A new study led by researchers at Harvard Pilgrim Health Care Institute, Boston University, Boston Medical Center, UMass Chan Medical School and Brown University finds that children’s mental health concerns are appearing more frequently during routine visits with primary care doctors. published in jama network openStudies show that there has been a steady increase over the past decade, with a particularly large increase in anxiety-related visits.
Researchers studied health insurance claims for nearly all insured children ages 1 to 18 in Massachusetts between 2014 and 2023. It included data from about 1.8 million children over 10 years.
The study found that primary care visits that included a mental health diagnosis increased from about 6 visits per 100 children in 2014 to about 10 visits per 100 children in 2023. The biggest change was seen in anxiety-related visits, which increased 300% over a decade. Attention-deficit/hyperactivity disorder (ADHD) remains the most common mental health condition addressed in primary care visits.
“Mental health needs affect 1 in 5 children, but many families struggle to get specialized mental health care,” said Megan Cole, senior author and Harvard Medical School associate professor of population medicine at the Harvard Pilgrim Health Care Institute. “Our findings suggest that primary care doctors are increasingly caring for children with mental health needs, particularly anxiety.”
Most children can easily get an appointment with a primary care provider. Yet, many children with mental health needs are unable to get an appointment with a mental health specialist.
Children often see their primary care provider more regularly than a mental health specialist. Because of this, primary care settings can play an important role in quickly identifying and addressing mental health concerns.
“Since almost all children have access to primary care, this creates a huge opportunity,” Cole said. “With the right training and support, primary care practices can help screen, diagnose and treat mental health conditions or connect families to care.”
The researchers say their findings point to a growing need for more mental health training and resources in pediatric primary care. This includes support for managing common conditions such as anxiety and ADHD, and models that integrate mental health services directly into primary care practices.
One such approach is the Team Up model, which brings mental health care into pediatric primary care settings. Such integrated care models can help reduce barriers to mental health services for children and families.
The authors say the study only looked at children in Massachusetts and relied on insurance claims data, which may not include every mental health concern. The study also did not examine differences based on age, sex, or type of medical practice.
Still, the researchers say the results highlight a clear trend: Children’s mental health needs are increasingly being addressed in primary care, and health systems must be prepared to support that change.
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