A recent study revealed a substantial rise in mental health-related outpatient visits and the use of psychotropic medications among adolescents and young adults between 2006 and 2019, before the onset of the COVID-19 pandemic. This surge was particularly notable among males.
RESEARCH METHOD:
The study analyzed data spanning from 2006 to 2019 obtained from the National Ambulatory Medical Care Survey (NAMCS), a survey that probabilistically samples visits to office-based physicians involved in direct patient care. Researchers identified outpatient visits for psychiatric or substance use disorders among adolescents (aged 13-17 years) and young adults (aged 18-24 years) using diagnostic codes during the study period. Psychiatric diagnoses were categorized into six groups: Mood-related, behavioral, psychosis, suicide-related, substance use, and other (e.g., tic, eating, and personality disorders). Psychotropic medications associated with visits were classified into seven classes: Antidepressants, antipsychotics, stimulants, anxiolytics, sedatives, and hypnotics, mood stabilizers, medications for substance use, and antiadrenergic agents.
KEY FINDINGS:
The proportion of visits linked to a mental health diagnosis nearly doubled from 2006 to 2019 (9% to 17%; P < .001), with significant increases observed for mood disorders (6% to 14%; P < .001), behavioral conditions (3% to 5%; P = .004), and substance use (0.6% to 1.2%; P = .04). Among adolescents, visits by females were more likely to be associated with a mood disorder compared to males (9% vs. 7%; P = .003). However, this trend reversed in young adults (13.5% for males vs. 8% for females; P < .001), a finding described as “unexpected” by the authors. Behavioral conditions were more prevalent among visits by male patients compared to females in both adolescents (10% vs. 5%; P < .001) and young adults (7% vs. 2%; P < .001). In total, 17% of all visits were linked to the prescription of at least one psychotropic medication, with prescriptions increasing significantly over the study period (13% in 2006 to 22% in 2019; P < .001). Medication use was highest for visits associated with behavioral conditions (85%), mood disorders (76%), and substance use (74%).
IMPLICATIONS:
The study underscores the ongoing mental health crisis, indicating substantial increases in mental health conditions that preceded the COVID-19 pandemic. This highlights the importance of addressing both preexisting psychiatric needs and the pandemic’s effects in treatment and prevention strategies.
SOURCE:
The study was conducted by Rosa Y. Ahn-Horst, MD, MPH, from the Department of Psychiatry at Massachusetts General Hospital, Boston, Massachusetts, along with colleagues. It was published online on March 7, 2024, in JAMA Network Open.
LIMITATIONS:
The NAMCS samples visits rather than patients, potentially inflating estimated outcomes due to repeated visits by the same patient. Visits were identified based on assigned diagnoses, which may not always be comprehensive or represent the primary reason for a healthcare encounter. Additionally, medication information may not correspond to prescriptions filled or administered. Results may not be generalizable to treatment settings other than office-based practices.
DISCLOSURES:
The authors reported no relevant financial disclosures.
