March 18, 2019 03:05 pm Michael Devitt – A recent analysis of 2016 National Survey of Children's Health data published online in JAMA Pediatrics indicated that as many as one in six U.S. children between the ages of 6 and 17 has a treatable mental health disorder such as depression, anxiety problems or attention deficit/hyperactivity disorder (ADHD).
The analysis also found that nearly half of children with these disorders did not receive counseling or treatment from a mental health professional such as a psychiatrist, psychologist or clinical social worker.
The findings should serve to raise awareness in family physicians, who -- of necessity -- are playing an increasingly significant role in the diagnosis and treatment of mental health conditions in children. In fact, FPs often are the main providers of mental health services for their patients of all ages.
The findings also highlight a greater need to integrate primary care and mental health, a topic the AAFP has frequently advocated to members of Congress.
Using an initial sample of more than 50,000 surveys regarding children ages 0 to 17 years, the researchers based their analysis on parents' responses to a series of questions about their child's mental health status.
According to the study report's Methods section, "Parents responded to the prompt, 'Has a doctor or other health care provider EVER told you that this child has" a mental health disorder?
If the answer to that initial prompt was positive, parents were then asked to respond to a second query: "'If yes, does this child CURRENTLY have the condition?'
"A mental health disorder was considered if the respondent reported yes to the second prompt for depression, anxiety problems, or attention-deficit/hyperactivity disorder compared with no from the first or second prompt for these conditions," the researchers explained.
Finally, parents were asked whether their child had received any treatment or counseling from a mental health professional (i.e., a psychiatrist, psychologist, psychiatric nurse or clinical social worker) in the past 12 months.
The researchers calculated prevalence estimates after adjusting for the survey design and selected covariates based on their relevance to children and outcomes. After excluding children without current health insurance and those younger than 6 years, they estimated that 16.5 percent of U.S. children between the ages of 6 and 17 -- about 7.7 million -- have at least one treatable mental health disorder (i.e., depression, anxiety or ADHD).
Having continuous insurance was the only factor not associated with a mental health disorder. Children ages 12 to 17 were 65 percent more likely to have a mental health disorder than those 6 to 11, and non-Hispanic white children were nearly twice as likely to have a mental health disorder as non-Hispanic black children.
At the state level, the prevalence of mental health disorders ranged from a low of 7.6 percent in Hawaii to a high of 27.2 percent in Maine. Other states with prevalence 20 percent or higher: Alabama, Indiana, Kentucky, Massachusetts, Mississippi, New Hampshire, Oklahoma, Rhode Island, South Carolina, Utah and West Virginia.
Nationally, 49.4 percent of children with a mental health disorder did not receive necessary treatment or counseling from a mental health professional. Prevalence rates varied significantly throughout the country, ranging from 29.5 percent of children in Washington, D.C., to 72.2 percent of children in North Carolina.
Notably, of states in the top quartile for prevalence of children with at least one mental health disorder, Alabama, Mississippi, Oklahoma, and Utah were also in the top quartile for prevalence of children with a mental health disorder who did not receive needed treatment.
The authors attributed the wide range of prevalence percentages from state to state to different practices and policies. They suggested that more effort be put into creating programs that work across states to make it easier for children (and their parents) to access the mental health services they need.
Julie Wood, M.D., M.P.H., AAFP senior vice president for health of the public, science and interprofessional activities, told AAFP News that family physicians are in an excellent position to address their patients' mental health issues.
"Promotion of mental health, diagnosis and treatment of mental illness in the individual and family context are integral components of family medicine," Wood said. "Through training and continuing medical education, family physicians are prepared to manage mental health problems in children, adolescents and adults of all ages."
Wood pointed out that the AAFP has a number of resources available to assist FPs in this area.
"Family physicians should be aware of screening recommendations for children and adolescents," she said. "Empowering the practice team, including behavioral health and mental health professionals, whenever possible can ensure the best care for their patients."
Wood also recommended the AAFP's Neighborhood Navigator tool. Family physicians can use the navigator, an integral component of the Academy's EveryONE Project, to connect patients with resources and programs in their communities.
"Regardless of practice location, physicians should be aware of local mental health resources," Wood said. "This tool lists over 40,000 social services by ZIP code, including mental health services."