Thursday, April 25

When Teens Visit Doctors, Increasingly the Subject is Mental Health

Increasingly, doctor visits by adolescents and young adults involve mental health diagnoses, along with the prescription of psychiatric medications.

That was the conclusion of a new study that found that in 2019, 17 percent of outpatient doctor visits for patients ages 13 to 24 in the United States involved a behavioral or mental health condition, including anxiety, depression, suicidal ideation, self-harm or other issues. That figure rose sharply from 2006, when just 9 percent of doctor’s visits involved psychiatric illnesses.

The study, published Thursday in JAMA Network Open, also found a sharp increase in the proportion of visits involving psychiatric medications. In 2019, 22.4 percent of outpatient visits by the 13-24 age group involved the prescription of at least one psychiatric drug, up from 13 percent in 2006.

The study is the latest evidence in a shift in the kinds of ailments affecting children, adolescents and young adults. For many decades, their health care visits involved more bodily ailments, such as broken bones, viruses and drunken-driving injuries. Increasingly, however, doctors are seeing a wide variety of behavioral and mental health issues.

The reasons are not entirely clear. Some experts have said that modern life presents a new kind of mental pressure, even as society has limited the risks of physical ailments.

The latest study does not posit a reason for the shift. But the pandemic alone was not to blame, it noted. “These findings suggest the increase in mental health conditions seen among youth during the pandemic occurred in the setting of already increasing rates of psychiatric illness,” wrote the authors, a pediatrician and psychiatrist at Harvard Medical School. “Treatment and prevention strategies will need to account for factors beyond the direct and indirect effects of the pandemic.”

The analysis was drawn from the National Ambulatory Care Survey, which asks a sample of clinicians from across the country about the reasons for patient visits. Between 2006 and 2019, patients aged 13 to 24 made 1.1 billion health care visits, of which 145 million involved mental health issues. But the share of mental-health-related visits rose each year, the study found, as did the prescription of psychiatric medications, including stimulants, antipsychotics, mood stabilizers and anti-anxiety drugs.

The study found that antidepressants had the greatest increase, but it did not specify the exact level, said Dr. Florence T. Bourgeois, a pediatrician at Boston Children’s Hospital, an associate professor of pediatrics at Harvard Medical School and a co-author of the paper.

The prescription patterns leave an open question, she said.

“We can’t differentiate whether this speaks to the severity of conditions or changes in prescribing attitudes and trends,” she said. Either way, she added, “We are treating these conditions aggressively.”