US National and State-Level Prevalence of Mental Health Disorders and Disparities of Mental Health Care Use in Children

In children, mental health disorders have deleterious consequences on individual and socioeconomic factors¹ and can impede healthful transitioning into adulthood,² and the incidence of mental health disorders has been increasing over the decades.³ Recent initiatives led by global and national agencies were created to identify priority focus areas regarding the mental health–related burden. Some of the emerging priorities included developing child mental health policies, implementing prevention and early intervention strategies for transition-age youth, and reducing disparities for mental health care use.⁴ This study sought to inform these initiatives by providing recent national and state-level estimates of the prevalence of treatable mental health disorders and mental health care use in children.

Data were from the 2016 National Survey of Children’s Health, a nationally representative, parent-proxy survey of US children younger than 18 years.⁵ The completion rate for those who initiated the web-based and mail-based survey instruments was 69.7%, with an overall response rate of 40.7%. A total of 50 212 surveys representing US children aged 0 to 17 years were completed.

Parents responded to the prompt, “Has a doctor or other health care provider EVER told you that this child has” a mental health disorder? If yes, parents responded to the prompt, “If yes, does this child CURRENTLY have the condition?” A mental health disorder was considered if the respondent reported yes to the second prompt for depression, anxiety problems, or attention-deficit/hyperactivity disorder compared with no from the first or second prompt for these conditions. Mental health care use in the last year in children with at least 1 mental health disorder was determined by the prompt, “DURING THE PAST 12 MONTHS, has this child received any treatment or counseling from a mental health professional? Mental health professionals include psychiatrists, psychologists, psychiatric nurses, and clinical social workers.”

Weighted prevalence estimates were calculated using SAS version 9.4 (SAS Institute) to account and adjust for the complex survey design. Logistic regression determined the association between mental health disorders and covariates. Covariates were selected based on their relevance to children and outcomes, availability in National Survey of Children’s Health, and the extent of missingness to avoid data truncation (<2%). The prevalence of the 2 outcome measures were transformed into quartiles to determine state-specific disparities. Children without current health insurance and younger than 6 years were excluded. Prevalence estimates were compared between those with and without mental health disorders using χ² test. All P values were 2-tailed, and significance was set at a P value less than .05.

An estimated 46.6 million children were included for analysis. The national prevalence of at least 1 mental health disorder was 16.5% (weighted estimate, 7.7 million). After adjustments, all covariates were associated with mental health disorders except for continuous insurance (Table). The state-level prevalence of at least 1 mental health disorder ranged from 7.6% (Hawaii) to 27.2% (Maine).

The national prevalence of children with a mental health disorder who did not receive needed treatment or counseling from a mental health professional was 49.4%, which ranged from 29.5% (Washington, DC) to 72.2% (North Carolina). After transforming state-level data into quartiles, Figure, A shows the prevalence of mental health disorders in children and Figure, B shows the prevalence of children with at least 1 mental health disorder who did not receive needed treatment or counseling from a mental health professional.

The principal finding was that half of the estimated 7.7 million US children with a treatable mental health disorder did not receive needed treatment from a mental health professional. This estimate varied considerably by state. Of the 13 states that were in the top quartile for mental health disorder prevalence (Figure, A), Alabama, Mississippi, Oklahoma, and Utah were also in the top quartile for the prevalence of children with a mental health disorder who did not receive needed treatment (Figure, B).

State-level practices and policies play a role in health care needs and use,⁶ which may help to explain the state variability observed in this study. Nevertheless, initiatives that assist systems of care coordination have demonstrated a reduction of mental health–related burdens across multiple domains.¹ Policy efforts aimed at reducing burden and improving treatment across states are needed.

Accepted for Publication: October 4, 2018.

Corresponding Author: Daniel G. Whitney, PhD, Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, 325 E Eisenhower Pkwy, Ann Arbor, MI 48108 (dgwhit@umich.edu).

Published Online: February 11, 2019. doi:10.1001/jamapediatrics.2018.5399

Author Contributions: Dr Whitney had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Whitney.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Whitney.

Study supervision: Peterson.

Conflict of Interest Disclosures: None reported.

Funding/Support: Dr Whitney is supported by the University of Michigan Advanced Rehabilitation Research Training Program in Community Living and Participation from grant 90AR5020-0200 from the National Institute on Disability, Independent Living, and Rehabilitation Research.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.