Mojtabai Ramin, Olfson Mark
Tulane University School of Medicine, New Orleans, Louisiana.
Vagelos College of Physicians and Surgeons and Mailman School of Public Health, Columbia University, New York, New York.
J Am Acad Child Adolesc Psychiatry. 2024 Aug 28. doi: 10.1016/j.jaac.2024.08.008.
To examine recent trends in clinical diagnoses of children and adolescents receiving treatment in publicly funded mental health treatment services in the United States.
Data on children and adolescents (≤17 years) receiving treatment from publicly funded mental health treatment services recorded in Mental Health Client-Level Data 2013-2021 (total number of records = 13,684,154) were used to examine temporal trends in the proportion of different child and adolescent psychiatric disorders. Trends were examined overall and in age, sex, racial/ethnic, and service strata focusing on community-based programs.
The analyses revealed increases in the proportion of anxiety disorders from 9.6% in 2013 to 19.2% in 2021 (adjusted odds ratio [AOR] 2.17, 95% CI 1.85-2.55, p < .001), trauma- and stressor-related disorders from 22.7% to 27.4% (AOR 1.31, 95% CI 1.09-1.57, p = .004), and depressive disorders from 13.4% to 17.0% (AOR 1.20, 95% CI 1.03-1.41, p = .04). During this same period, the proportion of bipolar disorders declined almost 8-fold from 10.0% to 1.3% (AOR 0.07, 95% CI 0.06-0.09, p < .001). The proportion of conduct disorder and oppositional defiant disorder also declined from 9.7% to 4.4% (AOR 0.42, 95% CI 0.32-0.55, p < .001) and from 11.1% to 7.8% (AOR 0.79, 95% CI 0.65-0.98, p = .03), respectively. Trends varied across sex, age, and racial/ethnic strata.
The composition of childhood psychiatric diagnoses in patients within publicly funded mental health treatment settings changed over the past decade. While some of the trends may reflect changes in diagnostic practices of clinicians, increases in anxiety and depressive disorders parallel trends in the prevalence of these conditions in the general population and highlight a growing need for identifying and treating these conditions in this age group.
研究美国接受公共资助心理健康治疗服务的儿童和青少年临床诊断的近期趋势。
利用2013 - 2021年心理健康客户层面数据中记录的接受公共资助心理健康治疗服务的儿童和青少年（≤17岁）的数据（记录总数 = 13,684,154），研究不同儿童和青少年精神疾病比例的时间趋势。总体以及按年龄、性别、种族/族裔和服务层次（重点是社区项目）对趋势进行了研究。
分析显示，焦虑症比例从2013年的9.6%增至2021年的19.2%（调整优势比[AOR] 2.17，95%置信区间1.85 - 2.55，p <.001），创伤及应激源相关障碍从22.7%增至27.4%（AOR 1.31，95%置信区间1.09 - 1.57，p =.004），抑郁症从13.4%增至17.0%（AOR 1.20，95%置信区间1.03 - 1.41，p =.04）。在同一时期，双相情感障碍比例从10.0%降至1.3%，下降近8倍（AOR 0.07，95%置信区间0.06 - 0.09，p <.001）。品行障碍和对立违抗障碍比例也分别从9.7%降至4.4%（AOR 0.42，95%置信区间0.32 - 0.55，p <.001）以及从11.1%降至7.8%（AOR 0.79，95%置信区间0.65 - 0.98，p =.03）。不同性别、年龄和种族/族裔层次的趋势有所不同。
在过去十年中，接受公共资助心理健康治疗的患者中儿童精神疾病诊断的构成发生了变化。虽然某些趋势可能反映了临床医生诊断实践的变化，但焦虑症和抑郁症的增加与这些疾病在普通人群中的流行趋势一致，并凸显了在该年龄组识别和治疗这些疾病的需求日益增长。
