Editorial: National Trends in Child Mental Health Disorders Signal Opportunities and Challenges for Precision Child Psychiatry.

Improving access to child mental health care is a national priority area. The US Department of Health and Human Services, through the Substance Abuse and Mental Health Services Administration (SAMHSA), recently awarded $68.5 million in grants that support behavioral health education, training and community programs to help address mental health and substance use conditions. One of the 4 guiding principles of SAMHSA's 2023-2026 Strategic Plan is a commitment to data and evidence to inform resource allocation, with priority on timely, high-quality data. The Behavioral Health Services Information System (BHSIS) is an integrated statistical data system that provides information at national, state, and local levels on the facilities and services available for substance abuse and mental health in the United States, as well as characteristics of individuals receiving care. In this issue of the Journal, research led by Mojtabai and Olfson summarizes findings from a secondary data analysis using the Mental Health-Client Level Data (MH-CLD), one of the 5 core components of the BHSIS. Using the first publicly available data in 2013 to 2021, the team examines trends in 8 diagnostic categories among individuals 0 to 17 years of age (hereafter referred to as "children") who received any mental health or support services during the reporting year. Across this 9-year interval, the proportion of children with documented anxiety, trauma- and stressor-related, and depressive disorders increased, whereas the proportion of children identified as having bipolar, oppositional defiant, and conduct disorders declined. Roughly one-half (46.2%-49.9%) of the children were less than 12 years of age, and almost all children (consistently 99%/year) received services in a state mental health agency (SMHA)-funded community-based program. In 2021, more than one-half of children receiving any care in community-based programs were documented to have a trauma- or stressor-related disorder (27.4%) or attention-deficit/hyperactivity disorder (25.4%), and an additional 19.3% and 16.9% had documented anxiety and depressive disorders, respectively. Using a conservative cut-point of an adjusted odds ratio ≥2.0, anxiety disorders significantly rose between 2013 and 2021, especially among older children (12-14, 15-17 years of age), female youth, and non-Hispanic Black and non-Hispanic White children. A series of sensitivity analyses explored whether main findings substantially changed, increasing the study's robustness. To support consistency, the findings were set within the context of studies using hospital discharge data, commercial insurance claims, and the National Surveys on Drug Use and Health. Overall, this study discovers a strong signal of a 9-year rise in documented anxiety and depressive disorders among children receiving care in SMHA-funded community-based programs.