Trends in Mental Disorders in Children and Adolescents Receiving Treatment in the State Mental Health System

Abstract

Objective

To examine recent trends in clinical diagnoses of children and adolescents receiving treatment in publicly funded mental health treatment services in the United States.

Method

Data on children and adolescents (≤17 years) receiving treatment from publicly funded mental health treatment services recorded in Mental Health Client-Level Data 2013-2021 (total number of records = 13,684,154) were used to examine temporal trends in the proportion of different child and adolescent psychiatric disorders. Trends were examined overall and in age, sex, racial/ethnic, and service strata focusing on community-based programs.

Results

The analyses revealed increases in the proportion of anxiety disorders from 9.6% in 2013 to 19.2% in 2021 (adjusted odds ratio [AOR] 2.17, 95% CI 1.85-2.55, p < .001), trauma- and stressor-related disorders from 22.7% to 27.4% (AOR 1.31, 95% CI 1.09-1.57, p = .004), and depressive disorders from 13.4% to 17.0% (AOR 1.20, 95% CI 1.03-1.41, p = .04). During this same period, the proportion of bipolar disorders declined almost 8-fold from 10.0% to 1.3% (AOR 0.07, 95% CI 0.06-0.09, p < .001). The proportion of conduct disorder and oppositional defiant disorder also declined from 9.7% to 4.4% (AOR 0.42, 95% CI 0.32-0.55, p < .001) and from 11.1% to 7.8% (AOR 0.79, 95% CI 0.65-0.98, p = .03), respectively. Trends varied across sex, age, and racial/ethnic strata.

Conclusion

The composition of childhood psychiatric diagnoses in patients within publicly funded mental health treatment settings changed over the past decade. While some of the trends may reflect changes in diagnostic practices of clinicians, increases in anxiety and depressive disorders parallel trends in the prevalence of these conditions in the general population and highlight a growing need for identifying and treating these conditions in this age group.

Plain language summary

Utilizing the records of services for children and adolescents (≤17 years) receiving treatment from publicly funded mental health treatment services that recorded in Mental Health Client-Level Data (n∼13.5 million), the authors found increases in the proportion of anxiety disorders, trauma- and stressor-related disorders, and depressive disorders between 2013 to 2021. During this same period, the proportion of bipolar disorders, conduct disorder, and oppositional defiant disorder declined. While some of these trends may reflect changes in diagnostic practices of clinicians, increases in anxiety and depressive disorders parallel trends in the prevalence of these conditions in the general population. Results highlight the need for identifying and treating pediatric depression, anxiety, and trauma-related disorders.