TOPLINE:

Girls aged 11-17 years had a 71% increase in anxiety diagnoses in primary care settings between pre-pandemic and post-pandemic periods, with boys in the same age group experiencing a 62% increase.

METHODOLOGY:

• Researchers analyzed electronic health record data from the American Family Cohort, a national primary care registry of more than 2000 clinicians across the US, and included patients aged 5-17 years who visited primary care clinics between January 2017 and December 2023.
• The final sample included 330,523 pediatric patients from 362 clinics, with a little over 2 million total patient encounters and an average of 9.3 visits per patient during the observation period.
• Researchers compared changes in monthly visit rates before (January 2017 to February 2020), during (March 2020 to February 2021), and after (March 2021 to December 2023) the first year of the pandemic.
• Primary outcomes included monthly visit rates for anxiety; affective mood disorders (depression and bipolar disorders); attention-deficit/hyperactivity disorder (ADHD); trauma and stressor-related disorders; behavior and conduct problems; and eating disorders, identified using codes from the International Classification of Diseases.
• The analysis stratified results by sex and age group (age, 5-10 and 11-17 years), with monthly visit rates calculated as the number of visits with qualifying diagnoses (anxiety, affective mood disorders, ADHD) divided by the number of children each month who had a primary care visit at least once in the previous year.

TAKEAWAY:

• The average monthly visit rate of female patients 11-17 years with anxiety diagnoses increased between pre- and post-pandemic periods by 304 per 100,000 (95% CI, 258.4-349.6) and 124.2 per 100,000 in boys of the same age group (95% CI, 100.5-147.7).
• Rates of mood disorder diagnoses increased by 150.5 per 100,000 (95% CI, 102.8-198.3) in older female patients between pre- and post-pandemic periods, while ADHD diagnosis rates increased by 41.1 per 100,000 (95% CI, 1.5-80.7) in this group.
• Monthly rates of anxiety diagnoses began to increase at 6.08 per 100,000 (95% CI, 4.41-7.76) per month among girls 11-17 years pre-pandemic but decreased in the post-pandemic period, with a change of -10.68 per 100,000 (95% CI, -13.68 to -7.69) per month.
• ADHD visit rates decreased between pre- and post-pandemic periods for younger male patients, changing by -218.4 per 100,000 (95% CI, -308.9 to -127.9) and for older male patients by -125.7 per 100,000 (95% CI, -207.3 to -44.0), with monthly rates changing by -6.59 per 100,000 (95% CI, -10.91 to -5.71) among younger male patients in the post-pandemic period.

IN PRACTICE:

“Primary care pediatricians develop longitudinal and close relationships with their patients, making them uniquely positioned to address the evolving mental health needs of today’s young people,” the study authors wrote. “The increases in mood and anxiety diagnoses we observe among older adolescents during the pandemic era emphasize the importance of regular anxiety and depression screening in primary care to detect underlying mental health concerns before they develop into psychiatric and social emergencies,” wrote the authors of the study.

SOURCE:

The study was led by Christopher Lowenstein, PhD, MPH, of the Department of Epidemiology and Population Health at Stanford University in Palo Alto, California. It was published online on April 13 in Pediatrics.

LIMITATIONS:

The method used to group data prevented them from distinguishing between incident and repeat diagnoses. The database used to assess trends did not represent the US primary care population nationally, which may have limited generalizability of findings. The study did not follow how individual patients did over time or how outcomes varied. The data did not distinguish between in-person or telehealth visits, which may have affected diagnosis rates across conditions.

DISCLOSURES:

One of the study authors reported working as a consultant in an analytic director role at the University of New Mexico, Center for Health Policy, and as a consultant for Lucent Surgical. No other financial disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.