In 2014, anxiety came up at 1.7% of pediatric visits in Massachusetts. By 2023 it was 6.1%. That is a rise of approximately 300% in ten years, and it outran every other mental health diagnosis the researchers tracked.
The figures come from a study in JAMA Network Open that looked through insurance claims covering over 1.8 million young people in the state between 2014 and 2023. Overall, 9.7% of pediatric visits carried a mental health diagnosis in 2023, against 5.9% in 2014. Megan Cole, the senior author and a Harvard Medical School researcher, said the team was surprised by “the rapid increase in pediatric anxiety visits in particular, which just far outpaced the growth of all other mental health diagnoses.”
Other diagnoses moved more slowly
Attention-deficit/hyperactivity disorder, the diagnosis recorded most often among children, accounted for 6.7% of visits in 2023, up from 5%. Depression went to 1.6% from 1.2%. Trauma and stressor-related disorders reached 1.6%, from 0.8%, and autism spectrum disorder reached 2%, from 0.5%.
Better screening, but not the whole story
Doctors do look harder than they used to. Screening for anxiety and other conditions has expanded in primary care over the past decade as national recommendations shifted. Cole said some of the increase may simply reflect clinicians being better equipped to spot needs that were always there. “But this is unlikely to explain the magnitude of the increase we see,” she said.
Nor can the pandemic take the blame. The study period began years before COVID-19, and the researchers said it cannot explain the scale of what they found either. Cole said she expects documented rates of anxiety to keep rising, “much beyond the study period we examined here.” One limit on the findings: the data came only from Massachusetts.
Sarah Tannenbaum, who directs outpatient clinical services at Boston’s Baker Center for Children and Families, was not involved in the research but said it matches what she has seen. Children pick up on stress around them, she said, from political strife, economic pressure and war, and when they look to adults or older kids and see those signals, it often shows up as anxiety. She called anxiety “a canary in the coal mine” that can appear before other symptoms and may lead on to conditions such as depression.
Where families end up
Close to a third of American children carry a diagnosed mental health or behavioral disorder, yet only half receive the care they need. Almost every child has access to primary care, which is why pediatricians have become frontline providers. Cole noted that primary care is often short on training and staffing for this work.
The state is short of mental health providers, and insurance does not cover every visit. In 2022 the state launched a pilot, run by the Massachusetts Association for Mental Health, to support free mental health clinics inside 23 public schools. Its grant funding is set to end in June.
Sources
- Children are increasingly visiting doctors for anxiety and other mental health issues, study shows
- Anxiety visits grow more common at Mass. pediatricians' offices
