National Trends in Clinically Recognized Anxiety Among US Children and Adolescents

To examine recent trends and correlates of clinically recognized anxiety among US children and adolescents by severity and sociodemographic group.

Repeated cross-sectional analysis of the 2016 to 2023 National Survey of Children's Health, a nationally representative survey of non-institutionalized youth. Outcomes included annual rates and adjusted prevalence ratios (aPRs) of caregiver-reported, clinician-diagnosed anxiety, stratified by demographic groups and severity. Multivariate logistic regression identified correlates of anxiety and severity.

In a nationally representative sample of children aged 6 to 17 years (N=223,178; 51.1% male; 26.4% Hispanic, 4.7% non-Hispanic Asian, 13.7% non-Hispanic Black, 49.3% non-Hispanic White), 10.0% had anxiety (4.5% moderate, 1.0% severe). From 2016 to 2023, anxiety increased from 8.2% to 12.8% (aPR 1.63; 95%CI, 1.53-1.75), with stable distributions of severity. Increases were greater among girls (aPR 1.85; 95%CI, 1.69-2.03, P<.001) and adolescents 12 to 17 years (aPR 1.76; 95%CI, 1.63-1.91, P<.001) than boys and children 6 to 11 years. Anxiety rose across most racial and ethnic groups with no significant interaction between sex and race and ethnicity over time. Overall, 70.1% of children with anxiety had at least 1 co-occurring mental health condition, most commonly ADHD (38.8%), depression (35.1%), and behavioral problems (32.0%), and co-occurrence was associated with higher severity.

Clinically recognized anxiety increased significantly among US youth from 2016 to 2023, especially among girls and adolescents. High rates of co-occurring mental health conditions and greater anxiety severity emphasize the need to expand access to mental health services to meet growing service demands of clinically complex presentations.