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

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 (MH-CLD) 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 with anxiety disorders from 9.6% in 2013 to 19.2% in 2021, AOR=2.17, 95% CI=1.85-2.55, p<0.001, trauma- and stressor-related disorders from 22.7% to 27.4%, AOR=1.31, 1.09-1.57, p=0.004, and depressive disorders from 13.4% to 17.0%, AOR=1.20, 1.03-1.41, p=0.04. During this same period, the proportion with bipolar disorders declined almost eight-fold from 10.0% to 1.3%; AOR=0.07, 0.06-0.09, p<0.001. The proportion with conduct disorders also declined from 9.7% to 4.4%; AOR=0.42, 0.32-0.55, p<0.001, and the proportion of oppositional-defiant disorder declined from 11.1% to 7.8%; AOR=0.79, 0.65-0.98, p=0.03. Trends varied across sex, age, and racial/ethnic strata.

Conclusion: The composition of childhood psychiatric diagnoses in patients within publicly funded mental health 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.