Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina.
Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina.
Depress Anxiety. 2019 Feb;36(2):179-189. doi: 10.1002/da.22849. Epub 2018 Oct 24.
Anxiety disorders are one of the most common mental illnesses in children and associated with high healthcare utilization. We aimed to estimate 2-year cumulative incidence of mental health-related hospitalizations, treated self-harm, and emergency room (ER) visits in children newly diagnosed with anxiety disorders and, for context, in children without anxiety disorders.
We identified commercially insured treatment naïve children (3-17 years) with a new office-based anxiety disorder diagnosis (ICD-9-CM) from 2005-2014 in the MarketScan claims database. We followed children for up to 2 years after diagnosis for the first of each event: mental health-related hospitalization, inpatient, treated self-harm, and ER visits (any, anxiety-related, injury-related). Children without anxiety diagnoses were included as comparators, matched on age, sex, date, and region. We estimated cumulative incidence of each event using Kaplan-Meier analysis.
From 2005-2014, we identified 198,450 children with a new anxiety diagnosis. One-year after anxiety diagnosis, 2.0% of children had a mental health-related hospitalization, 0.08% inpatient, treated self-harm, 1.4% anxiety-related ER visit, and 20% any ER visit; incidence was highest in older children with baseline comorbid depression. One-year cumulative incidence of each event was lower in the comparison cohort without anxiety (e.g., mental health-related hospitalizations = 0.5%, treated self-harm = 0.01%, and ER visits = 13%).
Given the prevalence of anxiety disorders, 2-year incidence estimates translate to a significant number of children experiencing each event. Our findings offer caregivers, providers, and patients information to better understand the burden of anxiety disorders and can help anticipate healthcare utilization and inform efforts to prevent these serious events.
焦虑症是儿童中最常见的精神疾病之一，与高医疗保健利用率有关。我们旨在估计新诊断出焦虑症的儿童和无焦虑症的儿童在 2 年内心理健康相关住院、治疗性自伤和急诊室 (ER)就诊的累计发生率。
我们从 MarketScan 索赔数据库中确定了 2005 年至 2014 年期间患有新的基于门诊的焦虑症诊断（ICD-9-CM）的商业保险治疗初治儿童（3-17 岁）。在诊断后最多 2 年内，我们为每位患者的首次事件（心理健康相关住院、住院、治疗性自伤和 ER 就诊（任何、焦虑相关、与伤害相关））进行随访。未诊断出焦虑症的儿童被作为对照，按年龄、性别、日期和地区匹配。我们使用 Kaplan-Meier 分析估计每种事件的累积发生率。
从 2005 年至 2014 年，我们确定了 198450 名患有新焦虑症的儿童。在焦虑症诊断后 1 年，2.0%的儿童有心理健康相关住院、0.08%住院、治疗性自伤、1.4%焦虑相关 ER 就诊和 20%任何 ER 就诊；年龄较大且基线合并抑郁的儿童发病率较高。无焦虑症的对照组中，每种事件的 1 年累积发生率较低（例如，心理健康相关住院治疗=0.5%，治疗性自伤=0.01%，ER 就诊=13%）。
鉴于焦虑症的患病率，2 年的发病率估计转化为大量儿童经历每种事件。我们的研究结果为护理人员、提供者和患者提供了更好地了解焦虑症负担的信息，并有助于预测医疗保健利用率，并为预防这些严重事件提供信息。
