Changes in the Proportion of Office-Based Child and Adolescent Physician Visits Addressing Mental Health, 2005-2019

This study aimed to characterize trends in office-based, mental health-related physician visits of children and adolescents.

This descriptive, repeated cross-sectional study analyzed visits (unweighted N=43,790) of children and adolescents, ages 4-17, in the 2005-2019 waves of the National Ambulatory Medical Care Survey, an annual nationally representative survey of U.S. office-based physician visits. The analysis estimated changes in the proportion of visits involving any psychiatric diagnosis, specific diagnoses, and psychiatric medications.

The average yearly number of all pediatric visits fell over the study period, whereas the yearly percentage of visits addressing mental health increased among children and adolescents, from 9.3% in 2005-2011 to 13.6% in 2012-2019. The proportion of primary care physician visits addressing mental health increased by 44.7% across the study period. The increase in psychiatric diagnoses was driven by anxiety disorders, which increased the most among female patients. Psychiatric diagnoses increased by 65.9% in visits with adolescents ages 13-17 and 30.9% in visits with children ages 4-12. The authors detected increases in mental health visits among non-Hispanic White and Hispanic youths but not among non-Hispanic Black youths. No statistically significant changes were found in psychiatric medication prescription or continuation at mental health visits.

Office-based physicians increasingly address mental health concerns, reflecting the increasing demand among children and adolescents. Psychiatric diagnoses at office-based physician visits differ by patients' sex and race-ethnicity. Many primary care physicians provide mental health care, highlighting the need for rigorous mental health training for pediatricians.