1 In 16 Kids’ Doctor Visits Now Includes An Anxiety Diagnosis

Childhood Anxiety Diagnoses By Pediatricians Have Tripled in 10 Years, Study Shows

Something is changing in pediatricians’ waiting rooms. More children are leaving primary care appointments with mental health diagnoses attached to their visits, and a new study reveals just how sharply that shift has accelerated over the past decade.

Published in JAMA Network Open, the study tracked insurance billing records for insured children in Massachusetts between 2014 and 2023. It found that the rate of primary care visits that included a mental health diagnosis rose markedly over that period, painting a picture of a children’s health system quietly absorbing a mental health crisis, one appointment at a time.

Anxiety diagnosis codes attached to pediatric primary care visits surged by 300% over the decade, making it the fastest-growing mental health concern turning up in those offices. For parents and pediatricians alike, the numbers confirm what many have already been sensing in exam rooms. Children’s mental health needs are not waiting for a specialist’s appointment.

A Decade of Data, Nearly 2 Million Kids

Researchers drew on a Massachusetts database that captures billing and insurance records across both Medicaid and private insurance plans. The study followed children ages 1 to 18 and analyzed more than 37 million data points, with each child counted for each three-month period they were enrolled in insurance coverage. In total, the data represented nearly 1.85 million unique children over the course of the decade.

The study population was roughly split between males and females, with an average age of about 9.5 years. Just over 41% of those tracked were enrolled in Medicaid, the government insurance program for lower-income families. Researchers used statistical models that accounted for age, sex, insurance type, and whether a child lived in a rural area.

The Numbers Behind the 300% Child Anxiety Surge

At the start of the study in early 2014, roughly 5.9 out of every 100 insured children had a primary care visit that included a mental health diagnosis in a given quarter. By early 2023, that number had climbed to 9.7 per 100 children. That jump represents a meaningful share of a pediatrician’s typical caseload.

Anxiety drove the most dramatic change. In early 2014, anxiety diagnosis codes appeared on about 1.7% of all primary care visits. By early 2023, that figure had risen to 6.1%. To put that plainly: anxiety went from appearing on a small share of pediatric primary care visits to one of the more common mental health labels attached to them.

ADHD, a condition affecting focus and impulse control, remained the most common mental health diagnosis seen in these visits throughout the entire decade, rising from about 5% of primary care visits in 2014 to about 6.7% in 2023. Other conditions also increased. Autism spectrum disorder diagnoses at primary care visits rose from 0.5% to 2.0% of visits. Depression went from 1.2% to about 1.6%. Diagnoses tied to trauma and stress climbed from 0.8% to about 1.6% of visits.

One detail that sharpens the picture: the overall number of primary care visits actually dipped slightly over this same period, from about 58.9 visits per 100 children in early 2014 to about 54.8 per 100 children in early 2023. Pediatricians were seeing fewer total patient visits, yet more of those visits involved mental health diagnoses. The mental health share of what pediatricians handle day-to-day has grown even as total foot traffic has slightly declined.

What’s Driving the Increase in Kids’ Mental Health Diagnoses?

Researchers were careful not to point to a single cause. The observed trends, they wrote, “may reflect increases in the underlying prevalence of pediatric MH needs alongside increases in PCP capacity to screen for and address MH needs.” In plain terms: either more children are actually developing these conditions, pediatricians are getting better at identifying and documenting them, or (most likely) some combination of both.

Mental health conditions affect roughly 28% of children in the United States, according to figures cited in the paper. At the same time, nearly half of children who need mental health treatment aren’t receiving it. That treatment gap has long been one of the most urgent problems in children’s healthcare, and primary care offices, places families already visit regularly, have increasingly been seen as a practical place to start closing it.

The authors argue the data supports a push for more mental health training for pediatric primary care providers, and for expanding what are called integrated mental health models, arrangements where mental health professionals work alongside pediatricians directly in primary care practices, rather than requiring families to navigate a separate referral to a specialist.

Pediatric primary care has long centered on vaccinations, ear infections, and growth charts. Anxiety, ADHD, and depression are now taking up more room in those same exam rooms. Yet, the capacity to handle them hasn’t kept pace. If primary care is where more and more of those needs are surfacing first, equipping those offices with the tools, staff, and training to respond has moved well beyond a policy suggestion. It is a practical necessity.

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Disclaimer: This study is observational and based on insurance billing data from Massachusetts, which may not reflect trends in other states. A diagnosis code attached to a primary care visit does not establish that a condition is new, confirmed, or the primary reason for the visit. The authors note that rising rates may reflect greater illness, improved screening and documentation, or a combination of both. Findings should not be interpreted as evidence of a confirmed increase in childhood anxiety prevalence. If you have concerns about a child’s mental health, consult a qualified healthcare provider.

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