Recent Trends in the Diagnosis and Treatment of Anxiety in US Children and AdolescentsRecent Trends in the Diagnosis and Treatment of Anxiety in US Children and Adolescents https://pediatricsnationwide.org/wp-content/uploads/2021/10/AdobeStock_71020796-1024x683.jpg 1024 683 Lauren Dembeck Lauren Dembeck https://pediatricsnationwide.org/wp-content/uploads/2021/03/Dembeck_headshot.gif
- July 31, 2023
- Lauren Dembeck
In 2021, the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association joined together to declare a national state of emergency in children’s mental health. The declaration was motivated by steadily increasing rates of childhood mental health concerns and suicide between 2010 and 2020. Among those concerns are anxiety disorder diagnoses; however, recent changes in diagnosis and treatment are not well understood.
Researchers at Nationwide Children’s Hospital, The Ohio State University, University of Ottawa, and Children’s Hospital of Eastern Ontario Research Institute reported on these trends for primary care anxiety disorder diagnosis and treatment among children, adolescents, and young adults in the journal Pediatrics.
“Given the building mental health crisis for children and adolescents in the United States, we expected to see similar trends in anxiety disorders,” says study author Laura Chavez, PhD, MPH, a principal investigator in the Center for Child Health Equity and Outcomes Research at Nationwide Children’s. “Our study was consistent with those national increases, but we were surprised to see how the treatment of anxiety disorders during in-office visits was also changing. We saw no overall change in the use of medications but a decline in the use of therapy during visits. That means there were more visits where patients were receiving medications alone, without therapy.”
The researchers assessed serial cross-sectional data from the National Ambulatory Medical Care Survey, a nationally representative annual survey of US physician office-based visits, from between 2006 and 2018. They evaluated changes in anxiety disorder diagnosis and categorized treatment into four categories, therapy alone, therapy and medications, medications alone, or neither, and compared the results across three time periods, 2006–2009, 2010–2013, and 2014–2018.
“The primary care office plays a critical role in identification, treatment, and referral for mental health disorders in children and adolescents because these patients will rarely be seen by a mental health specialist directly,” explains Kelly J. Kelleher, MD, principal investigator in the Center for Child Health Equity and Outcomes Research and vice president of Community Health at Nationwide Children’s.
The study showed the overall proportion of office visits with an anxiety disorder diagnosis significantly increased from 1.4% (9,246,921 visits) in 2006 to 2009 to 4.2% (23,120,958 visits) in 2014 to 2018. During those time periods, the researchers found the proportion of visits with any therapy decreased from 48.8% to 32.6%, but no significant change in the overall use of medications was observed. They also found the likelihood of patients receiving medication alone during office visits was 2.4-time higher from 2014-2018 than from 2006-2009.
“These changes are concerning because we know that kids have better outcomes when both therapy and medications are used in combination. The declining trend in the use of therapy may be occurring for a number of different reasons,” says Dr. Chavez. “Physicians are facing a growing burden of mental health disorders in their practices, and the supply of mental health providers in the United States is really inadequate. Thus, they may not have the capacity to be able to deliver therapy through specialists in the primary care office. Thus, they rely on medications alone as a way to address the condition or do not provide treatment.”
“Access to mental health care in our country is not great,” adds Dr. Kelleher. “We know that access to specialty care is associated with long wait lists for a variety of reasons. I think that is why, in the future, we are going to have to consider alternative ways of providing mental health services to children and adolescents.”
Dr. Chavez and Dr. Kelleher agree that while there is no one solution, an important first step is prevention and early intervention. “We are waiting until children have these anxiety disorders before we are intervening, but we should strive for early prevention and health promotion, teaching children to be more resilient, reducing the use and negative effects of social media, encouraging the use of positive digital tools and apps, and teaching parents and families how to interact more effectively with their children. We also have to create ‘communities that care’, which can include evidence-based peer models to be used in schools and investment in communities in general. These have been documented to have positive effects, leading to mental health improvements and reduction of anxiety and depressive symptoms in kids.”
The team is now conducting additional work into and beyond the COVID-19 pandemic to assess whether the current trends have continued, to determine if any particular subgroups of children and adolescents are at higher risk for not receiving therapy, and to evaluate potential interventions or policy-level changes that may impact access or quality of care.
Chavez LJ, Gardner W, Tyson D, Pajer K, Rosic T, Kemper AR, Kelleher K. Trends in Office-Based Anxiety Treatment Among US Children, Youth, and Young Adults: 2006-2018. Pediatrics. 2023 Jul 1;152(1):e2022059416.
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