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Trends in Mental Health Diagnoses Among Publicly Insured Children
Janet R Cummings1, Xin Hu1,2, Jordan Marchak3,4
1Department of Health Policy and Management, Emory University Rollins School of Public Health, Atlanta, Georgia.
Insights
Diagnoses for mental health and neurodevelopmental disorders in publicly insured children increased significantly from 2010 to 2019. This trend highlights the need for accessible services for these vulnerable youth.
Area of Science:
- Pediatric Health
- Public Health Policy
- Mental Health Services Research
Background:
- Children in poverty face higher risks for mental health and neurodevelopmental disorders.
- Public insurance programs, like Medicaid, cover over one-third of US children, yet trends in diagnoses for these conditions are not well understood.
Purpose of the Study:
- To estimate multistate trends in mental health and/or neurodevelopmental disorder diagnoses among publicly insured children.
- To analyze changes in diagnosis percentages from 2010 to 2019.
Main Methods:
- A serial, cross-sectional study utilizing administrative claims data from 22 states.
- Analysis of trends in diagnoses for children aged 3-17 years enrolled in public insurance.
- Regression models controlled for demographics, socioeconomic factors, and geographic variables.
Main Results:
- The percentage of publicly insured children with any mental health or neurodevelopmental disorder diagnosis rose from 10.7% in 2010 to 16.5% in 2019.
- Significant increases were observed across 9 of 13 specific diagnostic categories.
- Largest increases included attention-deficit/hyperactivity disorder, trauma- and stressor-related disorders, anxiety disorders, autism spectrum disorders, depressive disorders, and other neurodevelopmental disorders.
Conclusions:
- A significant increase in mental health and neurodevelopmental disorder diagnoses occurred among publicly insured children between 2010 and 2019.
- These findings underscore the critical need for enhanced access to appropriate mental health and neurodevelopmental services within safety net systems.
- Further research and policy interventions are warranted to address the growing diagnostic rates and ensure adequate care for this population.
Importance:
Children living in poverty are at increased risk of mental health and neurodevelopmental disorders. Little is known about the trends in diagnoses of these disorders among children enrolled in public insurance programs, such as Medicaid, which insure more than 1 in 3 US children.
Objective:
To provide comprehensive, multistate estimates of changes in the percentage of publicly insured children with mental health and/or neurodevelopmental disorder diagnoses.
Design, Setting, And Participants:
This serial, cross-sectional study used administrative claims data from 22 states to test trends from 2010 to 2019 in the percentage of publicly insured children aged 3 to 17 years with mental health or neurodevelopmental disorder diagnoses. Regression models included a dummy variable for each year, controlled for child demographics, county-level metropolitan status, median household income, and US Census region. Adjusted risk differences were estimated, with standard errors clustered at the state level.
Exposure:
Calendar year.
Main Outcomes:
Any mental health or neurodevelopmental disorder diagnosis in the calendar year, and any diagnosis in 1 of 13 specific diagnostic categories.
Results:
A total of 129 306 637 child-year observations (29 925 633 unique publicly insured children) were included. The percentage of publicly insured children with any diagnosed mental health or neurodevelopmental disorder increased from 10.7% in 2010 to 16.5% in 2019; this change remained significant after adjustment for covariates (adjusted risk difference [aRD], 6.7 percentage points [95% CI, 5.0-8.4]). Statistically significant increases were also observed in 9 of the 13 diagnostic categories examined. The largest absolute increases were observed for attention-deficit/hyperactivity disorder (aRD, 2.3 percentage points [95% CI, 1.4-3.3]), trauma- and stressor-related disorders (aRD, 1.7 percentage points [95% CI, 0.9-2.5]), anxiety disorders (aRD, 1.6 percentage points [95% CI, 1.2-2.1]), autism spectrum disorders (aRD, 1.1 percentage points [95% CI, 0.9-1.4]), depressive disorders (aRD, 0.9 percentage points [95% CI, 0.6-1.3]), and other neurodevelopmental disorders (aRD, 2.6 percentage points [95% CI, 1.8-3.5]).
Conclusions And Relevance:
The percentage of publicly insured children receiving any mental health or neurodevelopmental disorder diagnosis significantly increased between 2010 and 2019, with increases observed for most diagnostic categories examined. These findings highlight the need for access to appropriate services in safety net systems and other settings that serve this population.
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