Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena.
Department of Child and Adolescent Psychiatry, Kaiser Permanente Southern California, Pasadena.
JAMA Netw Open. 2024 Oct 1;7(10):e2436906. doi: 10.1001/jamanetworkopen.2024.36906.
Data from surveys show increased mental health disorders in youths. However, little is known about clinical diagnosis over time.
To assess the incidence, prevalence, and changes from 2017 to 2021 for depression and anxiety diagnosed clinically among children, adolescents, and young adults and to identify potential disparities.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included approximately 1.7 million individuals aged 5 to 22 years in Southern California. Data were extracted from electronic medical records; International Statistical Classification of Diseases, Tenth Revision (ICD-10), codes were used to identify depression and/or anxiety diagnosis for each study year from January 1, 2017, to December 31, 2021. Rates were stratified by age, gender, race and ethnicity, estimated household income, weight status, and comorbidity history. Changes over time and association with these variables were assessed using Poisson regression. Data were analyzed between June 1, 2022, and November 29, 2023.
Clinical diagnosis of (1) depression and (2) anxiety without a depression diagnosis using ICD-10 codes.
Among the 1.7 million participants, mean (SD) age was approximately 14 (5) years, and 51% were male. In terms of race and ethnicity for each study year, approximately 50% of participants were Hispanic; 8%, non-Hispanic Asian; 8%, non-Hispanic Black; and 23%, non-Hispanic White. From 2017 to 2021, depression diagnosis increased by 55.6% (from 1.35% to 2.10%) for incidence and 60.0% (from 2.55% to 4.08%) for prevalence; anxiety without depression diagnosis increased by 31.1% (from 1.77% to 2.32%) for incidence and 35.2% (from 3.13% to 4.22%) for prevalence (P < .001 for trend). The increases in rates were higher during the COVID-19 pandemic (2020-2021) than before the pandemic (2017-2019), except for depression incidence. Rates increased across all subgroups. Rates were highest for subgroups aged 14 to 17 and 18 to 22 years; female participants; those of non-Hispanic American Indian or Alaska Native, non-Hispanic White, or multiple races or ethnicities; and subgroups with higher household income, obesity (and underweight for anxiety without depression), or comorbidities. Among these factors, age was the most important factor for depression diagnosis, whereas weight status was the most important factor for anxiety without depression diagnosis.
This cohort study, using electronic medical record data from a large integrated health care system, found an increase in clinically diagnosed depression from 2017 to 2021, with a higher increase during the COVID-19 pandemic and higher rates in some subgroups. Equally important, this study identified high rates and an increase in clinical diagnosis of anxiety without a depression diagnosis. These results support the increased need in public health and health care effort to combat the mental health crisis in youths.
调查数据显示，青少年的心理健康障碍有所增加。然而，关于随时间推移的临床诊断知之甚少。
评估儿童、青少年和年轻人中临床诊断的抑郁和焦虑在 2017 年至 2021 年期间的发生率、患病率和变化，并确定潜在的差异。
设计、设置和参与者：本队列研究纳入了南加州约 170 万名年龄在 5 至 22 岁的个体。数据从电子病历中提取；国际疾病分类，第十次修订版（ICD-10）代码用于确定每个研究年份（从 2017 年 1 月 1 日至 2021 年 12 月 31 日）的抑郁和/或焦虑诊断。按年龄、性别、种族和民族、估计家庭收入、体重状况和合并症病史对比率进行分层。使用泊松回归评估随时间的变化和与这些变量的关联。数据分析于 2022 年 6 月 1 日至 2023 年 11 月 29 日之间进行。
使用 ICD-10 代码对（1）抑郁和（2）无抑郁诊断的焦虑进行临床诊断。
在 170 万参与者中，平均（SD）年龄约为 14（5）岁，51%为男性。就每个研究年份的种族和民族而言，大约 50%的参与者为西班牙裔；8%，非西班牙裔亚裔；8%，非西班牙裔黑人；23%，非西班牙裔白人。从 2017 年到 2021 年，抑郁诊断的发病率增加了 55.6%（从 1.35%到 2.10%），患病率增加了 60.0%（从 2.55%到 4.08%）；无抑郁诊断的焦虑发病率增加了 31.1%（从 1.77%到 2.32%），患病率增加了 35.2%（从 3.13%到 4.22%）（趋势 P <.001）。在 COVID-19 大流行（2020-2021 年）期间，除了抑郁发病率外，发病率和患病率的增长率均高于大流行前（2017-2019 年）。在所有亚组中，发病率均呈上升趋势。发病率最高的是 14 至 17 岁和 18 至 22 岁的亚组；女性参与者；非西班牙裔美洲印第安人或阿拉斯加原住民、非西班牙裔白人或多种种族或民族；以及家庭收入较高、肥胖（焦虑无抑郁为消瘦）或合并症的亚组。在这些因素中，年龄是抑郁诊断最重要的因素，而体重状况是焦虑无抑郁诊断最重要的因素。
本队列研究使用大型综合医疗保健系统的电子病历数据发现，从 2017 年到 2021 年，临床诊断的抑郁有所增加，在 COVID-19 大流行期间增加幅度更高，在一些亚组中发病率更高。同样重要的是，本研究确定了临床诊断的焦虑无抑郁的高发病率和增加。这些结果支持在公共卫生和医疗保健方面加大力度，以应对青少年的心理健康危机。
