Post-Pandemic Trends in Pediatric Mental Health Treatment: A Nationwide Study

This study examined temporal trends in mental health diagnoses and treatment patterns among children and adolescents across the COVID-19 pre-pandemic, pandemic, and post-pandemic periods in the United States.

This retrospective cohort study used the TriNetX U.S. Collaborative Network, including 13.3 million children and adolescents aged 3 to 18 years with health care encounters from October 2018 to December 2022. Using 2 complementary approaches-rolling monthly health care-seeking incidence and treatment-engaged cohorts (≥2 encounters per phase)-we assessed psychiatric diagnoses, psychotropic medication initiation, and psychotherapy use across 3 phases: pre-pandemic (October 2018 to February 2020), pandemic (March 2020 to July 2021), and post-pandemic (August 2021 to December 2022). Analyses were stratified by age, sex, race, and ethnicity.

Incidence rates declined sharply during early pandemic lockdowns, rebounded by March 2021, and remained elevated post-pandemic. Compared with pre-pandemic levels, psychiatric diagnoses increased 24%, psychotropic medications 35%, and psychotherapy 26%. Antidepressants had the largest increases (58%-94%), with female children and adolescents showing steeper rises (65%-137%) compared with male children and adolescents (41%-57%). Attention-deficit/hyperactivity disorder (ADHD) medication use also increased, with the greatest rise in preschoolers (147%), whereas male adolescents showed minimal change or decreases. Racial and ethnic disparities persisted. Among treatment-engaged youth, adolescents had higher antidepressant use (32%-36%) and hydroxyzine use (7%-10%), with reduced benzodiazepine use (7%-4%).

Substantial and sustained increases in pediatric behavioral health treatment persisted beyond the acute pandemic period, concentrated among female individuals and driven primarily by antidepressant prescribing. These patterns warrant monitoring and targeted interventions to address sex disparities and persistent racial and ethnic inequities.