Mental health diagnoses among publicly insured children

In a recent issue of JAMA, a paper by Cummings and colleagues reported that the rates of mental health conditions among publicly insured children are increasing, aligned with other evidence that also demonstrates increased rates of depression, suicide, and emergency mental health visits between 2010 and 2019. While there is evidence for increasing rates of child mental health conditions, the underlying reason for the trend is complex and unclear.

Vikki Wachino and Richard Frank, in a new paper published by JAMA, comment on the evidence presented by Cummings et al. regarding the increasing child mental health diagnosis trend and their claims of increasing prevalence of mental illness as a potential cause. However, Wachino and Frank suggest that this trend may be further facilitated by an increase in screening, case identification, and treatment, as well as other factors such as expanded insurance coverage for children through Medicaid, Children’s Health Insurance Program, and the Affordable Care Act, and delivery system changes such as more access to prevention services and telehealth, during this time period. The implication is that making inferences about population health on the basis of paid claims is challenging and requires complementary information.

The increase in mental health diagnosis rates, whether it be prevalence or screening, or a multitude of factors, is concerning and justifies a research and policy response. Given this need, Wachino and Frank urge more research and assessments on the underlying conditions associated with increasing rates of mental health conditions among children, risk factors and prevalence by geographical differences, and comparisons between diagnosis rates and treatment rates for children with mental illness. Furthermore, they conclude that the continuation of current efforts by the government, as well as insurers and providers, to strengthen the availability and accessibility of screening, diagnosis, and treatment services to children experiencing mental health conditions is crucial, especially among threats to cut federal funding to Medicaid that could impact health care access for children.

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