目的:研究在美国公共资助的精神卫生治疗服务中接受治疗的儿童和青少年的临床诊断的最新趋势。
方法:使用2013-2021年心理健康客户水平数据(MH-CLD)中记录的接受公共资助的心理健康治疗服务的儿童和青少年(≤17岁)的数据(记录总数=13,684,154)来检查不同儿童和青少年精神疾病比例的时间趋势。总体趋势和年龄趋势进行了检查,性别,种族/族裔和服务阶层侧重于社区计划。
结果:分析显示,焦虑症患者的比例从2013年的9.6%增加到2021年的19.2%,AOR=2.17,95%CI=1.85-2.55,p<0.001,创伤和压力源相关疾病从22.7%增加到27.4%,AOR=1.31,1.09-1.57,p=0.004,抑郁障碍从13.4%到17.0%,AOR=1.20,1.03-1.41,p=0.04。在同一时期,双相情感障碍患者的比例从10.0%下降至1.3%,下降了近8倍;AOR=0.07,0.06-0.09,p<0.001.品行障碍的比例也从9.7%下降到4.4%;AOR=0.42,0.32-0.55,p<0.001,对立-反抗障碍的比例从11.1%下降到7.8%;AOR=0.79,0.65-0.98,p=0.03。趋势因性别而异,年龄,和种族/民族阶层。
结论:在过去十年中,在公共资助的精神健康环境中,儿童精神病诊断的组成发生了变化。虽然一些趋势可能反映了临床医生诊断实践的变化,焦虑和抑郁障碍的增加与普通人群中这些疾病的患病率呈平行趋势,并突显了在该年龄组中识别和治疗这些疾病的需求日益增长。
OBJECTIVE: To examine recent trends in clinical diagnoses of children and adolescents receiving treatment in publicly funded mental health treatment services in the United States.
METHODS: Data on children and adolescents (≤17 years) receiving treatment from publicly funded mental health treatment services recorded in Mental Health Client Level Data (MH-CLD) 2013-2021 (total number of records=13,684,154) were used to examine temporal trends in the proportion of different child and adolescent psychiatric disorders. Trends were examined overall and in age, sex, racial/ethnic and service strata focusing on community-based programs.
RESULTS: The analyses revealed increases in the proportion with anxiety disorders from 9.6% in 2013 to 19.2% in 2021, AOR=2.17, 95% CI=1.85-2.55, p<0.001, trauma- and stressor-related disorders from 22.7% to 27.4%, AOR=1.31, 1.09-1.57, p=0.004, and depressive disorders from 13.4% to 17.0%, AOR=1.20, 1.03-1.41, p=0.04. During this same period, the proportion with bipolar disorders declined almost eight-fold from 10.0% to 1.3%; AOR=0.07, 0.06-0.09, p<0.001. The proportion with conduct disorders also declined from 9.7% to 4.4%; AOR=0.42, 0.32-0.55, p<0.001, and the proportion of oppositional-defiant disorder declined from 11.1% to 7.8%; AOR=0.79, 0.65-0.98, p=0.03. Trends varied across sex, age, and racial/ethnic strata.
CONCLUSIONS: The composition of childhood psychiatric diagnoses in patients within publicly funded mental health settings changed over the past decade. While some of the trends may reflect changes in diagnostic practices of clinicians, increases in anxiety and depressive disorders parallel trends in the prevalence of these conditions in the general population and highlight a growing need for identifying and treating these conditions in this age group.