Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio.
Department of Psychiatry.
Pediatrics. 2023 Jul 1;152(1). doi: 10.1542/peds.2022-059416.
Anxiety disorder diagnoses in office-based settings increased for children through the mid-2010s, but recent changes in diagnosis and treatment are not well understood. The objectives of the current study were to evaluate recent trends in anxiety disorder diagnosis and treatment among children, adolescents, and young adults.
This study used serial cross-sectional data from the National Ambulatory Medical Care Survey (2006-2018), a nationally representative annual survey of US office-based visits. Changes in anxiety disorder diagnosis and 4 treatment categories (therapy alone, therapy and medications, medications alone, or neither) are described across 3 periods (2006-2009, 2010-2013, 2014-2018). Multinomial logistic regression compared differences in treatment categories, adjusting for age group, sex, and race/ethnicity, contrasting the last and middle periods with the first.
The overall proportion of office visits with an anxiety disorder diagnosis significantly increased from 1.4% (95% confidence interval [CI] 1.2-1.7; n = 9 246 921 visits) in 2006 to 2009 to 4.2% (95% CI 3.4-5.2; n = 23 120 958 visits) in 2014 to 2018. The proportion of visits with any therapy decreased from 48.8% (95% CI 40.1-57.6) to 32.6% (95% CI 24.5-41.8), but there was no significant change in the overall use of medications. The likelihood of receiving medication alone during office visits was significantly higher in the last, relative to the first period (relative risk ratio = 2.42, 95% CI 1.24-4.72).
The proportion of outpatient visits that included a diagnosis of anxiety increased over time, accompanied by a decrease in the proportion of visits with therapy.
2010 年代中期，儿童在门诊环境中的焦虑症诊断有所增加，但最近的诊断和治疗变化尚不清楚。本研究的目的是评估儿童、青少年和年轻人中焦虑症诊断和治疗的最新趋势。
本研究使用了全国门诊医疗调查（2006-2018 年）的连续横断面数据，这是一项针对美国门诊就诊的全国性年度调查。描述了三个时期（2006-2009 年、2010-2013 年和 2014-2018 年）焦虑症诊断和 4 种治疗类别（仅治疗、治疗加药物、仅药物或两者都没有）的变化。多变量逻辑回归比较了治疗类别的差异，调整了年龄组、性别和种族/民族，将最后和中间时期与第一时期进行对比。
门诊就诊中焦虑症诊断的总体比例从 2006 年至 2009 年的 1.4%（95%置信区间[CI]，1.2-1.7；n=9246921 次就诊）显著增加到 2014 年至 2018 年的 4.2%（95%CI，3.4-5.2；n=23120958 次就诊）。接受任何治疗的比例从 48.8%（95%CI，40.1-57.6）降至 32.6%（95%CI，24.5-41.8），但药物的总体使用量没有明显变化。与第一时期相比，最后时期门诊就诊时单独使用药物的可能性显著更高（相对风险比=2.42，95%CI，1.24-4.72）。
随时间推移，包括焦虑症诊断的门诊就诊比例增加，同时接受治疗的就诊比例下降。
