Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, Maryland (all authors); Walter Reed National Military Medical Center, Bethesda (Gorman).
Psychiatr Serv. 2019 Aug 1;70(8):657-664. doi: 10.1176/appi.ps.201800101. Epub 2019 Apr 10.
Childhood psychiatric disorders affect current functioning and predispose individuals to more severe adult mental health problems. Provider survey research has suggested that children's mental health problems are increasing; observed changes may be due to increased illness or improved access to care. The authors sought to quantify trends in the prevalence of diagnosed and treated mental health conditions, outpatient treatment, and psychiatric medication prescriptions in a large population of children who were continuously insured.
The authors performed a retrospective trend study of diagnosed mental health conditions, treatment, and psychiatric medication prescriptions from 2003 to 2015 in children ages 2-18 who were military dependents (N=1,798,530). Poisson regression analyses and Cochran-Armitage tests determined trends in the prevalence of treated psychiatric diagnoses overall and by subcategory, rates of outpatient mental health visits, and psychiatric medication use overall and by specific class.
From 2003 to 2015, the prevalence of children with diagnosed mental health conditions increased from 9.2% to 15.2% (rate ratio=1.04, 95% confidence interval=1.04-1.05, p<0.001). Identified suicidal ideation prevalence increased by 20% a year. Mental health care visits increased by 2% a year, and psychiatric medication prescriptions increased by 3% a year between 2003 and 2015, with larger increases seen among older children. Prescriptions for children with identified mental health conditions did not increase.
Diagnosed mental health conditions, pharmaceutical treatment, and outpatient visits all increased across a diverse U.S. pediatric population from 2003 to 2015. Results suggest that use of psychiatric medications kept pace with the increased number of diagnoses and that older children are most affected.
儿童期精神疾病会影响当前的功能，并使个体易患更严重的成人心理健康问题。提供者调查研究表明，儿童的心理健康问题正在增加；观察到的变化可能是由于疾病增加或获得更好的治疗机会。作者试图量化在一个大规模的连续投保的儿童人群中，诊断和治疗的心理健康状况、门诊治疗和精神药物处方的流行趋势。
作者对 2003 年至 2015 年期间，年龄在 2-18 岁的军人子女（N=1,798,530）中诊断出的心理健康状况、治疗和精神药物处方进行了回顾性趋势研究。采用泊松回归分析和 Cochran-Armitage 检验，确定总体和各亚类治疗性精神诊断、门诊心理健康就诊率以及总体和特定类别精神药物使用的流行率趋势。
从 2003 年至 2015 年，患有诊断性心理健康疾病的儿童比例从 9.2%上升至 15.2%（发病率比=1.04，95%置信区间=1.04-1.05，p<0.001）。每年识别出的自杀意念发生率增加 20%。心理健康就诊次数每年增加 2%，精神药物处方每年增加 3%，其中年龄较大的儿童增加幅度更大。针对有明确心理健康问题的儿童的处方并没有增加。
从 2003 年至 2015 年，在美国多样化的儿科人群中，诊断出的心理健康状况、药物治疗和门诊就诊都有所增加。结果表明，精神药物的使用与诊断数量的增加保持同步，而年龄较大的儿童受影响最大。
