Trends in Youth Mental Health Among Patients in Family Medicine Practices: 2017-2023.

Abstract

The burden of poor mental health among young people in the United States was rising before the onset of COVID-19. Prior research documents short-term increases in anxiety and depression in the wake of the pandemic, especially among older females. We study how the pandemic altered pre-existing trends in adolescent mental health and examine differential effects across demographic groups and time. We used electronic health record data from a national primary care practice registry to identify primary care visits with diagnoses for anxiety, affective mood disorders, attention-deficit hyperactivity disorder (ADHD), trauma and stressor-related disorders, behavior and conduct problems, and eating disorders. Using an interrupted time-series design, we compared changes in the level and slope of monthly visit rates before (January 2017-February 2020), during (March 2020-February 2021), and after (March 2021-December 2023) the first year of the pandemic. Average monthly visit rates with anxiety diagnoses increased significantly between the pre- and postpandemic periods, especially among 12 to 17-year-old females (71% increase) and males (62% increase). Rates of mood disorder and ADHD diagnoses also increased among older females and remained significantly higher (35% and 8.5%) one year after the pandemic. Despite short-term increases, monthly rates began decreasing significantly in the postpandemic period. The impact of the pandemic on pediatric mental health was heterogeneous across demographic groups and mental health conditions. Older adolescent females experienced persistently high levels of diagnosed ADHD, anxiety, and mood disorders, although there are signs of reversion to prepandemic levels.