as youth navigate digital overload, social instability, climate change, and other pressing issues in the national and global landscape. Now, a new study led by a the School of Public Health researcher has found that 1 in 10 children in Massachusetts visited a primary care office to address a mental health need in 2023.
Published in JAMA Network Open, the study estimated trends in pediatric primary care visits for mental health problems from 2014 to 2023 and found that appointments for anxiety-related issues increased the most, rising from 1.7 percent of visits in 2014 to 6.1 percent in 2023—a 300 percent increase.
The study builds upon previous data that indicates that mental health visits to doctor’s offices have doubled among adolescents in the US over the past two decades by providing insight into the specific types and extent of mental health care that youth are seeking. Mental, behavioral, and developmental disorders affect nearly 30 percent of children in the US, and almost half of youth with these conditions do not receive treatment for them. The new findings can inform opportunities for pediatric primary care offices to integrate mental health services into their practices to increase access to this much-needed care.
“Our findings may reflect both the underlying increasing prevalence of pediatric mental health needs, alongside primary care physicians having greater capacity to screen for and address them,” says study lead and corresponding author Kerrin Gallagher, who recently received her PhD in health services and policy research at SPH and was a doctoral student at the time of the study. “Primary care providers should continue to build up training and staffing to both screen for and treat mental health conditions, and integrating behavioral health is one strategy to achieve this goal.”
For the study, Gallagher and colleagues utilized claims data among nearly two million children and young adults ages 1 to 18 in Massachusetts to examine trends in visits to primary care practitioners for mental health-related reasons. Pediatric visits for any mental health diagnosis increased from 5.9 visits per 100 children in 2014 to 9.7 visits per 100 children in 2023, and the top five mental health diagnoses among children were attention-deficit/hyperactive disorder (ADHD), depression, anxiety, autism spectrum disorder (ASD), and trauma or stressor-related disorders. ADHD was the most common mental health condition addressed in pediatric primary care visits, increasing from five percent to 6.7 percent during the study period, while visits for depression, ASD, and trauma- and stressor-related disorders also increased.
While the study did not examine the underlying causes driving these increases in mental health-related visits, the results showed that anxiety-related visits were particularly high during the COVID-19 pandemic, supporting copious research that has documented worsening mental health among youth during and after the unprecedented global crisis. Increased screening may also contribute to the rise in documented prevalence of these conditions since 2014, but likely does not fully explain the increases, Gallagher notes.
“We need to continue studying anxiety and what may be underlying this trend, including the influence of social media usage,” she says. “Continued research into integrated behavioral health is also crucial for understanding how we can better address anxiety and other conditions in primary care settings and ensure access to care for patients.”
The TEAM UP program (Transforming and Expanding Access to Mental Health Care Universally in Pediatrics) at Boston Medical Center—for which Gallagher supported the research and evaluation team (led by Megan Cole Brahim, adjunct associate professor of health law, policy & management at SPH and division director in the Division of Health Policy and Insurance Research at Harvard Medical School and the Harvard Pilgrim Health Care Institute) during her PhD program—is a leading example of these efforts, she says. The program model integrates behavioral health services into primary care practices with a goal to reduce barriers to pediatric mental healthcare treatment.