Youth Mental Health Outpatient Visits Increased Before COVID

TOPLINE:

Mental health-related outpatient visits and use of psychotropic medications among adolescents and young adults increased significantly between 2006 and 2019, before the COVID-19 pandemic, a new study found. The increase was especially high among males.

METHODOLOGY:

• The analysis included 2006-2019 data from the National Ambulatory Medical Care Survey (NAMCS), a probability survey of visits to office-based physicians engaged in direct patient care.
• Using diagnostic codes, researchers identified outpatient visits for psychiatric or substance use disorders made by adolescents (ages, 13-17 years) and young adults (ages, 18-24 years) during the study period.
• They classified psychiatric diagnoses into six categories: Mood-related, behavioral, psychosis, suicide-related, substance use, and other (eg, tic, eating, and personality disorders).
• And they categorized psychotropic medications associated with visits into seven classes: Antidepressants; antipsychotics; stimulants; anxiolytics, sedatives, and hypnotics; mood stabilizers; medications for substance use; and antiadrenergic agents.

TAKEAWAY:

• The proportion of visits associated with a mental health diagnosis nearly doubled from 2006 to 2019 (9%-17%; P < .001), with significant increases for mood disorders (6%-14%; P < .001), behavioral conditions (3%-5%; P = .004), and substance use (0.6%-1.2%; P = .04).
• Among adolescents, visits by females were more likely to be associated with a mood disorder than by males (9% vs 7%; P = .003), but this trend reversed in young adults (13.5% for males vs 8% for females; P < .001), a finding the authors called "unexpected."
• Behavioral conditions were more common among visits by male vs female patients in adolescents (10% vs 5%; P < .001) and young adults (7% vs 2%; P < .001).
• A total of 17% of all visits were associated with the prescription of at least one psychotropic medication, with prescriptions increasing significantly over the study period (13% in 2006 to 22% in 2019; P < .001), with medication use highest for visits with behavioral conditions (85%), mood disorders (76%), and substance use (74%).

IN PRACTICE:

“Our study provides additional context to the current mental health crisis, indicating that substantial increases in mental health conditions were occurring already for a prolonged period” before the COVID-19 pandemic, suggesting treatment and prevention strategies need to address preexisting psychiatric needs as well as the effects of the pandemic, the authors wrote.

SOURCE:

The study was conducted by Rosa Y. Ahn-Horst, MD, MPH, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, and colleagues and published online on March 7, 2024, in JAMA Network Open.

LIMITATIONS:

As NAMCS samples visits rather than patients, there may be repeated visits by the same patient, potentially inflating estimated outcomes. Visits were identified on the basis of assigned diagnoses, which may not always be comprehensive or represent the principal reason for a healthcare encounter. Medication information may not correspond to prescriptions filled or administered. Results may not be generalizable to treatment settings other than office-based practices.

DISCLOSURES:

The authors reported no relevant financial disclosures.