Increases of anxiety disorder diagnoses met with declining treatment visits

Increases of anxiety disorder diagnoses met with declining treatment visits
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The proportion of outpatient visits that included an anxiety diagnosis for US children, youth, and young adults increased from 2006 to 2018, while proportions of office visits for treatment decreased, according to a study published in Pediatrics.

Anxiety disorders are the most common mental health condition among children, adolescents, and young adults, and over the last 2 decades, anxiety symptoms among these individuals have increased. According to the authors, anxiety treatment seemingly lags behind the increase in the need for treatment. More parents and caregivers are reporting that anxiety is being diagnosed without follow-up treatment.

Using serial cross-sectional data from the National Ambulatory Medical Care Survey (NAMCS) (2006-2018), a nationally representative annual survey of US office-based visits, the study aimed to evaluate recent trends in anxiety disorder diagnosis and treatment. Patients included in the study were aged 4 to 24 years and stratified into 3 age groups (4-11 years, 12-17 years, and 18-24 years). Visits with an anxiety disorder diagnosis were defined as having the following diagnostic codes: “International Classification of Diseases, 9th Edition 300.0, 300.2, 309.21, 313.23; International Classification of Diseases, 10th Edition F40, F41, F930, and F940,” the authors wrote.

Treatment categories were created based on the NAMCS survey collection tool, consisting of: (1) psychotherapy or counseling (therapy alone), (2) therapy and medications, (3) medications alone, and (4) neither therapy nor medication (neither). Because of small numbers of visits for anxiety disorder diagnosis for individual years, 3 time periods were created so data could be pooled together. The time periods included (1) 2006 to 2009, (2) 2010 to 2013, and (3) 2014 to 2016 and 2018, as the NAMCS was not released for 2017. Investigators compared differences in treatment categories using multinomial logistic regression adjusting for age, sex, group, and race and ethnicity, accounting for differences over time in sample demographics associated with mental health treatment.

“We included categorical indicator variables for the periods and compared the second and third periods to the first period (referent group) to assess temporal changes in the use of treatments; we considered P values for coefficients to be significant at a <.05,” the authors wrote. Resulting proportions were weighted to reflect national estimates.

According to the study, 1734 visits for anxiety disorder of the study period in the sample represented a total of 46.4 million office visits with an anxiety disorder diagnosis. The overall proportion of office visits with an anxiety disorder diagnosis significantly increased from 1.4% in 2006 to 2009 (95% CI 1.2-1.7 [n = 9,246,921 visits]) to 4.2% in 2014 to 2018 (95% CI 3.4-5.2 [n = 23,120,958 visits]).

The proportion of visits with an anxiety disorder diagnosis increased for all age groups, particularly for adolescents (1.4% [95% CI 1.1–1.9] to 4.6% [95% CI 3.3–6.4]) and young adults (2.5% [95% CI 2.1-3.1] to 7.1% [95% CI 5.7-8.9]). Smaller proportion increases in anxiety disorder diagnoses were observed among children (0.6% [95% CI 0.4-0.9] to 1.5% [95% CI 1.0-2.2]).

In the first to last time periods, the overall proportion of visits with therapy alone or therapy and medication decreased from 48% (95% CI 40.1-56.7 [n = 4,513,468 visits]) to 32.6% (95% CI 24.5-41.8 [n = 7,536,619 visits]). “However, the overall proportion of visits with medication prescribed did not differ by period, and in the last period, medications were prescribed in 61.8% (95% CI 54.1–68.9 [n = 5 14 286 916]) of all visits,” authors wrote. Compared to the first, the likelihood of receiving medication alone during office visits was significantly higher in the last period (relative risk ratio = 2.42, 95% CI 1.24-4.72).

Overall, the proportion of outpatient visits which included an anxiety diagnosis increased over time. The increase was accompanied by a decrease in the proportion of visits with therapy. Investigators concluded, “The reduction in therapy during office visits and the greater reliance on medications for anxiety disorders may reflect growing resource constraints in office settings in the context of a child and youth mental health crisis that has been building over time.” Authors note further research is needed to investigate whether reliance on medications trends, which evolved during the COVID-19 pandemic, have continued or worsened.

Reference:

Chavez L, Gardner W, Tyson D, et al. Trends in office-based anxiety treatment among US children, youth, and young adults: 2006–2018. Pediatrics 2023; e2022059416. 10.1542/peds.2022-059416